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Biomedical subjects

G Mooney

Publications and source records attributed to G Mooney.

At least 55 records · Page 3Linked to original sources
PubMed1994

The NSW health outcomes initiative and economic analysis.

The New South Wales Health Department's initiative on health outcomes promises some important advances in the planning and priority setting of health services. However, the potential to promote better health care will not be realised unless resources are redeployed to the programs where health outcomes (and other benefits) can be purchased most cheaply. The initiative reflects firmly the economic concept of efficiency but leaves less certainty about how concerns for equity are to be handled. This paper proposes that program budgeting and marginal analysis be used to create a framework for redeploying resources to follow the good buys--in terms of health and other outcomes. Additionally, the paper argues for creating the right incentives to promote efficiency, and expressly argues against the use of diagnostic related groups or casemix funding, as such funding is concerned, by definition, with cases and not with health per se. The goal of the initiative of trying to maximise health outcomes implies that there are no other valued gains to be had from health care. This is challenged. In reaching decisions about how best to deploy resources, more account should be taken, in a structured way, of community values.

Delivery of Health Care↗
PubMed1993

QALY league tables: handle with care.

This paper examines some of the difficulties in using QALY league tables in priority setting. Such tables sometimes are seen as being 'the' way to prioritise in health care and in particular, at present, with respect to priority setting among purchasers in the UK NHS. However the paper highlights the fact that the base on which such tables is built is small--relatively few studies in the English language using CUA have been conducted anywhere. Further, four issues which require handling with care are set out: (i) the relevant measure of cost in QALY league tables has to be restricted to health service resource use; (ii) the relevant measure of benefit in QALY league tables is clearly restricted to QALYs, thereby the utility of health gains and indeed the maximisation of the utility of health gains; (iii) in incorporating the results of CUA studies into QALY league tables there is a need for greater clarification on what the margin constitutes; and (iv) those who might use CUA results in QALY league tables need to ascertain whether the original context of the study will allow the results to be transferred to the local context of the decision maker. The paper suggests that there is a need to be quite clear what goal QALY league tables serve. The authors argue that the only legitimate (and clearly important) goal of QALY league tables is the maximization of the utility of health gains within a health service budget.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1993

Agency in health care: getting beyond first principles.

This paper is concerned with the application of the theory of agency to health care. It is argued that the basic theory of agency raises more questions than it provides answers when it is applied to the doctor-patient relationship. More research is needed into the nature of both the patient's and the doctor's utility functions. Only then can we begin to devise optimal incentive structures to encourage doctors to take adequate account of patient preferences.

Contract Services↗
PubMed1993

Remuneration of GP services: time for more explicit objectives? A review of the systems in five industrialised countries.

The paper examines the nature and use of GP remuneration systems as instruments of health policy in five different countries--Australia, Canada, Denmark, Norway and the UK. Since doctors are not naturally efficient, they need to be encouraged to adopt efficient practices. The paper indicates that while there are great differences in the nature and level of remuneration across the five countries, there is little evidence that policy-makers in these countries have given adequate thought to how to use remuneration to influence the activities of GPs. In all five countries except the UK the objectives of GP services are somewhat vague and largely non-operational. The designs of the remuneration systems seem directed more towards deciding doctors' income levels and controlling public expenditure than towards meeting health care objectives. The remuneration for similar services varies widely across the five study countries. There is a need to clarify what the objectives of general practice are and thereafter to experiment more with GP remuneration systems to determine how best to get doctors to meet these objectives efficiently.

Australia↗
PubMed1993

The new NHS in a global context: is it taking us where we want to be?

In this paper, the new NHS is put in a global context, comparing the UK internal market arrangements with changes occurring in other health care systems. An assessment is made of whether the new UK NHS will result in more efficient and equitable health care provision than the 'old' NHS. Regarding financing of health care, most countries seem to be moving in the direction of NHS or public-insurance-based systems. New Zealand and The Netherlands are among the few countries attempting to inject competition into health care financing. There is a greater move, globally, towards competition in the provision of services. In terms of allocative efficiency and equity, we believe that, on balance, the new NHS will bring no improvement. Indeed, in terms of equity, it may be detrimental. If there is any improvement, it is likely to be in technical efficiency.

Economic Competition↗
PubMed1993

Ante-natal screening: what constitutes 'benefit'?

This paper discusses the application of economic appraisal in pre-natal screening. In particular it examines the way in which economists to date have attempted to measure and value the benefits of pre-natal screening. The authors argue that there are problems with existing approaches particularly in terms of the nature of women's utility functions and which arguments are present in these utility functions. They suggest that policy makers are unlikely to take full account of the results of such analyses until economists better attempt to reflect measures of what women want from pre-natal screening.

Abortion, Induced↗
PubMed1993

The general practitioner's use of time: is it influenced by the remuneration system?

The practice pattern of 116 general practitioners in 60 rural municipalities in Northern Norway was studied with respect to length of consultation, the weekly number of consultations and the proportion of return visits. The average length of consultation was 14 mins, and only slightly lower for fee-for-service (FFS) doctors (13.7) than for salaried ones (14.8). The weekly average number of surgery consultations was higher for FFS doctors than for the salaried (63 vs 49), but the weekly number of hours spent consulting and the proportion of return visits were about the same. Further, the characteristics of the health care system (doctor density and doctor turnover) were associated with variations in the doctors' use of time. The most consistent effects, even if weak, were the age and sex of the patients. The strongest effects on the length of consultation were referrals and various medical procedures. This suggests that in this instance the medical condition at hand would appear to have a greater influence on the doctors' use of time than either the remuneration system or other characteristics of the health care system. Although the association between the doctors' use of time and the type of remuneration was weak, the study indicates that the type of remuneration does matter. Consequently, financial incentives can be used to influence the practice pattern of GPs.

Adult↗
PubMed1990

Changing remuneration systems: effects on activity in general practice.

OBJECTIVE: To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN: Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING: General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS: 265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES: Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS: Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105.3, 107.6 and curative services 106.0, 115.0) whereas referral rates to secondary care fell (specialist referrals 90.1 (80.7 to 100.6) and 77.0 (68.6 to 86.4) and hospital referrals 87.4 (71.1 to 107.5) and 68.4 (54.7 to 85.4] in doctors in the city. CONCLUSIONS: Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Capitation Fee↗