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PubMed2000

Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

OBJECTIVE: To develop a managed care curriculum for primary care residents. DESIGN: This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. RESULTS: The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. CONCLUSION: Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care.

Curriculum↗
PubMed2006

Access to care - what can the United States learn from other countries?

This paper briefly describes the US system for dental care services; asserts that there is much to be learned by considering the experience of other countries; identifies a few lessons that may be learned from comparisons with England, Australia, and other nations; and encourages the monitoring of outcomes associated with innovations in financing and delivery of services elsewhere. Oral health is affected by more factors than access to dental care. Because so many factors at the individual, environmental, and delivery system levels affect oral health, interpreting the findings from international studies is difficult. Furthermore, the findings of these international studies are confounded by significant intra-country variation in outcomes and expectations. While public funding and the public provision of services (such as programs in schools or community health centers) can be powerful instruments of change, they have their limitations. Examination of all types of public subsidization of dental care may reveal inadvertent distributions that may increase disparities. The discovery of best practices and lessons learned in the financing and organization of dental care may begin by comparing US experiences with those of other countries.

Community Dentistry↗
PubMed1998

Child health care in changing times.

Unprecedented transformations in the financing and organization of child health care are driving change in the practice of pediatrics at a remarkably fast pace. The health care needs of children also are evolving, reflecting changing disease patterns, new technologies, and shifting socioeconomic and demographic characteristics of children and families. Changes in the financing and organization of child health services catalyzed by managed care and legislative initiatives need to be responded to proactively by the pediatric community. Yet, the anticipated health care needs of children also must be addressed as models for both pediatric training and practice in the future are developed. This article summarizes briefly these changes in health care services and in child health needs, addresses training implications, and discusses several initiatives the pediatric community is undertaking to develop guidelines for training pediatricians for the 21st century.

Adolescent↗
PubMed1994

Physicians in health care management: 5. Payment of physicians and organization of medical services.

The financing, payment and organization of medical services are closely related. Canada's health care system is financed publicly, from tax revenue, and administered in each province by a single government payer. Although the chief method of payment to physicians is fee for service (FFS), the need to control costs and organize practice more efficiently has led to increased interest in FFS variants, such as capping payments at a certain level or fixing a budget, and alternative payment methods such as capitation-based payment, salary and combinations of these methods. Although solo practice is reportedly still the chief method of practice organization, it is being steadily replaced by arrangements in which physicians share expenses or calls, and by formal partnerships and group and team practices. As medical practice in Canada continues to shift from solo to group and team practice alternative payment methods that facilitate these models will become more common.

Canada↗
PubMed1998

Cash streams: five powerful income streams to increase your net income.

You can dramatically increase your profits by: Cash stream #1--extending credit and earning interest on the unpaid balance; Cash stream #2--doing all of the undone treatment in your practice; Cash stream #3--providing financing for everyone who deserves it; Cash stream #4--treating bigger cases; Cash stream #5--avoid treating deadbeats. There isn't anything I know of, which will jump start your practice as much as these five cash streams--more new patients, better case acceptance as well as increased cash flow. But you must get good at financing. You must have in place an organized, proven, financing system--just like the finance companies do.

Patient Acceptance of Health Care↗
PubMedDate not supplied

Cashstreams: five powerful income streams to increase your net income.

You can dramatically increase your profits by: extending credit and earning interest on the unpaid balance; doing all of the undone treatment in your practice; providing financing for everyone who deserves it; treating bigger cases; and avoid treating deadbeats. These five cash stream strategies will revitalize your practice with more new patients, better case acceptance, and increased cash flow. But bottom line, you must get good at financing. You must have in place an organized, proven, financing system--just like the finance companies do.

Humans↗
PubMed1996

Preventing academic medical center from becoming an oxymoron.

Many academic medical institutions are facing serious threats to their survival today as changes in the organization and financing of health care delivery and reductions in federal support create damaging pressures. In order for Americans to continue to have the best health care in the world, academic medicine and its crucial contributions of medical education, training, and research must receive adequate support. The author maintains that it is up to the Association of American Medical Colleges and associated organizations to ensure that this message is heard and recognized and to seek an all-payer approach that would support the costs associated with medical education and training and would allow teaching hospitals to compete on a level playing field with non-teaching hospitals. Academic medical institutions must face painful transformations while maintaining their academic missions; the author discusses the nature of these transformations and missions, particularly research, and outlines useful strategies to maintain these missions, such as establishing a centralized approach to curriculum and having clinical and basic science faculty form alliances to address common research problems and secure more research funding. He concludes that many of the structural and other changes that academic medicine's institutions must make may result in true improvements and help maintain the validity of the term academic medical center in the future.

