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PubMed2000

Selected demographic, social and work characteristics of the Australian general medical practitioner workforce: comparing capital cities with regional areas.

The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full- or part-time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26,359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part-time work, 42% of females also reported part-time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues.

Adult↗
PubMedDate not supplied

Strength in nursing leadership: the key to the evolution of intellectual capital in nursing.

Intellectual capital, what does it mean? After reading several articles on the subject, I found the perfect definition by Leif Edvinsson, the chief architect behind a dynamic and holistic reporting model. According to the model, the hidden factors of human and structural capital, everything that gets left behind when the employee goes home added together comprises intellectual capital. "Human Capital is defined as the combined knowledge, skill, innovativeness, and ability of the company's individual employees to meet the task at hand. It also includes the company's values, culture, and philosophy. Human capital cannot be owned by the company" (Bontis N. Assessing knowledge assets: a review of the models used to measure intellectual capital. Int J Manag Rev. 3(1):41-60). Today there seems to be an extraordinary value being placed on what people know, and yet knowing doesn't always translate into action. The action most often occurs when social connections are strong and numerous so that trust is built and information flows. This article will address how nursing leadership is critical to unleashing the human capital inside every staff nurse.

Attitude of Health Personnel↗
PubMed2000

Social capital and the political economy of violence: a case study of Sri Lanka.

This article examines the links between militarised violence and social capital (trans)formation. It first maps out emerging theoretical and policy debates on social capital and violent conflict and questions a number of the assumptions underpinning these debates. This is followed by an empirical analysis of several war-affected communities in Sri Lanka. The case studies illustrate that the links between militarised violence and social capital are complex, dynamic and context specific. It is argued that social capital cannot be understood in isolation from political and economic processes, and the belief that violent conflict inevitably erodes social capital is questioned. Finally, the implications for external agencies are highlighted. Rather than focusing on engineering social capital, external agencies need to focus on understanding better the preconditions for social capital formation and how they can contribute to the creation of an enabling environment. This requires as a starting-point a rigorous analysis of political and economic processes.

Humans↗
PubMed2005

Risk modifying effect of social capital on measures of heavy alcohol consumption, alcohol abuse, harms, and secondhand effects: national survey findings.

STUDY OBJECTIVE: To examine associations between social capital and individual risk for alcohol abuse and harms and identify protective effect mechanisms. DESIGN: Multilevel multivariate analysis with individual level data from a national panel survey of drinking and a contextual measure of social capital reflecting college mean aggregate reports of student volunteerism. Outcomes include heavy episodic (binge) drinking, frequent drinking, frequent drunkenness, diagnosable alcohol abuse, intentional drunkenness, acquisition of binge drinking, harms, secondhand effects from others' drinking. SETTING: United States, 119 four year colleges. PARTICIPANTS: Representative samples of youth ages 18-24 surveyed in 1997 and 1999 using an anonymous mailed questionnaire (total n = 27 687). MAIN RESULTS: Students from colleges with higher levels of social capital reported reduced risks for binge drinking (adjusted OR 0.38, 95% CI 0.20 to 0.69, p = 0.002), frequent drunkenness (adjusted OR 0.58, 95% CI 0.34 to 0.98, p = 0.04), acquisition of binge drinking in college (adjusted OR 0.48, 95% CI 0.24 to 0.95, p = 0.03), and alcohol abuse (adjusted OR 0.55, 95% CI 0.34 to 0.91, p = 0.02) in multilevel multivariate analyses that controlled for individual volunteering, the measure on which social capital was based. Higher levels of social capital protected against multiple drinking related harms (adjusted OR 0.51, 95% CI 0.29 to 0.90, p = 0.02) and secondhand drinking effects (adjusted OR, 0.30, 95% CI 0.16 to 0.58, p = 0.0003). Significant cross level interactions exist between fraternity/sorority membership and social capital for measures of risky drinking. Harm reduction primarily reflects consumption modification. CONCLUSIONS: Social capital exerts strong protective effects on alcohol abuse and harm in college including among high risk students.

