Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Remuneration”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1993

[Cost-benefit analysis of education programs and of treatment in type 2 diabetes].

Structured teaching and treatment programmes for Type-II non insulin dependent diabetic patients have been proved in several studies to be cost effective. K. Davidson in Atlanta described the considerable decrease of health care costs after the introduction of his programme. Recently a similar programme was introduced into the German health care system and physicians in private practice are remunerated for providing the programme. Until now more than 10,000 physicians have participated in postgraduate courses, which are the prerequisite to be remunerated. The evaluation of the programme including a cost benefit analysis demonstrated the financial benefits of the programme even in a short time. The methods of nation-wide multiplication of the programme and its contents are summarised in this article. The principles of the treatment strategy follows the objectives which have been published already in 1875 by A. Bouchardat: Urine testing, hypocaloric diet and exercise.

Body Weight↗
PubMed1996

Interest in different types of patients. What factors influence new-to-practice family physicians?

OBJECTIVE: To identify factors that influence new-to-practice family physicians to be particularly interested in certain types of patients. DESIGN: Qualitative study and cross-sectional survey. SETTING: Ontario family practices. PARTICIPANTS: Seven focus groups involved a volunteer sample of 34 physicians who completed family medicine residency training between 1984 and 1989. A convenience sample of 43 physicians who had completed their residencies between 1990 and 1992 were interviewed. All certificates of the College of Family Physicians of Canada currently practising in Ontario who received certification between 1989 and 1991 were surveyed. MAIN OUTCOME MEASURES: Physician interest as determined by scores on two scales: one labeled "Chronic/Older Patient," designed to assess special interest in geriatric patients, chronic pain patients, palliative care patients, and chronically ill patients, and one labeled "Young Patient," designed to assess special interest in young families and adolescents. RESULTS: In general, new-to-practice physicians had little interest in caring for older or chronic patients; older physicians and male physicians had greater interest in caring for chronic or older patients. Women physicians, physicians rating higher on the "empathy" and "interest in counseling" scale, and physicians receiving primarily fee-for-service remuneration showed greater interest in caring for young families and adolescents than other physicians. CONCLUSIONS: Physicians' age, sex, attitudes to patient care, method of remuneration, undergraduate and postgraduate schools of medical training, and the age and sex composition of their practices all influenced their interest in caring for different types of patients.

Adult↗
PubMed1996

[Collection and utilization of plasma in Austria: on the way to national self-sufficiency].

Self-sufficiency for plasma and plasma products on the basis of voluntary non-remunerated donation is more than guaranteed in Austria. Historically commercial enterprises are co-operating with the non profit sector of the Austrian Red Cross in an ideal way since more than 30 years. Austria needs about 16 millions IE of factor VIII yearly to treat the haemophilia patients as it should be. About 100,000 1 source plasma (FFP) coming from the industry and some 50,000 1 of frozen plasma per year being given for fractionation by the Red Cross Blood Transfusion Services seem to be sufficient for preparing the amount of factor VIII needed. Austria feels furthermore responsible to also fulfill its part as a member of the European Community in order to reach the common European goal of self-sufficiency in due time. As for the term "non remunerated' it is our strong concern that to compensate the plasma donor's time- and work-spending by reinbursement does not mean any sort of "payment'. We agree herewith with the opinion of the "Arbeitskreis Blut' in Germany. To change the successful way of having enough raw material to treat all our haemophilia patients with the necessary amounts of factor VIII by abruptly and artificially pressing for unpaid plasma donations would be a bad decision. By certainly not getting enough plasma by using such an unusual way this idea would not be successful. Austrian Red Cross does not intend to create own plasmapheresis-centres.

Austria↗
PubMed1996

[Cost effectiveness and evaluation of a structured therapy and education program for insulin-treated type II diabetic patients in Bradenburg].

