A Broader Vision for Managed Care, Part 2: A Typology of Community Benefits

Health Affairs

Volumn 17, Issue 5, 1998, Pages 26-49

  Schlesinger, Mark ^a   Gray, Bradford ^a   Carrino, Gerard ^a   Duncan, Mary ^a   Gusmano, Michael ^a   Antonelli, Vincent ^a   Stuber, Jennifer ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

COMMUNITY CARE; HEALTH CARE AND PUBLIC HEALTH; HEALTH INSURANCE; HUMAN; NONBIOLOGICAL MODEL; ORGANIZATION AND MANAGEMENT; PUBLIC RELATIONS; REVIEW; SOCIAL WELFARE; UNITED STATES;

HEALTH CARE AND PUBLIC HEALTH;

CHARITIES; COMMUNITY HEALTH SERVICES; COMMUNITY-INSTITUTIONAL RELATIONS; HUMANS; MANAGED CARE PROGRAMS; MODELS, ORGANIZATIONAL; UNITED STATES;

EID: 0032162191     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.5.26     Document Type: Article

References (89)

1. See, for example, M. Schlesinger, "Paradigms Lost: The Persisting Search for Community in U.S. Health Policy," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 937-992; J.E. Rohrer, Planning for Community-Oriented Health Systems (Baltimore: American Public Health Association, 1996); D. Kindig, Purchasing Population Health: Paying for Results (Ann Arbor: University of Michigan Press, 1997); E.J. Emanuel and L.L. Emanuel, "Preserving Community in Health Care," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 147-184; and D. Patrick and T. Wickizer, "Community and Health," in Society and Health, ed. B. Amick et al. (New York: Oxford University Press, 1995), 46-92.
2. See, for example, M. Schlesinger, "Paradigms Lost: The Persisting Search for Community in U.S. Health Policy," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 937-992; J.E. Rohrer, Planning for Community-Oriented Health Systems (Baltimore: American Public Health Association, 1996); D. Kindig, Purchasing Population Health: Paying for Results (Ann Arbor: University of Michigan Press, 1997); E.J. Emanuel and L.L. Emanuel, "Preserving Community in Health Care," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 147-184; and D. Patrick and T. Wickizer, "Community and Health," in Society and Health, ed. B. Amick et al. (New York: Oxford University Press, 1995), 46-92.
3. See, for example, M. Schlesinger, "Paradigms Lost: The Persisting Search for Community in U.S. Health Policy," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 937-992; J.E. Rohrer, Planning for Community-Oriented Health Systems (Baltimore: American Public Health Association, 1996); D. Kindig, Purchasing Population Health: Paying for Results (Ann Arbor: University of Michigan Press, 1997); E.J. Emanuel and L.L. Emanuel, "Preserving Community in Health Care," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 147-184; and D. Patrick and T. Wickizer, "Community and Health," in Society and Health, ed. B. Amick et al. (New York: Oxford University Press, 1995), 46-92.
4. See, for example, M. Schlesinger, "Paradigms Lost: The Persisting Search for Community in U.S. Health Policy," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 937-992; J.E. Rohrer, Planning for Community-Oriented Health Systems (Baltimore: American Public Health Association, 1996); D. Kindig, Purchasing Population Health: Paying for Results (Ann Arbor: University of Michigan Press, 1997); E.J. Emanuel and L.L. Emanuel, "Preserving Community in Health Care," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 147-184; and D. Patrick and T. Wickizer, "Community and Health," in Society and Health, ed. B. Amick et al. (New York: Oxford University Press, 1995), 46-92.
5. See, for example, M. Schlesinger, "Paradigms Lost: The Persisting Search for Community in U.S. Health Policy," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 937-992; J.E. Rohrer, Planning for Community-Oriented Health Systems (Baltimore: American Public Health Association, 1996); D. Kindig, Purchasing Population Health: Paying for Results (Ann Arbor: University of Michigan Press, 1997); E.J. Emanuel and L.L. Emanuel, "Preserving Community in Health Care," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 147-184; and D. Patrick and T. Wickizer, "Community and Health," in Society and Health, ed. B. Amick et al. (New York: Oxford University Press, 1995), 46-92.
6. M. Schlesinger and B. Gray, "A Broader Vision for Managed Care, Part 1: Measuring the Benefit to Communities," Health Affairs (May/June 1998): 152-168.
