1. Issel, L. Michele PhD, RN, Editor-in-Chief

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Many elements of daily life may seem removed and almost irrelevant to the management of health care organizations, including the workings of the Office of Management and Budget (OMB). But wise health care administrators know to look closely for the devil in the details of documents recently released from federal offices such as the White House.

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On February 7, 2006, President Bush released his proposed budget for the federal fiscal year 2007. Over the following week analyses of the proposed budget were released by organizations varying from political on both sides of the aisle to the United Way of America. As I read the variety of those analyses, one thing is clear: One person's savings are another person's safety net. This is not just an issue of spin. There are a variety of ways to decrease the federal deficit, yet the proposed budget has more than a few devils that will affect the administration and management of our health care system and organizations. If there are any counterbalancing angels in the proposed budget for health care, they are hiding.


Also released in early February was the OMB's rating of federally funded programs.1 Among the numerous programs with "no results demonstrated" were Head Start and the National Hospital Bioterrorism Preparedness Program, and among the "ineffective" programs was the Healthy Community Access Program that helps improve access to health services for uninsured or underinsured by focusing on improving integrated community health care delivery systems that coordinate health care services.


My purpose here is not to "go political," but to go with eyes open. From all accounts, what we have traditionally considered safety nets, like Community Block Grants, and scientifically sound programs, such as Head Start, are no longer sacred territory. They are balanced against savings through reduced Social Security payments and politically sound (but scientifically ineffective) programs like abstinence-only programs.


Having a substantial body of research at hand on the effectiveness of federally funded or supported health programs is one way health care administrators can brace for the board room discussions that will inevitably occur. HCMR is an optimal outlet for publishing well-constructed reviews of research of that nature. Health administrators also will likely need relevant and current data on the ways that the missing safety net, or its enlarged holes, will create new fiscal and services delivery burdens and human resource issues for hospitals and health systems. Again, HCMR is poised to provide that information. The 2007 budget proposes almost $1 billion cuts in health care grants to states and eliminates federal programs supporting education of health administrators, inner-city Indian health clinics, brain-injury centers, defibrillators in rural areas, an Alzheimer's education campaign, a national registry for Lou Gehrig's disease, and the entire budget of the Christopher and Dana Reeve Paralysis Resource Center. In such an environment, health services managers, administrators, and executives will need reliable and effective strategies that can be implemented to brace for and against the burdens of the emerging devils. I hope HCMR will be a place they look for exemplars.


L. Michele Issel, PhD, RN






1. Available from: Accessed 22 February 2006. [Context Link]