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Biomedical subjects

Alan Maynard

Publications and source records attributed to Alan Maynard.

36 records · Page 2Linked to original sources
PubMed2004

Variation in activity rates of consultant surgeons and the influence of reward structures in the English NHS.

OBJECTIVES: To explore variation in the National Health Service (NHS) activity rates of consultant surgeons, and examine whether activity is dependent upon the type of contract held and/or bonus payments, after accounting for age and other consultant and hospital characteristics. METHODS: NHS Hospital Episode Statistics (HES) for England were used in combination with workforce data in five surgical specialties in 1998/99 and 1999/2000. Descriptive statistics were used to explore variation in activity rates. A multi-level model was used to analyse the relationship between NHS contract and bonus payments, and activity. RESULTS: There is considerable variation in activity rates of English NHS consultant surgeons, with and without adjustment for casemix. Interquartile variation shows that the top 25% of consultants have activity rates 60 to 85% higher than the bottom 25%. A multi-level model indicates that consultant surgeons with a 'maximum part-time' contract have significantly higher activity rates than those with a full time contract (129 more finished consultant episodes (FCEs) per year, 95% CI 97-160). Consultant surgeons who hold discretionary salary points undertake significantly more activity than those without (95 FCEs, 95% CI 62-128). Those with a distinction award (a type of bonus payment) have a tendency towards higher activity rates, but this does not reach statistical significance (48 FCEs, 95% CI -4 to 103). CONCLUSIONS: 'Maximum part-time contract' status is associated with higher absolute activity rates among NHS surgeons. Rich data sources like HES merit careful exploration and increased use as an essential first step in measuring and managing variations in specialists' performance.

Analysis of Variance↗
PubMed2003

Evaluating health interventions: exploiting the potential.

The importance of the evaluation of health care interventions (EHI) including formal health technology assessment (HTA) cannot be over-emphasised, as its results can inform and improve resource allocation decisions in all parts of the health care system, public and private. At present, fragmented and inefficient resource allocation processes are a universal problem and, as a consequence, patients are deprived of care from which they could benefit. Such outcomes are not only inefficient but also unethical. In this paper we focus on HTA, which emphasises the need to link evidence to policy and practice, but our conclusions can be applied to all types of EHI. There is a need for greater use of economic evidence within HTA. Four principle characteristics of HTA are discussed in this paper: types of knowledge and evaluation, and commissioning and knowledge utilisation. Policy-makers must invest in improving research and receptor capacities for producing and using knowledge, improve quality control, and invest in research into dissemination and implementation mechanisms. The potential of HTA is great, and its use has increased, but it remains largely unexploited in most countries.

Delivery of Health Care↗
PubMed2003

Managing medical workforces: from relative stability to disequilibrium in the UK NHS.

The management of the medical workforce, in particular the market for physicians, is costly and complex. For decades this process has been dominated by largely mechanistic forecasting (e.g., fixed doctor-population ratios), which ignored economic determinants. Internationally, and specifically in the UK, such practices achieved some success in producing modest cyclical shortages and surpluses in the past. However with large increases in UK health care funding, together with the international recognition of significant practice, activity and outcome variations in health care, this approach is now inadequate. With physician shortages emerging internationally, the impact of incentives (both financial and non-financial) on skill-mix (are nurses cost effective substitutes or complements for physicians?), activity (can distribution means be shifted and variation reduced?) and outcomes (can survival duration and quality of life of survival be improved?) is now central to policy development. Such issues create nice challenges for researchers and policy makers.

Budgets↗
PubMed2002

Why do folk clutch at straws when there is a lifeboat on hand?

The Mazankowski committee considered all too familiar problems with the Alberta healthcare system, in particular expenditure inflation and public "affordability," and the efficiency of the provision of care to the population. The remedies if offers are incomplete and unconvincing because of the failure to use rigorously the evidence base. Is the system unaffordable when the modest effects of the aging of the population and efficient health technology assessment could control inflation? Why advocate "competition" when it is not defined and managed care in the United States has failed? The Council's report glosses over the crucial issues of how physicians ration healthcare in Alberta and how the profession has failed to evaluate and manage major variations in medical activity and outcomes. Investment in these areas together with global budgets and equitable financial allocations offers better health for the Alberta population. Many of the Council's proposals are not consistent with the goals of expenditure control, equity and efficiency.

Alberta↗
PubMedDate not supplied

Nurse staffing and healthcare outcomes: a systematic review of the international research evidence.

The relationship between quality of care and the cost of the nursing workforce is of concern to policymakers. This study assesses the evidence for a relationship between the nursing workforce and patient outcomes in the acute sector through a systematic review of international research produced since 1990 involving acute hospitals and adjusting for case mix. Twenty-two large studies of variable quality were included. They strongly suggest that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably. The association appears to show diminishing marginal returns.

Acute Disease↗
PubMedDate not supplied

Dilemmas in regulation of the market for pharmaceuticals.

What can be learned from international experience of efforts to control spending and to improve efficiency and access in pharmaceutical markets? Policymakers tend to reinvent many policies to control the behavior of patients, doctors, and industry, despite a lack of evidence of those policies' cost-effectiveness. There is an emerging consensus that reimbursement in public and private health care systems should be informed by evidence of the cost-effectiveness of treatments and that utilization should be constrained by budget caps and information systems. Whatever the policy chosen, evaluation is as essential as it is rare.

Cost Control↗
PubMedDate not supplied

Let's visit the PROMs.

Explore the source record for details and available documents.

Family Practice↗