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PubMedDate not supplied

A national action plan to meet health care quality information needs in the age of managed care.

Concerted national action is needed to meet the growing demand for health care quality information among all health care stakeholders. We propose a coordinated national network of independent, public-private quality measurement alliances established through strong purchaser and consumer leadership at the state, regional, or local levels. These independent alliances could assume a variety of organizational forms, but all would undertake specific quality measurement and consumer information projects to meet local health care market needs by drawing on various combinations of the emerging national standardized quality measures. Local implementation of quality measures based on national standards will facilitate cross-market benchmarking and multistate comparisons useful not only to state and local market constituencies, but to national employers, health plans, provider organizations, and the federal government as well. Successful models of such alliances already exist that demonstrate the feasibility of this national strategy, but concerted national leadership and federal matching funding will be needed to meet the scope of implementation required in markets across the country.

Benchmarking↗
PubMed2002

Internet-based search tools can help reduce bad debt.

The healthcare industry wrote off more than $20 billion in bad debt in 1999 alone, according to one estimate. Bills frequently do not reach patients because healthcare organizations do not have accurate patient contact and billing information. Incorrect billing information can be easily and inexpensively corrected by using Internet-based search tools. Healthcare accounts receivable staffs are using these tools to improve the patient experience and the bottom line with no capital outlay, minimal staff training or workflow change requirements, and low cost.

Financial Management, Hospital↗
PubMed2000

Digital health care--the convergence of health care and the Internet.

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.

Commerce↗
PubMed1999

A decision technology system for health care electronic commerce.

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Commerce↗
PubMed2001

Driving a more effective health care market by putting consumers behind the wheel.

In any other rational market, the consumer drives demand, and the provider responds with products and services aimed at meeting individual needs. This rational market does not exist in today's group health care system. The ramifications are significant: declining consumer and provider satisfaction, out-of-control costs, a rising uninsured population, and growing employer burdens. Turning this chaotic world around requires a more active and informed consumer. Transformation is under way with solutions like Sageo, a new e-business from Hewitt Associates that is revolutionizing the way health care benefits are offered, selected, and administered. For companies that offer Sageo's services, their employees and retirees gain direct access to health care coverage and content, enabling them to research, select, and enroll in the appropriate package based on their individual needs.

Consumer Behavior↗
PubMed2005

Use of Internet audience measurement data to gauge market share for online health information services.

BACKGROUND: The transition to a largely Internet and Web-based environment for dissemination of health information has changed the health information landscape and the framework for evaluation of such activities. A multidimensional evaluative approach is needed. OBJECTIVE: This paper discusses one important dimension of Web evaluation-usage data. In particular, we discuss the collection and analysis of external data on website usage in order to develop a better understanding of the health information (and related US government information) market space, and to estimate the market share or relative levels of usage for National Library of Medicine (NLM) and National Institutes of Health (NIH) websites compared to other health information providers. METHODS: The primary method presented is Internet audience measurement based on Web usage by external panels of users and assembled by private vendors-in this case, comScore. A secondary method discussed is Web usage based on Web log software data. The principle metrics for both methods are unique visitors and total pages downloaded per month. RESULTS: NLM websites (primarily MedlinePlus and PubMed) account for 55% to 80% of total NIH website usage depending on the metric used. In turn, NIH.gov top-level domain usage (inclusive of NLM) ranks second only behind WebMD in the US domestic home health information market and ranks first on a global basis. NIH.gov consistently ranks among the top three or four US government top-level domains based on global Web usage. On a site-specific basis, the top health information websites in terms of global usage appear to be WebMD, MSN Health, PubMed, Yahoo! Health, AOL Health, and MedlinePlus. Based on MedlinePlus Web log data and external Internet audience measurement data, the three most heavily used cancer-centric websites appear to be www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society), and www.breastcancer.org (non-profit organization). CONCLUSIONS: Internet audience measurement has proven useful to NLM, with significant advantages compared to sole reliance on usage data from Web log software. Internet audience data has helped NLM better understand the relative usage of NLM and NIH websites in the intersection of the health information and US government information market sectors, which is the primary market intersector for NLM and NIH. However important, Web usage is only one dimension of a complete Web evaluation framework, and other primary research methods, such as online user surveys, usability tests, and focus groups, are also important for comprehensive evaluation that includes qualitative elements, such as user satisfaction and user friendliness, as well as quantitative indicators of website usage.