7. Ibid.
8. T.E. Miller, "Managed Care Regulation: In the Laboratory of the States," Journal of the American Medical Association 278, no. 13 (1997): 1102-1109.
9. For a more complete discussion, see Schlesinger, "Paradigms Lost." A recent review of state policies designed to promote community benefit activities by nonprofit hospitals notes that "there is a tendency for community to be defined as the service area of a nonprofit health care organization." K. Barnett, The Future of Community Benefit Programming (Berkeley, Calif.: Public Health Institute, 1997), 3-21.
10. For a more complete discussion, see Schlesinger, "Paradigms Lost." A recent review of state policies designed to promote community benefit activities by nonprofit hospitals notes that "there is a tendency for community to be defined as the service area of a nonprofit health care organization." K. Barnett, The Future of Community Benefit Programming (Berkeley, Calif.: Public Health Institute, 1997), 3-21.
11. R. Sigmond and J.D. Seay, "In Health Care Reform, Who Cares for the Community?" Journal of Health Administration Education 12, no. 3 (1994): 259-268.
12. These four categories are our own creation; not everyone who has written about community benefit would necessary agree that these represent the only distinct perspectives. For example, Barnett, The Future of Community Benefit Programming, presents what he terms a "public trust" definition of community benefit. Although it was developed from a somewhat different intellectual tradition, we would argue that this model fits most closely with the community-health approach. Its emphasis on "assumption of special skills" for health care providers and "protection from political influence" places it firmly in the perspective that retains professional authority over the health care system. Nonetheless, the public-trust perspective shares some features of the healthy-community orientation, as we discuss later in the paper.
13. M. Schlesinger, B. Gray, and E. Bradley, "Charity and Community: The Role of Nonprofit Ownership in a Managed Health Care System," Journal of Health Politics, Policy and Law 21, no. 4 (1996): 697-752.
14. J.D. Seay, "From Pemsel's Case to Health Security: Community Benefit Comes of Age," Journal of Health Administration Education 12, no. 3 (1994): 373-382.
15. D. Fox and D.C. Schaffer, "Tax Administration as Health Policy: Hospitals, the Internal Revenue Service and the Courts," Journal of Health Politics, Policy and Law 16, no. 2 (1991): 251-280.
16. Schlesinger et al., "Charity and Community."
17. M.A. Potter and B.B. Longest, "The Divergence of Federal and State Policies on the Charitable Tax Exemption of Nonprofit Hospitals," Journal of Health Politics, Policy and Law 19, no. 2 (1994): 393-419.
18. A. R. Kovner and P.A. Hattis, "Benefiting Communities," Healthcare Management Quarterly 12, no. 4 (1990): 6-10; and A.R. Kovner, "The Hospital Community Benefit Standards Program and Health Reform," Hospital and Health Services Administration 39, no. 2 (1990): 143-157.
19. A. R. Kovner and P.A. Hattis, "Benefiting Communities," Healthcare Management Quarterly 12, no. 4 (1990): 6-10; and A.R. Kovner, "The Hospital Community Benefit Standards Program and Health Reform," Hospital and Health Services Administration 39, no. 2 (1990): 143-157.
20. D.R. Longo, "The Measurement of Community Benefit: Issues, Options, and Questions for Further Research," Journal of Health Administration Education 12, no. 3 (1994): 291-318.
21. R.A. Boisture, "Health Reform Speeds Shift to Tax-Exempt Integrated Managed Care Plans," Healthspan 11, no. 5 (1994): 3-20.
22. After the Tax Reform Act of 1986, insurance companies such as Blue Cross/Blue Shield can claim federal tax-exempt status only if they have a substantial program of subsidized premiums. Schlesinger et al., "Charity and Community." These subsidies would have to be sufficiently large that it was clear that the plan was on average losing money on these enrollees, not simply offering a lower price to groups whose medical care costs less than average.
23. D. Stone, "The Struggle for the Soul of Health Insurance," Journal of Health Politics, Policy and Law 18, no. 2 (1993): 287-317.
24. J. Gabel, "Ten Ways HMOs Have Changed during the 1990s," Health Affairs (May/June 1997): 134-145.
25. Ibid.
26. M. Schlesinger, "Countervailing Agency: A Strategy of Principled Regulation under Managed Competition," Milbank Quarterly 75, no. 1 (1997): 35-87.
