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PubMed2000

Big studies, simple lessons.

Goldman describes how service systems research examines the impact of economic and organizational strategies designed to promote particular service combinations (such as continuity of care) and inhibit others (such as preferentially serving only those individuals who are the easiest to treat). The recurring theme from the large services research initiatives is that the content of care, as well as the organization and financing of care, matters. This theme is distinct from what these large services research projects were designed to assess, which speaks both to the unexpected benefits from these massive studies and the need for more efficient tools to examine the interrelationships among the organization, financing and content of care.

Journal Article↗
PubMedDate not supplied

Initiative for change.

Explore the source record for details and available documents.

Community Health Services↗
PubMedDate not supplied

[Economics of health systems in developing countries: what is the contribution of work published in french?].

Health economics is poorly developed in the francophone community. There is little published work addressing developing francophone countries, and it is largely limited to the sub-Saharan Africa. Few specialist research workers from developing countries contribute. Universities only propose global analyses, and other groups involved (expert consultants) only conduct narrow studies, targeted at immediate action or decision making. The article analyses some of the reasons from this underdevelopment, and overviews what has been produced over the last 15 years. Three areas appear to be preferred: the analysis of costs and financing of vertical programs (vaccination programs in particular), the issue of supply and the price of essential drugs, and the effects and consequences of attempts to recover costs. Research work is mainly conducted by experts and consultants working for the financing bodies or international organizations. Their ideas, methods and conclusions often reflect the interests and working methods of those sponsoring the study. In many cases, pragmatism and short-termism dominate over intellectual and ethical rigor. A major issue is that of the roles of the State and the marker in the organization and financing of health systems and policies. Francophone economist differ from others on this issue, although, since the 1993 World Bank report entitled "Investing in Health" the opposition is less direct, and the "specificities" in the health sector, including those concerning economics, are now universally recognized.

Africa↗
PubMed2003

The role of managed care and financing in medical practices: how does psychiatry differ from other medical fields?

BACKGROUND: The organization and financing of medical practice has experienced substantial changes during the past decade. Today the majority of individuals with private insurance are enrolled in managed care plans and traditional indemnity insurance is only predominant among Medicare enrollees. At the same time that managed care was growing in general, there was also substantial growth in the number of managed care companies specializing in behavioral health care and separating them out ("carved-out") from other medical care. While it is clear that these changes in managed care penetration and financing arrangements have affected physicians and the way they practice medicine, it is less clear whether there has been a differential effect across physician types. METHOD: Data are from the Community Tracking Study (CTS) physician survey, a national survey of active physicians in the United States fielded between August 1998 and November 1999. To be eligible, physicians had to have completed their medical training (which excludes residents, interns, or fellows), be practicing in the contiguous United States, and be providing direct patient care for at least 20h per week. The total number of completed interviews was 12,304, including 566 psychiatrists, 7,217 primary care physicians, and 4,521 other medical or surgical specialists. Consistent with the previous literature, our analysis is primarily descriptive presenting weighted means and odds ratios from multivariate models. RESULTS: Psychiatrists are significantly less likely than primary care physicians or other specialists to agree with the statements that clinical decisions in the interest of their patients do not reduce income. Further, in comparison to primary care physicians, psychiatrists are less likely to agree that it is possible to maintain continuing relationships with patients over time that promote the delivery of high quality care and that they have the freedom to make clinical decisions that meet their patients' needs. In contrast to the perceived impacts on practice, psychiatrists tend to work in practices with a lower dependence on managed care than either other specialists or primary care physicians. Regarding individual physician compensation among non-owners, psychiatrists are less likely than other physicians to have their income adjusted based on individual productivity. CONCLUSIONS: Psychiatrists are more concerned that managed care has a negative impact on patient-provider relationships than other physicians; however, based on the available measures of financing and organization, psychiatrists are less dependent on managed care. This may suggest that other aspects of managed care, such as pre-authorization and gatekeeping, that disproportionately affect specialists are driving psychiatrists' perceptions of the patient-provider relationship.

Adult↗
PubMedDate not supplied

Organizational development and privatization: a Bolivian success story.

