PubMed · 16410590
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
Ann McDonnell, Richard Wilson, Steve Goodacre. 2006-01-14. Evaluating and implementing new services.. https://doi.org/10.1136/bmj.332.7533.109
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system - the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals - rapid cost and price inflation, a race for the best technology, and so on - illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more 'rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists.
Consult letters are the main way of relaying information between attending physicians involved in patient treatment at different levels of care and should therefore reach continuing care physicians with minimal delay. The quality assurance project described here was intended to reduce dispatch times for inpatient consult letters at our department of psychiatry and psychotherapy. To accomplish this, different measures were put to work at two levels of intervention. These included standardizing work flow, centralizing and optimizing work distribution in the secretaries' office, enabling faster access to typewritten consult letters by way of central data storage on the clinic's server, sending email notifications to all persons involved, using a central office for signing letters, and prompt monitoring and reporting of consult letter delays. These interventions helped reduce the average delay of dispatching consult letters from 29 days to 11. All in all, the project led to a high degree of workplace satisfaction for all persons involved and should be adaptable to other departments and units without difficulty. In our own department, ward-specific consult letter efficiency has become an important quality indicator.
Explore the source record for details and available documents.