Adolescent↗
PubMed1991

Effects of peer-mediated instruction on the acquisition and generalization of written capitalization skills.

This study investigated the effects of a peer teaching procedure, combined with student letter-writing activities, on the acquisition and generalization of capitalization skills. Three students, aged 9 years, obtained instruction from peer partners that included (a) an introduction and review of capitalization rules, (b) feedback on each participant's previous capitalization work, and (c) guided and independent practice on sentences that required capitalization. All three students demonstrated acquisition of the capitalization rules after participating in the teaching sessions with one or two peer partners. In addition, there were increases in capitalization accuracy in participants' letters to peers who did not serve as teaching partners, thus demonstrating a measure of across-peer (stimulus) generalization. Mixed results were obtained on a response generalization task (sentence writing). Finally, sentencing-writing activities also showed that two of the peer partners substantially improved their use of capitalization skills as a result of teaching the target students.

Child↗
PubMed2003

Social capital and successful aging: the role of senior housing.

Social capital is defined as the resources available to individuals and groups through social connections and social relations with others. Access to social capital enables older citizens to maintain productive, independent, and fulfilling lives. As the U.S. population ages, accompanied by a rise in the prevalence of seniors living alone, the availability of social capital within communities will become an important ingredient of successful aging. Recent evidence suggests that many traditional forms of social capital in communities-as represented by civic engagement in local associations and by the extent of voluntarism and social trust-are on the decline. If this observation in correct, there is no simple solution to rebuilding this lost social capital. Novel forms of senior housing, such as planned care developments and assisted-living facilities, may offer promising modes of delivery of social capital to the aging population. However, assisted living remains financially inaccessible for a large segment of the U.S. population, so investment in communities "aging in place" may be the key to delivering the health dividends of social capital.

Activities of Daily Living↗
PubMed1988

Cost of capital to the hospital sector.

This paper provides estimates of the cost of equity and debt capital to for-profit and non-profit hospitals in the U.S. for the years 1972-83. The cost of equity is estimated using, alternatively, the Capital Asset Pricing Model and Arbitrage Pricing Theory. We find that the cost of equity capital, using either model, substantially exceeded anticipated inflation. The cost of debt capital was much lower. Accounting for the corporate tax shield on debt and capital paybacks by cost-based insurers lowered the net cost of capital to hospitals.

Capital Expenditures↗
PubMedDate not supplied

Methods of reducing the financial risk of physicians under capitation.

In today's rapidly changing medical marketplace, managed care plans are not the only entities assuming risk for the care of enrollees through capitation. Increasingly, managed care plans are transferring this risk to their primary care and specialty physicians by paying them on a fully or partially capitated basis. Although capitation provides a strong incentive for physicians to provide cost-effective care, there are concerns that capitation may place some physicians at considerable financial risk. Our purpose is to familiarize physicians with issues they will want to consider when they evaluate capitation options and methods that are available to reduce their financial risk. Specifically, we analyze 3 issues: the range of services that are capitated, who accepts the risk, and size of patient panel. We conclude with a discussion of 3 methods for reducing or limiting risk--reinsurance, "carve outs," and risk adjustment.

Capitation Fee↗
PubMed1997

Primary care physicians and capitated reimbursement. Experience, attitudes, and predictors.

Given the explosive expansion of capitated reimbursement for the services of primary care physicians, we conducted a national survey of a random sample of these practitioners to measure attitudes toward capitated payment and identify predictors of important attitudes. Descriptive, factor analytic, and regression techniques were used. The response rate was 54%. As measured by scales derived from factor analysis, perceptions were strong that capitation was costly to professional and patient relationships. Patients' access to care was perceived as slightly reduced. Actual participation in capitation attenuated feelings of lack of access but not those of capitation's costly effects. Physicians' attitudes toward capitation remain negative, but participants perceive their patients' access to appropriate care as reasonable.

Attitude of Health Personnel↗
PubMed1993

Use of capital budgeting techniques by foodservice directors in for-profit and not-for-profit hospitals.