Humans↗
PubMed2001

Whatever happened to eHealth?

Innovations in information technology will continue to transform the health care system to a system that more closely resembles that envisioned in the 1999 and 2001 IOM reports. Healthcare Leadership & Management Report will continue to report over the next few months on practical use of technology to improve the health care system. We are now researching several systems and providers that are using technology to improve their patient care, productivity, bottom line and host of operational concerns.

Commerce↗
PubMed1998

Risks and benefits of private health care: exploring physicians' views on private health care in Ho Chi Minh City, Vietnam.

As in a number of other low- and middle-income countries, the health sector in Vietnam is transforming with a rapid shift from fully state run and financed health care towards more private financing and delivery of health care. This development has been particularly noticeable in the largest city in the country, Ho Chi Minh City, where a majority of physicians now are practising in private clinics and where the private health care sector is an increasingly popular option for people. While the private sector is an important part of the health care system in Vietnam, few data are available on the characteristics and quality of private health care services. This case study describes some aspects of the re-emerging private health care sector in Ho Chi Minh City, Vietnam, from the view of 27 private and non-private physicians. The paper explores physicians' reasons for going private, physicians' notions of patients' health care preferences, and physicians' views on potential influence of financial incentives on characteristics of private health care. The characteristics of private health care are discussed in relation to a context of private health care characterised by a fully patient-financed fee-for-service payment system, weak regulatory mechanisms, and a public health care system (government-run and-financed health care) that operates under resource constraints. Issues to consider when attempting to steer private health care in Vietnam in a direction where it can optimally contribute to public health, are discussed while considering the interplay between authorised private practitioners, private pharmacies, the informal private sector, and the public health care sector.

Adult↗
PubMed2004

Health in the information and knowledge economy age--a European perspective.

The health sector today faces great challenges. Health is an information-intensive sector where Information and Communication Technologies (ICTs) could significantly contribute to efficiency and productivity gains. European Union is looking at the different facets of eHealth and mainly at the following three: a) Research and development, in particular to support the development of several regional health information networks, telemedicine services, and personal health systems for patients and citizens. b) Regulatory framework and standardisation, which ensure competition, interoperability and, at the same time, the confidentiality of personal data. c) Promotion of eHealth best practices through various eEurope 2002 and 2005 initiatives. After the pharmaceutical and radiology industry, eHealth is now the third industrial pillar for health. This emerging sector forms the backbone for the reengineering of health systems. It actually improves the access to and quality of care and places citizens at the very centre of its concern.

Computer Communication Networks↗
PubMed2004

Occupational injuries identified by an emergency department based injury surveillance system in Nicaragua.

OBJECTIVES: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua. SETTING: Urban emergency department in Managua, Nicaragua serving 200-300 patients per day. METHODS: Secondary analysis from the surveillance system data. All cases indicating an injury while working and seen for treatment at the emergency department between 1 August 2001 and 31 July 2002 were included. There was no exclusion based on place of occurrence (home, work, school), age, or gender. RESULTS: There were 3801 work related injuries identified which accounted for 18.6% of the total 20 425 injures captured by the surveillance system. Twenty seven work related fatalities were recorded, compared with the 1998 International Labor Organization statistic of 25 occupational fatalities for all of Nicaragua. Injuries occurring outside of a formal work location accounted for more than 60% of the work related injuries. Almost half of these occurred at home, while 19% occurred on the street. The leading mechanisms for work related injuries were falls (30%), blunt objects (28%), and stabs/cuts (23%). Falls were by far the most severe mechanism in the study, causing 37% of the work related deaths and more than half of the fractures. CONCLUSIONS: Occupational injuries are grossly underreported in Nicaragua. This study demonstrated that an emergency department can be a data source for work related injuries in developing countries because it captures both the formal and informal workforce injuries. Fall prevention initiatives could significantly reduce the magnitude and severity of occupational injuries in Managua, Nicaragua.

