General Health and Wellness Center

Academic medical centers provide cutting edge acute care, train tomorrow's physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent care -- experts generally agree that many are suffering acute -- even life-threatening -- financial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physician's office; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades.While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered species -- that could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problems -- and then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. Theseexperts address the key issues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health.

Migration from less-developed nations to the United States and Western Europe is steadily increasing, and it is unlikely that this trend will reverse. There are currently over a hundred million immigrants worldwide. And many of these immigrants are in a condition of poverty or near poverty, while many also suffer from poor health. The articles in this collection address the health conditions of international labor migrants and the availability and limitations of human and health services for them. Written by leading social scientists and health professionals from both the United States and the European Union, six of the articles focus on Europe, three on the United States, and two on psychological issues related to immigration. The contributors to this volume, representing a wide variety of disciplines (including medicine, social work, political science, sociology, anthropology, psychology, and biology), are in agreement that the health and human services offered in industrial nations are generally monocultural, and not well suited for migrants from other cultures. One article even arrives at the disquieting conclusion that the mental health services offered to immigrants not only do not respond to their needs, but rather serve to reinforce negative perceptions regarding immigrants from third-world countries. This book represents a timely and urgently needed contribution to the discourse on health services for migrants. It demonstrates that the issues and problems of immigration in the United States and Europe have many commonalities and that much can be learned from examining the experiences, successes, and failures of both. Antonio Ugalde is Professor of Sociology at the University ofTexas at Austin and Adjunct Professor at the School of Public Health, University of Texas Health Science Center at Houston.