Foodservice directors, who often control one of the largest cost centers in the hospital, are being challenged to manage resources more effectively. Capital budgeting techniques can help enhance a department's cost-effectiveness. The purpose of this study was to assess the use by foodservice directors in nongovernment, not-for-profit and investor-owned, for-profit hospitals of capital budgeting techniques such as payback period, average accounting rate of return, net present value, profitability index, and internal rate of return. Data collected from 84 directors included their use of capital budgeting techniques and operational information about their department. Results indicated that not-for-profit hospital foodservices had significantly more full-time equivalent employees than for-profit hospital foodservices--means of 66 and 52, respectively. Size of capital budget was not strongly correlated with any of the operational variables measured. Many of the directors in both types of hospitals used some capital budgeting techniques. However, directors in for-profit hospitals were much more likely than those in not-for-profit hospitals (92% vs 72%) to use capital budgeting techniques.

Analysis of Variance↗
PubMed1998

Capitation for cardiologists: accepting risk for coronary artery disease under managed care.

Patients with chronic disease may be excluded from capitated managed care plans due to higher than average expected costs. In an attempt to remedy this inequity, one type of risk adjustment technique proposes to set separate capitation rates for certain chronic illnesses, including coronary artery disease (CAD). Cardiologists, who increasingly are requested to accept capitation, will benefit from understanding the impact of using clinical factors as opposed to using demographic factors to set capitation rates. Using a 5% national random sample of the 1992 Medicare population, we determined mean annual expenditures and variation in expenditures of individuals with CAD. We compared the use of 2 demographic factors currently used for capitation rate adjustment (age and gender) with 2 factors not currently used--3-digit International Classification of Disease (ICD-9) code (a measure for severity) and Charlson index (a measure for comorbidity). Mean annual expenditures for individuals with CAD were more than double mean annual expenditures for the general Medicare population ($6,944 vs $3,247). Among individuals with CAD, mean expenditures of subgroups defined by both age and gender ranged from $6,205 to $7,724. In comparison, stratifying by measures of severity and comorbidity identified subgroups with lower and higher mean expenditures, producing a range of $1,702 to $19,959. Substantial variation of expenditures for individuals within subgroups defined by severity and comorbidity remained, with few patients having substantially higher expenditures than the rest. When capitation rates are set with the use of demographic factors alone, patients may be subjected to risk selection and physicians to financial loss. Using clinical measures may decrease the incentive for patient risk selection, but substantial financial risk to physicians would remain, because of a relatively few patients with high expenditures (or costs).

Aged↗
PubMed2003

Social capital: a strategy for enhancing health?

The idea of social capital is currently being discussed as a source of support for health, though it is often argued that the concept should not be used in an attempt to evolve neutral policy strategies but underlines the need for moral and political debate in health policy. This article, first, supports this argument by indicating the complex and culturally diverse nature of social capital. Its components react with their social contexts to produce a range of variants which differ from each other along several dimensions. Social solidarity and support involve different conventions in different places, with results which need appraisal before they can be supported. The article explores these issues by drawing on ethnographic material illustrating aspects of social relatedness in a variety of settings. Secondly, writers who treat social capital as invariably positive tend to associate it with conditions in the neo-liberal societies of late capitalism, even though they also see it as threatened there. Again examining social contexts, the article locates the reasons for this paradox in the cultures and structures of the societies concerned. Large-scale institutions in the West-including both those required to implement public health measures and those in which the majority of people work-are organised via neo-liberal processes which are not all conducive to the types of social relatedness which the social capital debate seeks to explore. In particular, significant aspects of social trust are difficult to support in neo-liberal organisations. The assumption that social capital can be promoted via social engineering which relies upon these very institutions is thus questionable. This, together with more positive aspects of the debate, draws attention to the need for further research on social relatedness if it is to be supported by public policy.

Anthropology, Cultural↗
PubMed1996

Multiyear diagnostic information from prior hospitalization as a risk-adjuster for capitation payments.