27. Many past applications of the market-failures perspective involving hospitals have focused narrowly on charity care. See M.V. Pauly, "Health Systems Ownership: Can Regulation Preserve Community Benefits?" Frontiers of Health Services Management 12, no. 3 (1996): 3-34; and M.A. Morrisey, G.J. Wedig, and M. Hassan, "Do Nonprofit Hospitals Pay Their Way?" Health Affairs (Winter 1996): 132-144. Some have recognized at least some limited role for involvement in research or education as forms of public goods. See S.M. Sanders, "The 'Common Sense' of the Nonprofit Hospital Tax Exemption: A Policy Analysis," Journal of Policy Analysis and Management 14, no. 3 (1995): 446-466; and C. Madden and A. Katz, Community Benefits and Not-for-Profit Health Care: Policy Issues and Perspectives, Report prepared for the Catholic Health Association (Seattle: University of Washington School of Public Health and Community Medicine, 1995).
28. Many past applications of the market-failures perspective involving hospitals have focused narrowly on charity care. See M.V. Pauly, "Health Systems Ownership: Can Regulation Preserve Community Benefits?" Frontiers of Health Services Management 12, no. 3 (1996): 3-34; and M.A. Morrisey, G.J. Wedig, and M. Hassan, "Do Nonprofit Hospitals Pay Their Way?" Health Affairs (Winter 1996): 132-144. Some have recognized at least some limited role for involvement in research or education as forms of public goods. See S.M. Sanders, "The 'Common Sense' of the Nonprofit Hospital Tax Exemption: A Policy Analysis," Journal of Policy Analysis and Management 14, no. 3 (1995): 446-466; and C. Madden and A. Katz, Community Benefits and Not-for-Profit Health Care: Policy Issues and Perspectives, Report prepared for the Catholic Health Association (Seattle: University of Washington School of Public Health and Community Medicine, 1995).
29. Many past applications of the market-failures perspective involving hospitals have focused narrowly on charity care. See M.V. Pauly, "Health Systems Ownership: Can Regulation Preserve Community Benefits?" Frontiers of Health Services Management 12, no. 3 (1996): 3-34; and M.A. Morrisey, G.J. Wedig, and M. Hassan, "Do Nonprofit Hospitals Pay Their Way?" Health Affairs (Winter 1996): 132-144. Some have recognized at least some limited role for involvement in research or education as forms of public goods. See S.M. Sanders, "The 'Common Sense' of the Nonprofit Hospital Tax Exemption: A Policy Analysis," Journal of Policy Analysis and Management 14, no. 3 (1995): 446-466; and C. Madden and A. Katz, Community Benefits and Not-for-Profit Health Care: Policy Issues and Perspectives, Report prepared for the Catholic Health Association (Seattle: University of Washington School of Public Health and Community Medicine, 1995).
30. Many past applications of the market-failures perspective involving hospitals have focused narrowly on charity care. See M.V. Pauly, "Health Systems Ownership: Can Regulation Preserve Community Benefits?" Frontiers of Health Services Management 12, no. 3 (1996): 3-34; and M.A. Morrisey, G.J. Wedig, and M. Hassan, "Do Nonprofit Hospitals Pay Their Way?" Health Affairs (Winter 1996): 132-144. Some have recognized at least some limited role for involvement in research or education as forms of public goods. See S.M. Sanders, "The 'Common Sense' of the Nonprofit Hospital Tax Exemption: A Policy Analysis," Journal of Policy Analysis and Management 14, no. 3 (1995): 446-466; and C. Madden and A. Katz, Community Benefits and Not-for-Profit Health Care: Policy Issues and Perspectives, Report prepared for the Catholic Health Association (Seattle: University of Washington School of Public Health and Community Medicine, 1995).
31. M. Gold et al., Arrangements between Managed Care Plans and Physicians, Report submitted to the Physician Payment Review Commission (Washington: Mathematica Policy Research, 1995).
32. D.R. Gerstein and H.J. Harwood, Treating Drug Problems (Washington: National Academy Press, 1990).
33. H.S. Luft and R.H. Miller, "Patient Selection in a Competitive Health Care System," Health Affairs (Fall 1988): 97-119.
34. M. Gold et al., "Disabled Medicare Beneficiaries in HMOs," Health Affairs (September/October 1997): 149-162.
35. B. Gray, "Trust and Trustworthy Care in the Managed Care Era," Health Affairs (January/February 1997): 34-49; and D.C. Thomasma, "Promisekeeping: An Institutional Ethos for Healthcare Today," Frontiers of Health Services Management 13, no. 2 (1996): 5-34.