This article presents a case study of a US Agency for International Development-sponsored privatization effort in Bolivia. This privatization effort differs from AID's more common approach in that rather than merely helping already existing organizations to expand, this project has created a new organization. More ambitious and encompassing, this approach is also preferable because it directly addresses one of the most serious bottlenecks to economic development, viz., organizational development. The article describes the evolution of PROSALUD, a private, non-profit network of 17 community-sponsored health centers. The article describes factors and characteristics which have either conditioned or have directly contributed to PROSALUD's success. First, PROSALUD's health care environment is analysed, starting with a broad brush profile of select characteristics and trends which exist throughout the health sector of Bolivia, then narrows the focus to the local health sector. The structure and operations of PROSALUD are then analysed, focusing on the organization's managerial practices and financing and the series of tradeoffs it has been forced to strike: in its pricing strategy, between striving for financial viability and maintaining access to care; between, on the one hand, responding to community needs and demands and improving coverage by opening more facilities, and, on the other hand, focusing managerial efforts and outreach on a more limited number of clinics and neighborhoods; between providing a socially desirable mix of services--in particular, continuing to provide a great deal of free preventive care--and focusing care on more lucrative curative services; between maintaining commitments to neighborhoods and communities and eliminating the less economically viable (especially rural) clinics.

Bolivia↗
PubMed2006

Individual pay-for-performance in Canadian healthcare organizations.

Pink et al. discuss some of the issues related to pay-for-performance for individual and organizational healthcare providers. This commentary addresses key success factors for the implementation of individual pay-for-performance in publicly financed Canadian healthcare organizations. Publicly financed healthcare organizations in Canada have been relatively slow to adopt performance-pay programs as compared with private sector organizations; and those that have been developed have been, for the most part, rather crude. In many cases, they have become an additional mechanism for delivering base pay, rather than a true variable-pay program that motivates and differentiates performance. In light of the many issues that need to be addressed, we feel that pay-for-performance should be introduced gradually, beginning at the most senior levels of the organization. Above all, it is critical for publicly financed healthcare organizations to recognize that introducing pay-for-performance involves not only a set of structures and processes, but also likely a profound change in organizational values and behaviours.

Canada↗
PubMed2003

Market competition: everybody is talking, but what do they say?. A sociological analysis of market competition in policy networks.

From providers and insurers to governments and consumers, it appears that everybody is talking about market competition in health care. However, what do they actually mean? Are they talking about the same things? These questions are relevant for health systems consisting of policy networks, such as in the Netherlands. In policy networks, different actors (besides the government) are engaged in policy-making. Based on their particular frame ('mode of interpretation'), actors proceed and, from this, give meaning to the concept of market competition. Since there are differences in frames (of reference) among the various actors, it is important to understand what market competition means from the perspective of each network participant. This study, with regard to the Dutch health care system, demonstrates 'market competition' as a broad concept, relating to 13 different frames. Only four frames (i.e. cost control, deregulation, competition and increased power) are shared by a maximum of two (out of a total of four) network participants. Clearly, there are differences in the meanings and underlying frames about market competition amongst the key players. The resulting implications and options for policy-making are discussed.

Consumer Organizations↗
PubMed2004

New York City group leads the way toward a more optimistic future for ASOs. ASO went from near bankruptcy to $26 million.

A do-it-yourself AIDS social organization: AIDS service organizations are struggling because of tighter reins on government funding, but an alternative organization in New York City is showing how it can be done. It has developed a successful social entrepreneur program that employs HIV-infected clients, pays them living wages, and makes money from retail, food services, and medical care business entities, contributing three-quarters of the organization's revenues.

Bankruptcy↗
PubMed1990

Barriers to the care of persons with dual diagnoses: organizational and financing issues.

Among the frustrations of managing the dual disorders of chronic mental illness and alcohol and drug abuse is the fact that knowing what to do (by way of special programming) is insufficient to address the problem. The system problems are at least as intractable as the chronic illnesses themselves. Organizing and financing care of patients with comorbities is complicated. At issue are the ways in which we administer mental health and alcohol and drug treatment as well as finance that care. Separate administrative divisions and funding pools, while appropriate for political expediency, visibility, and administrative efficiency, have compounded the problems inherent in serving persons with multiple disabilities. Arbitrary service divisions and categorical boundaries at the State level prevent local governments and programs from organizing joint projects or creatively managing patients across service boundaries. When patients cannot adapt to the way services are organized, we risk reinforcing their overutilization of inpatient and emergency services, which are ineffective mechanisms for delivering the care these patients need. This article reviews the barriers in organization and financing of care (categoric and third party financing, including the special problem of diagnosis-related groups limitations) and proposes strategies to enhance the delivery of appropriate treatment.

Alcoholism↗