Accidents, Home↗
PubMed2000

E-health: the changing model of healthcare.

E-health--any electronic exchange of healthcare data or information across organizations--reflects an industry in transition. Even as its form and structure continue to emerge, e-health is being used to change business and medical practices, affecting every facet of the American health experience. Business, medical, social, and technological factors are converging to make wide-scale, continuum-based care functionally achievable perhaps for the first time. The Internet clearly drives the development and adoption of e-health applications; standing alone, it has the reach, the infrastructure, and the acceptance to achieve widespread change. As the public grows increasingly Internet-enabled, healthcare organizations have an opportunity to cost-effectively reach a large part of the U.S. population. The sheer breadth of e-health, the many options available to healthcare organizations, and the relative immaturity of the applications in most areas make navigating the spectrum of possibilities a clear healthcare management challenge. Deciding how to incorporate the demand for e-health has extensive technological, organizational, managerial, and ethical implications.

Community Participation↗
PubMed1996

Does women's work improve their nutrition: evidence from the urban Philippines.

Women's market work in developing countries is thought to improve their well-being directly through increased income for health-related purchases and indirectly through elevating women's status within the household. While a number of studies have looked at the effects of women's work and the cost of women's time on child nutrition and welfare, the direct effects of women's work on their own welfare have been largely untested. Using data on 1963 urban Filipino women from the Cebu Longitudinal Health and Nutrition Survey, we examined the relationship between women's work and their dietary intakes of energy, protein, fat, calcium, and iron from home and commercially prepared foods. Determinants equations for home and commercial intakes were estimated simultaneously to adjust for non-independence. Appropriate methods were used to deal with selectivity, endogeneity, and unobserved heterogeneity. Nearly half (48%) of the women worked for pay, and commercially prepared foods made up an important part of working women's diets. Not only did women's work improve the quality of their diets, but there were strong distributional implications; lower-income women gained more than higher-income women. Employment sector also influenced women's dietary patterns. Informal non-wage work was associated with increased intakes, whereas formal sector work was associated with decreased intakes. Positive effects of work in the informal sector were greater for women from low-income households. Policy implications of the dietary benefits of informal non-wage work for low-income women are discussed.

Adult↗
PubMed1990

Economic aspects of patterns of mental health care: cost variation by setting.

The paper examines the evidence regarding the extent to which differences exist in health and mental health status of psychiatric patients treated in the specialty mental health, general medical, and informal care sectors. Differences in types of patients treated in the three sectors are important to identify since there are dramatic differences in the average costs of treatment. We use data from the Baltimore Epidemiological Catchment Area Survey to estimate a statistical model of treatment setting choice. Our results suggest that there is little support for attributing major differences in treatment costs across sectors to differences in the health and mental health status of patients.

Costs and Cost Analysis↗
PubMed1987

Employment, economy and care in Sweden by the year 2000.

Within the context of the future study 'Care in Society' an analysis has been made concerning the relationships between employment, economy and care. The changed economic outlook for Sweden creates problems for employment as well as for the public care systems. Employment in the future will be influenced by: --the growing labour force; --the changing structure of the labour market; --the expansion of the public care systems; --working hours per week and life. It is argued that shorter working hours--besides positive effects on employment--also will create more favourable conditions for the informal care sector--care in the family and voluntary care. A conscription system for care might be a solution to the problems of care and employment in the future.

Delivery of Health Care↗
PubMed2006

Integrated pollution prevention and control for heavy ceramic industry in Galicia (NW Spain).