36. B. Gray, "Trust and Trustworthy Care in the Managed Care Era," Health Affairs (January/February 1997): 34-49; and D.C. Thomasma, "Promisekeeping: An Institutional Ethos for Healthcare Today," Frontiers of Health Services Management 13, no. 2 (1996): 5-34.
37. Miller, "Managed Care Regulation."
38. D. Mechanic and M. Schlesinger, "The Impact of Managed Care on Patients' Trust in Medical Care and Their Physicians," Journal of the American Medical Association 275, no. 21 (1996): 1693-1697.
39. Barnett, The Future of Community Benefit Programming.
40. D. Mechanic, M. Schlesinger, and D. McAlpine, "Management of Mental Health and Substance Abuse Services: State of the Art and Early Results," Milbank Quarterly 72, no. 4 (1996): 19-56.
41. L.A. Bergthold, "Medical Necessity: Do We Need It?" Health Affairs (Winter 1995): 180-190; and E.B. Hirshfeld and G.H. Thomason, "Medical Necessity Determinations: The Need for a New Legal Structure," Health Matrix 6, no. 1 (1996): 3-52.
42. L.A. Bergthold, "Medical Necessity: Do We Need It?" Health Affairs (Winter 1995): 180-190; and E.B. Hirshfeld and G.H. Thomason, "Medical Necessity Determinations: The Need for a New Legal Structure," Health Matrix 6, no. 1 (1996): 3-52.
43. Miller, "Managed Care Regulation;" Mechanic and Schlesinger, "The Impact of Managed Care on Patients' Trust;" and G. Anders, Health against Wealth: HMOs and the Breakdown of Medical Trust (Boston: Houghton Mifflin, 1996).
44. Miller, "Managed Care Regulation;" Mechanic and Schlesinger, "The Impact of Managed Care on Patients' Trust;" and G. Anders, Health against Wealth: HMOs and the Breakdown of Medical Trust (Boston: Houghton Mifflin, 1996).
45. Miller, "Managed Care Regulation;" Mechanic and Schlesinger, "The Impact of Managed Care on Patients' Trust;" and G. Anders, Health against Wealth: HMOs and the Breakdown of Medical Trust (Boston: Houghton Mifflin, 1996).
46. D. Mechanic, "Changing Medical Organization and the Erosion of Trust," Milbank Quarterly 74, no. 2 (1996): 171-189.
47. A. Ortmann and M. Schlesinger, "Trust, Repute, and the Role of Nonprofit Enterprise," Voluntas 8, no. 2 (1997): 97-119.
48. B.C. Amick et al., "Introduction," in Society and Health, 3-17.
49. A. Sardell, The U.S. Experiment in Social Medicine (Pittsburgh: University of Pittsburgh Press, 1988); and National Commission on Community Health Services, Health Is a Community Affair (Bethesda, Md.: National Health Forum, 1966).
50. A. Sardell, The U.S. Experiment in Social Medicine (Pittsburgh: University of Pittsburgh Press, 1988); and National Commission on Community Health Services, Health Is a Community Affair (Bethesda, Md.: National Health Forum, 1966).
51. L. Brown, Politics and Health Care Organizations: HMOs as Federal Policy (Washington: Brookings Institution, 1983).
52. E. Connor and F. Mullan, eds., Community-Oriented Primary Care: New Directions for Health Services Delivery (Washington: National Academy Press, 1983); R. Bogue et al., "Community Experiments in Action: Developing Community-Defined Models for Reconfiguring Health Care Delivery," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 1051-1076; and Rohrer, Planning for Community-Oriented Health Systems.
53. E. Connor and F. Mullan, eds., Community-Oriented Primary Care: New Directions for Health Services Delivery (Washington: National Academy Press, 1983); R. Bogue et al., "Community Experiments in Action: Developing Community-Defined Models for Reconfiguring Health Care Delivery," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 1051-1076; and Rohrer, Planning for Community-Oriented Health Systems.
54. E. Connor and F. Mullan, eds., Community-Oriented Primary Care: New Directions for Health Services Delivery (Washington: National Academy Press, 1983); R. Bogue et al., "Community Experiments in Action: Developing Community-Defined Models for Reconfiguring Health Care Delivery," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 1051-1076; and Rohrer, Planning for Community-Oriented Health Systems.