The aim of the study was to evaluate the practicability and efficacy of a structured treatment and teaching programme (STTP) for Type II diabetic outpatients on conventional insulin treatment after introducing a remuneration for physicians. Reimbursement policy was introduced in the state of Brandenburg, Germany, in July 1993. Between August 1993 and February 1994, 108 practices in Brandenburg participated in a postgraduate seminar, which is a prerequisite for remuneration. Within the first year 10% of the target group of physicians participated in the seminars. A standardised interview was performed with 103 physicians. Twenty of the practices who had performed STTP were visited in order to collect data on all the patients who had participated in the programme. The seminar and the programme were well accepted. An improvement of HbA1c levels was observed in patients (n = 54) who had started insulin treatment (9.7 +/- 1.6% of total Hb before, 8.2 +/- 1.3% of total Hb after the programme) and in those (n = 189) who were already being treated with insulin before the STTP (9.6 +/- 2.5% of total Hb before, 8.1 +/- 1.4% of total Hb after the programme). The results of the study demonstrate the efficacy and practicability of an STTP for Type II diabetic patients on conventional insulin therapy in ambulatory health care.

Aged↗
PubMed1998

Serological monitoring of thalassaemia major patients for transfusion associated viral infections.

A total of 39 patients with thalassaemia major who received multiple blood transfusions were followed up clinically and serologically for 3 successive years (1993, 1994, 1995). They were screened for hepatitis B surface antigen (HBsAg), and antibodies to hepatitis B core (HBc-total), hepatitis C virus (HCV), human immunodeficiency virus I and II (HIV-I/II) and cytomegalovirus (CMV-total). In spite of transfusing HBsAg screened (by third generation ELISA) blood from voluntary non-remunerated donors, there was a significant increase of HBsAg positivity (P < 0.001) from 17.9 per cent (1993) to 35.9 per cent (1994) to 69.2 per cent (1995). This was probably due to the prevalence of undetectable HBV infection in the population. Anti HBc was present in 17 (43.6%), 14 (35.9%) and 16 (41%) patients in consecutive years. An increase in the units of blood transfused was observed every year. Blood units were not screened for anti HCV antibodies but a gradual increase in positivity [9 (23%), 12 (30.7%) and 14 (35.9%) patients] was seen in consecutive years. Anti-HIV antibodies were found in a 16 yr old male who was included in the study without any clinical evidence of AIDS. Anti CMV antibody was found in 30 (76.9%), 32 (82%) and 29 (74.3%) patients without any apparent clinical infection. Some patients showed change of antibody pattern (from negative to positive or vice versa) and a few patients showed inconsistent results probably due to immune modulation. Recruitment of 'repeat' non-remunerated voluntary blood donors may reduce the risk of high HBV transmission.

Adolescent↗
PubMedDate not supplied

Community preceptors' views of a required third-year family medicine clerkship.

BACKGROUND: Previous studies documented the importance of family medicine clerkships to medical student education and to the potential costs of precepting students borne by community physicians. But what are the physicians' views of their experience, their perceived needs for teaching, and sources of satisfaction from the preceptor role? OBJECTIVES: To explore preceptors' views of a required, third-year family medicine clerkship, focusing on satisfaction with the teaching experience, effect of having students in the practice, and concerns about continuing as a preceptor. METHODS: Preceptors from 38 private practices were asked to participate in a 15-minute telephone survey, using a semistructured interview format. RESULTS: Thirty-five physicians (92%) agreed to participate and 33 of the 35 primary preceptors were interviewed. Of those interviewed, 29 (88%) indicated a positive teaching experience, and 31 (94%) desired to continue precepting. Intangible rewards (eg, love of teaching or "giving back" to the specialty of family medicine) far out-weighed tangible rewards (eg, dinners or letters of appreciation) with regard to their desire to precept. Continued satisfaction with precepting seemed to be affected by loss of revenue to the practice, longer work hours, ability to effectively manage time and patient load, and need for additional educational resources and equipment. CONCLUSIONS: Intrinsic rewards seem to be a key factor in the physicians' decision to precept. Moreover, to reinforce the preceptor's continued desire to precept, faculty development, provision of educational tools and resources, and remuneration may be necessary. Preceptors should be asked routinely about their needs, and special programs of support should be offered.

Clinical Clerkship↗
PubMed1994

Noradrenergic dysregulation during discontinuation of cocaine use in addicts.