The heavy ceramic industry (building materials and refractory products manufacture) is an important source of pollutants to the environment. For this reason these industrial sub-sectors are included in prevention and control pollution policies, specifically those of the European Union. The IPPC Directive pays particular attention to the mineral industries, not least to the ceramic industry (epigraph 3.5, Annex I). In this paper, a methodology which is being applied to support IPPC installations and the competent administrative authority in Galicia (NW Spain) is presented. For that, the Galician heavy ceramic industry is analysed, as also are the ways to study the Best Available Techniques (BAT) with a view to establishing the emission limit values (ELV) for each specific case. Hence, a technological state of the art has been carried out for both sub-sectors, from the point of view of implementation of the IPPC in Galicia. Following this, the processes are described briefly and an analysis of the consumption and emission levels of the main pollutants is made. An inventory that includes the best environmental practices and the preventive and abatement candidate techniques as BAT was elaborated for both considered sub-sectors. An information data sheet for each candidate BAT is presented as a method to help both the industries and the competent authority to identify a candidate technique of the inventory as BAT. Three illustrative examples of the application of this procedure are presented for different emissions to environmental media for Galician installations.

Ceramics↗
PubMed2000

Applying the health care industry representative statement to your setting. Association of periOperative Registered Nurses.

AORN values the role our industry partners play in the care of our patients. Table 3 is an example of a policy on the health care representative in the OR. This article is meant to assist perioperative nurses in writing policies that enhance the role of the health care industry representative in the OR, promote collegial relationships with an important player on the team, and preserve patient safety and privacy.

Humans↗
PubMed2004

The management of fevers in Kenyan children and adults in an area of seasonal malaria transmission.

This study investigates the source, timing and types of treatment for fevers across all ages in a low malaria-transmission area of Kenya. The period prevalence for fever, and subsequent treatment seeking behaviour, was similar across all ages. The use of the informal retail sector was common (47% of first actions), though most visits to shops and chemists (77%) resulted in treatment with an antipyretic not an antimalarial. The major source of the first line recommended drug, sulfadoxine-pyrimethamine (SP), was at the formal health sector, and 32% of fevers made at least one visit to a health care facility. Although only 7% of fevers received SP within 24 hours of fever onset, 27% ultimately received treatment with this antimalaria. It is estimated that of the total amount of SP consumed in this population, only 20% is administered to children less than 5 years old. In this area of Kenya disease risks decline with increasing age, however, adult populations consume over 40% of prescribed or purchased anti-malarial drugs. In light of the proposed new, more costly anti-malarial drug combinations these findings have major implications for the effective allocation of limited financial resources at household and government levels.

Adolescent↗
PubMed2003

Practice variation and physician-specific effects.

This study provides estimates of practice variation for primary physician services in Norway. Nearly all previous studies on practice variation have encompassed mainly specialist and hospital services. Thus we provide evidence for treatment variation for a health care sector where information about treatment variation is relatively scarce. Our analyses were carried out on a large set of data from individual physician practices. We estimated the extent of practice variation according to type of diagnosis and type of treatment option. The main finding is that variation in clinical practice between physicians is an important determinant of expenditure for primary physician services. Depending on the type of diagnosis, physician-specific effects explained 47-66% of the variation in expenditure for laboratory tests, 59-66% of the variation in expenditure for consultations lasting over 20min and 49-61% of the variation in expenditure for specific procedures. The age and gender of the patients explained only about 1% of the variation in expenditure. This finding supports the results from previous studies, which have shown that patients' age and gender are inadequate when used as risk adjusters. We also identified physicians who moved their practice from one municipality to another, i.e. they changed their patient population completely. Our results showed that those physicians who moved did not change practice style after they moved, i.e. that physician's style of practice is stabile. This indicates that practice style reflects a deeply rooted behaviour with respect to how to practice medicine.

Contract Services↗