55. See, for example, S.M. Shortell et al., Remaking Health Care in America: Building Organized Delivery Systems (San Francisco: Jossey-Bass, 1996); and J. Showstack et al., "Health of the Public: The Private-Sector Challenge," Journal of the American Medical Association 276, no. 13 (1996): 1071-1074.
56. See, for example, S.M. Shortell et al., Remaking Health Care in America: Building Organized Delivery Systems (San Francisco: Jossey-Bass, 1996); and J. Showstack et al., "Health of the Public: The Private-Sector Challenge," Journal of the American Medical Association 276, no. 13 (1996): 1071-1074.
57. B. Spitz, "Community Control in a World of Regional Delivery Systems," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 1021-1050; and Bogue et al., "Community Experiments in Action."
58. B. Spitz, "Community Control in a World of Regional Delivery Systems," Journal of Health Politics, Policy and Law 22, no. 4 (1997): 1021-1050; and Bogue et al., "Community Experiments in Action."
59. K.K. Marczynski-Music, Health Care Solutions: Designing Community-Based Systems That Work (San Francisco: Jossey-Bass, 1994), 101.
60. Barnett, The Future of Community Benefit Programming, 3-18.
61. J. Durch, L. Bailey, and M. Stoto, Improving Health in the Community: A Role for Performance Monitoring, Report from the Committee on Using Performance Monitoring to Improve Community Health (Washington: National Academy Press, 1997).
62. Marczynski-Music, Health Care Solutions, 101.
63. W.E. Welton, T.A. Kantner, and S.M. Katz, "Developing Tomorrow's Integrated Community Health Systems," Milbank Quarterly 75, no. 2 (1997): 261-288.
64. Showstack et al., "Health of the Public."
65. R.J. Baxter and R.E. Mechanic, "The Status of Local Health Care Safety Nets," Health Affairs (July/August 1997): 7-23.
66. Showstack et al., "Health of the Public;" D.R. Lairson et al., "Managed Care and Community-Oriented Care: Conflict or Complement?" Journal of Health Care for the Poor and Uninsured 8, no. 1 (1997): 36-55; and H.H. Schauffler and J. Wolin, "Community Health Clinics under Managed Competition: Navigating Uncharted Waters," Journal of Health Politics, Policy and Law 211, no. 3 (1996): 461-488.
67. Showstack et al., "Health of the Public;" D.R. Lairson et al., "Managed Care and Community-Oriented Care: Conflict or Complement?" Journal of Health Care for the Poor and Uninsured 8, no. 1 (1997): 36-55; and H.H. Schauffler and J. Wolin, "Community Health Clinics under Managed Competition: Navigating Uncharted Waters," Journal of Health Politics, Policy and Law 211, no. 3 (1996): 461-488.
68. Showstack et al., "Health of the Public;" D.R. Lairson et al., "Managed Care and Community-Oriented Care: Conflict or Complement?" Journal of Health Care for the Poor and Uninsured 8, no. 1 (1997): 36-55; and H.H. Schauffler and J. Wolin, "Community Health Clinics under Managed Competition: Navigating Uncharted Waters," Journal of Health Politics, Policy and Law 211, no. 3 (1996): 461-488.
69. M.E. Cogswell, D. Nelson, and J.P. Koplan, "Surveying Managed Care Members on Chronic Diseases," Health Affairs (November/December 1997): 219-227.
70. J. Holahan et al., "Medicaid Managed Care in Thirteen States," Health Affairs (May/June 1998): 43-63.
71. J. Weiner and J. Skaggs, "Current Approaches to Integrating Acute and Long-Term Care Financing and Services," AARP Public Policy Institute Report no. 9516 (Washington: American Association of Retired Persons, 1995); and Mechanic et al., "Management of Mental Health and Substance Abuse Services."
72. J. Weiner and J. Skaggs, "Current Approaches to Integrating Acute and Long-Term Care Financing and Services," AARP Public Policy Institute Report no. 9516 (Washington: American Association of Retired Persons, 1995); and Mechanic et al., "Management of Mental Health and Substance Abuse Services."
73. A.F. Nelson, E.S. Quiter, and L.I. Solberg, "The State of Research within Managed Care Plans: 1997 Survey," Health Affairs (January/February 1998): 128-138.