Academic Medical Centers↗
PubMed2002

Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture.

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.

Attitude to Health↗
PubMedDate not supplied

[Health financing in Lebanon. I. Organization of health care services, coverage system and contribution of the Ministry of Public Health].

This paper intends to analyze the health care system in Lebanon from the organizational and financial points of view. It allows for an understanding of the health services' market by tackling it from different angles: supply versus demand, private versus public sectors, curative versus preventive services, hospital versus ambulatory care. This study necessitated a review of all previous surveys made in this field, during the after-war period. It also needed the daily collection and follow-up of pertinent data with all private and public agencies and concerned ministries, over a one-year period. In addition, a critical analysis has been made to the survey Conditions de vie des ménages, en 1997, that was carried out by the Central Administration of Statistics, that came to complete the missing data concerning household expenditures on insurance and health services. Especially that this survey covered the same period (1997), subject of this study. The paper reveals that, although the private sector is the main provider of both hospital and ambulatory care, private hospitals are flourishing on public money, whereas outpatients care is mainly financed by the households. Evidence shows that the Lebanese health care system succeeded in resolving the problem of accessibility to primary, secondary and tertiary health care, responding thus to the value of equity. But, at the price of an ever escalating cost, threatening the sustainability of the system. This is what is attained in this paper, as it shows clearly that expenditures on health have reached an alarming level of the GDP share. Our purpose being providing solid arguments in favor of reforming the health system.

Budgets↗
PubMed1981

Professional standards review; Professional Standards Review Organization (PSRO)--Health Care Financing Administration. Interim final regulation with a comment period.

This interim final rule is required to conform current regulations to certain provisions of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). To conform with current statutory authority, this rule makes technical changes to Parts 431, 432, 433, 456, 462, 463, 466, 473, 478, and 480 of Chapter 42 of the Code of Federal REgulations. The Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) made several adjustments to the PSRO program. In conformance with that Act, this rule changes PSRO membership and advisory group requirements. The Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) has further modified the PSRO program. In conformance with that Act, this rule changes the agreement requirements between HCFA and each PSRO. Accordingly, such agreements may be for any period not to exceed 12 months (42 CFR 462.11(a)(2)), and the procedures for termination or non-renewal of the agreement are modified.

Professional Review Organizations↗
PubMed1994

Government intervention in cardiovascular disease--help or hindrance? The US viewpoint.

Health and medical care services are not yet subject to the laws of supply and demand or the impersonal effects of the economic market. However, finite resources mean that governments and other payers are forced to make trade-offs. The United States, which has relied most heavily on market forces for its medical system, is now moving towards greater government responsibility for organization and financing, if not delivery, of services. President Clinton has proposed a national program of unified organization, service delivery, and financing so as to improve access to the US health care system and control cost. The proposed plan will enfranchise upwards of 50 million people who currently have no, or limited, access to medical care. Therefore, the initial effects will be more care of all kinds being provided by physicians. Such increases of services will increase expenditure, at least over the short-term.

Delivery of Health Care↗
PubMed1996

Clinical revenues used to support the academic mission of medical schools, 1992-93.

This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U.S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. A total of 60 medical schools (48%) participated in the study. The results, projected for all 126 U.S. medical schools, indicate that faculty practice plans in 1992-93 provided an estimated $2.4 billion in support for medical school academic programs. (1992-93 was the latest year for which complete financial data were available.) This amount represents 28 cents of every faculty-practice-plan dollar collected that year. The primary way in which faculty practice plans support academic programs is by underwriting clinical faculty time spent in academic activities, but direct transfers of funds, from the practice plan to the school and departments, also play a major role. The major beneficiary of faculty-practice-plan support is research, defined broadly to include a range of scholarly activities, at an estimated level of $816 million for all U.S. schools. This is followed by undergraduate medical education, at $702 million, graduate medical education, at $594 million, and other, largely undifferentiated academic support at $244 million. In addition to faculty practice plan revenues, teaching by volunteer faculty contributed another $545 million in imputed-dollar support of academic programs, bringing the total level of support to nearly $3 billion. Volunteer faculty teaching was divided nearly evenly between undergraduate and graduate medical education. Hospitals may also provide clinical revenues in support of the academic mission by applying hospital funds to academic programs and by absorbing academic-program expenses that are not otherwise reimbursed. However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.

Education, Medical↗