As part of a move toward a more market-oriented health-care system, major changes have been implemented in the Dutch social health insurance system. The competing sickness funds now receive risk-adjusted capitation payments, currently based on the age-sex distribution of the insurance portfolios. These very crude health indicators do not reflect expected costs accurately. The authors examine whether the incorporation of inpatient diagnostic information over a multiyear period can increase the accuracy of the capitation model. Using a panel data set (n approximately 50,000) comprising annual costs and diagnostic information for 5 successive years, the authors compare demographic and diagnostic models in their ability to predict future health care costs. The predictive accuracy of an age-sex-based capitation formula improves substantially when diagnostic information from an individual's prior hospitalizations is used as an additional risk-adjuster. The longer the period over which diagnostic information is available, the better is the predictive accuracy. The expected loss in 1992 for insured persons with the highest costs in 1988 decreases from 88% (demographic model) to 62% (1-year diagnostic model) and to 43% (3-year diagnostic model). The use of diagnostic information from prior hospitalizations is a promising option for improving the capitation formulae. The authors' results are relevant not only for situations where competing insurers are capitated, as in the Netherlands, but also when providers (United Kingdom) or health maintenance organizations (United States) are capitated.

Adult↗
PubMed2002

Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness.

OBJECTIVE: To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado. DATA SOURCE: A large sample of adult, Medicaid beneficiaries with severe mental illness drawn from regions where capitation contracts were (1) awarded to local community mental health agencies (direct capitation), (2) awarded to a joint venture between local community mental health agencies and a large, private managed behavioral health organization, and (3) not awarded and care continued to be reimbursed on a fee-for-service basis. STUDY DESIGN: The three samples were compared on treatment outcomes assessed over 2 years (total n = 591). DATA COLLECTION METHODS: Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE. PRINCIPAL FINDINGS: Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples. CONCLUSIONS: Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program. Furthermore, the type of capitation model was unrelated to outcomes in this study.

Adolescent↗
PubMed1991

Human-capital selectivity in interstate migration.

"Using Public Use Microdata Sample A from the 1980 United States Census, human capital measures are developed and used to test whether states experience human-capital migration that is significantly different from human migration. Strong evidence demonstrates that human-capital migration differs significantly from human migration. For example, Arkansas and Vermont are shown to have a net in-migration of people, but a net out-migration of human capital. Conversely, the data for Connecticut and Minnesota indicate a net out-migration of people and a net in-migration of human capital. This study suggests that traditional models of interstate migration mask the flow of human capital."

Americas↗
PubMed1987

Methods for developing relative need criteria to accompany a health care capital expenditure limit.

In recent years capital spending in the health care industry has escalated tremendously, and most forecasters agree that needs will increase at an even faster rate throughout the 1990s. As a result of this trend, there is a dire need to develop effective and equitable controls on capital spending in health care. One of the capital payment options under consideration is the establishment of a lid on capital expenditures and the concomitant allocation of capital to health care providers whose applications are the most meritorious. The purpose of this article is to present some ideas and methods for the development of a relative need system to accompany a capital expenditure limit and to supplement and expand the absolute need determinations of the typical CON process.

Capital Expenditures↗
PubMed1998

Preparing for managed care: family practice residents and capitated care in community health centers.

This article examines the financial impact on patients of family practice residents when a community health center (CHC) serving as a residency training site is converted to a capitated payment system. The costs in this analysis included using and educating family practice residents at CHCs, the cost of patient encounters at CHCs, and the cost of contracted capitated services. These costs were measured against capitated per member per month (pmpm) payments received by the CHC. If capitated patients were cared for by residents, the CHC would lose $8.42 pmpm. The CHC faced a $5.98 pmpm loss if it used staff physicians rather than residents. This analysis suggests there are educational costs associated with training physicians in capitated health care delivery systems. Family practice residencies and CHCs must prepare for the conversion to capitated systems; academic centers with managed care contracts must control patient encounter costs and utilization to remain competitive.

California↗
PubMedDate not supplied

Scale and structure of capitated physician organizations in California.

Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.

California↗