Capital cost reimbursement to community hospitals under Federal health insurance programs

Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.     

The experience of sexual assault: findings from a statewide victim needs assessment

A statewide assessment was conducted of assaults, experiences, needs, and recommendations of 125 adult victims receiving care at 19 sexual assault centers (SACs) in the State of Maryland. More than one half of the victims (55.6%) waited years before disclosing, with delays in reporting especially likely if the assault was perpetrated by a family member (the most frequent perpetrators at 42.4% of respondents). About one half of the victims (51.3%) had been previously sexually assaulted, yet only 9% of these victims had sought treatment. The majority of respondents (69.4%) indicated they would not be filing charges against perpetrators, and of those who did, 46.2% reported dissatisfaction with the interview with police. Psychological symptoms such as depression and anxiety were the most common reasons for seeking care at the centers. Nearly all of respondents rated the care they received at the centers as very good or excellent. Respondents recommended more SACs, better advertising of their services, more mental health care within them (especially group therapy), and improved laws and law enforcement of perpetrators.