74. I. Kawachi et al., "Social Capital, Income Inequality, and Mortality," American Journal of Public Health 87, no. 9 (1997): 1491-1498; R. Wallace and D. Wallace, "U.S. Apartheid and the Spread of AIDS to the Suburbs: A Multi-City Analysis of the Political Economy of Spatial Epidemic Threshold," Social Science and Medicine 41, no. 3 (1995): 333-345; and T.A. LaViest, "The Political Empowerment and Health Status of African-Americans: Mapping a New Territory," American Journal of Sociology 97, no. 2 (1992): 1080-1095.
75. I. Kawachi et al., "Social Capital, Income Inequality, and Mortality," American Journal of Public Health 87, no. 9 (1997): 1491-1498; R. Wallace and D. Wallace, "U.S. Apartheid and the Spread of AIDS to the Suburbs: A Multi-City Analysis of the Political Economy of Spatial Epidemic Threshold," Social Science and Medicine 41, no. 3 (1995): 333-345; and T.A. LaViest, "The Political Empowerment and Health Status of African-Americans: Mapping a New Territory," American Journal of Sociology 97, no. 2 (1992): 1080-1095.
76. I. Kawachi et al., "Social Capital, Income Inequality, and Mortality," American Journal of Public Health 87, no. 9 (1997): 1491-1498; R. Wallace and D. Wallace, "U.S. Apartheid and the Spread of AIDS to the Suburbs: A Multi-City Analysis of the Political Economy of Spatial Epidemic Threshold," Social Science and Medicine 41, no. 3 (1995): 333-345; and T.A. LaViest, "The Political Empowerment and Health Status of African-Americans: Mapping a New Territory," American Journal of Sociology 97, no. 2 (1992): 1080-1095.
77. D.G. Whiteis, "Unhealthy Cities: Corporate Medicine, Community Economic Underdevelopment, and Public Health," International Journal of Health Services 27, no. 2 (1997): 227-242; and J. McKnight, The Careless Society: Community and Its Counterfeits (New York: Basic Books, 1995).
78. D.G. Whiteis, "Unhealthy Cities: Corporate Medicine, Community Economic Underdevelopment, and Public Health," International Journal of Health Services 27, no. 2 (1997): 227-242; and J. McKnight, The Careless Society: Community and Its Counterfeits (New York: Basic Books, 1995).
79. This perspective has been most fully articulated in the World Health Organization's Healthy Cities program, an initiative that has been primarily directed at local government. See Patrick and Wickizer, "Community and Health." Recently, however, it also has been suggested as a standard for assessing national health policy in Canada and the performance of hospitals and other health care organizations in the United States. See M. Renaud et al., "Determinants of Health Working Group Synthesis Report," in Canada Health Action: Building on the Legacy, vol. 2 (Ottawa: National Forum on Health, 1996); and Whiteis, "Unhealthy Cities."
80. This perspective has been most fully articulated in the World Health Organization's Healthy Cities program, an initiative that has been primarily directed at local government. See Patrick and Wickizer, "Community and Health." Recently, however, it also has been suggested as a standard for assessing national health policy in Canada and the performance of hospitals and other health care organizations in the United States. See M. Renaud et al., "Determinants of Health Working Group Synthesis Report," in Canada Health Action: Building on the Legacy, vol. 2 (Ottawa: National Forum on Health, 1996); and Whiteis, "Unhealthy Cities."
81. This perspective has been most fully articulated in the World Health Organization's Healthy Cities program, an initiative that has been primarily directed at local government. See Patrick and Wickizer, "Community and Health." Recently, however, it also has been suggested as a standard for assessing national health policy in Canada and the performance of hospitals and other health care organizations in the United States. See M. Renaud et al., "Determinants of Health Working Group Synthesis Report," in Canada Health Action: Building on the Legacy, vol. 2 (Ottawa: National Forum on Health, 1996); and Whiteis, "Unhealthy Cities."
82. S.J. Tannenbaum, "Health Accounts and Communicative Power," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 223-230; and L.A. Aday and S.H. Under, "'Community' as the Ideal for Health Care Reform," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 231-244.
83. S.J. Tannenbaum, "Health Accounts and Communicative Power," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 223-230; and L.A. Aday and S.H. Under, "'Community' as the Ideal for Health Care Reform," Journal of Health Politics, Policy and Law 22, no. 1 (1997): 231-244.
84. Renaud et al., "Determinants of Health."
85. McKnight, The Careless Society.
86. Ibid., 72.
87. Renaud et al., "Determinants of Health."
88. Whiteis, "Unhealthy Cities."
89. H.M. Allen et al., "The Employee Health Care Value Survey: Round One," Health Affairs (Winter 1994): 26-41.