An overview of the specialized alcoholism treatment field in Canada is presented based on a 1976 national survey of 338 programs. Descriptive information on these programs is presented to provide an understanding of the state of current treatment efforts and to identify emersent policy issues in this field. Programs activities are described under six headings: (1) the pattern of program development, (2) types of treatment agencies, (3) treatment capacity and utilization, (4) the characteristics of persons using treatment services, (5) approaches employed in treatment, and (6) program costs and financing of alcoholism treatment. Findings from the national study are related to three policy issues: access, quality, and cost. The need for future research aimed at these issues is discussed.
Physician maldistribution is a widely recognized problem facing virtually all health care systems. In this study, information from three health care systems--the United States, the United Kingdom, and Sweden--was used to address two questions: How do organizational features of health care systems affect their ability to deal with the problem of physician maldistribution? What are the effects of physician distribution on the health status of populations? It was found, first, that all three systems perceived similar problems of physician maldistribution and drew on a repertoire of similar solutions, none of which was altogether responsive to the problem. Second, the relationship of physician distribution to health status was found to be ambiguous, with some evidence that physician/population ratios may affect some health measures but not others.
The medical care program (MCP) concept emerged from a conviction that it would be possible to combine biomedical knowledge about a certain disease, principles of care and an efficient organization into a holistic approach to care. The purpose of the present review of nine MCPs was to: (1)provide and overview of MCP development and and evaluation in the Stockholm County; (2) present different perspectives regarding the current status of the MCP policy and future developments; and (3) contribute to a discussion of factors which enhance or block the effectiveness of MCPs. Information was gathered during interviews with 32 representatives of professionals and interest groups. The majority of MCPs were initiated by medical professionals while two, the program for alcohol disorders and that for rheumatoid diseases, were initiated by politicians or the rheumatoid patients. Three central problems were identified: (1) the original desire for standardization and the emergent demand for local variation; (2) ambiguities about specific roles of the newly developing general practitioners; and (3) lack of resources to develop, implement and evaluate MCPs to the standards of the original concept. The experience of the MCPs certainly has increased understanding of the policy-program-implementation-outcome process and inevitable gaps that materialize as policy struggles towards implementation.