BACKGROUND: The primary objective of the study was to prospectively determine possible noradrenergic dysregulation in cocaine addicts by assessing biochemical, behavioral, and cardiovascular responses to intravenous yohimbine hydrochloride during early and late discontinuation of cocaine use. METHODS: Twelve male and two female hospitalized cocaine-dependent subjects (mean +/- SD age, 30.9 +/- 7.3 years) who were not seeking primary treatment for addiction participated voluntarily for monetary remuneration. Following an initial test dose of intranasal cocaine, 2 mg/kg, cocaine addicts received single-blind, monitored cocaine insufflation, 2 mg/kg three times each day, for 3 consecutive days. One to two days (early discontinuation) and 15 to 16 days (late discontinuation) after the last dose of cocaine, subjects received double-blind, randomized intravenous infusions of yohimbine hydrochloride, 0.4 mg/kg, or placebo. Plasma 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) and plasma cortisol levels, anxiety-related symptoms on clinician- and subject-rated scales, blood pressure, and heart rate were measured throughout each test day. Ten of 14 subjects completed the entire study. RESULTS: Subjects had a significantly greater placebo-corrected MHPG response to yohimbine during early compared with late discontinuation. Subjects rated themselves significantly more nervous following yohimbine administration during early compared with late discontinuation. Seventy-one percent of subjects experienced a yohimbine-induced panic attack during early discontinuation compared with none during late discontinuation. CONCLUSIONS: The results of this study provide evidence of an underlying dysregulation in noradrenergic function and a vulnerability to panic anxiety during early discontinuation of cocaine use in addicts. Additional investigations of noradrenergic function appear warranted to further clarify derangements associated with cocaine addiction.

Administration, Intranasal↗
PubMed2002

Legal issues in scientific research.

In recent years, regulatory and law enforcement authorities responsible for combating fraud and abuse have focused greater attention on the scientific research process, in particular, the process of seeking reimbursement for research costs, the process of performing clinical research, and the potential improper remuneration of researchers or research subjects. This article describes how the federal False Claims Act, which allows the government to recover treble damages plus substantial penalties from persons who knowingly submit false claims or make false statements to the government, has been used to achieve a number of multimillion-dollar settlements with research institutions. The article also discusses instances of temporary suspension of research activities at a number of prominent institutions and the investigation of illegal "inducements" or "kickbacks" provided by manufacturers to researchers and by research institutions to patients.

Biomedical Research↗
PubMedDate not supplied

An incentive approach to physician implementation of medical practice guidelines.

We propose a probabilistically based incentive payment system for guideline implementation that provides rewards for physicians who follow practice guidelines and additional remuneration for physician leaders who engage in information sharing. All payments are based on observed outcomes of patient treatment. A fixed base payment forms the core of the system with probabilistic offsets calculated from the chance that a 'good' outcome occurs without optimal treatment or information. The system pays different physician types for different task sets.

Cost Control↗
PubMedDate not supplied

Swedish models of health care reform: a review and assessment.

Resource constraints and the necessity to improve efficiency and effectiveness have provided challenges for the Swedish health care system during the 1990s. Whereas there are no comprehensive reforms of funding and organization, measures have been taken at both national and regional level to meet these challenges. Decentralization has been a core issue in long-term reforms and current changes can be seen as continuing this pattern. As a consequence different solutions are sought in the various county councils (locally elected self-government bodies financing and procuring health services). In about one third of these county councils some sort of purchaser-provider models have been introduced. Emerging evaluation reports claim that the models have succeeded in improving efficiency; making the system more patient-oriented; and enhancing cost-consciousness. The roles of politicians, managers and professionals are also more clear, according to the proponents. However, there are also problems with more difficulties in controlling costs, and with inadequate remuneration systems. Over time the purchaser-provider schemes have matured, developing from emphasizing short-term tendering, negotiations and detailed contracts to more comprehensive agreements based on mutual commitments to improve health services. Rhetoric has changed; competition has been replaced by co-operation. The lure of the market concept has diminished. Similarities can be seen between county councils with and without purchaser-provider models.

Ambulatory Care↗
PubMed2003

Care home versus hospital and own home environments for rehabilitation of older people.

BACKGROUND: Rehabilitation for older people has acquired an increasingly important profile for both policy-makers and service providers within health and social care agencies. This growing demand for rehabilitation services has generated an increased interest in the use of alternative care environments, for example care home environments, for older persons' rehabilitation. At a time when there is pressure for policy decision-makers and service providers to explore the use of such care settings for the provision of rehabilitation for older people, there appears limited evidence on which to base decisions. OBJECTIVES: The objective of this review is to compare the effects of care home environments (e.g. nursing home, residential care home and nursing facilities) versus hospital environments and own home environments in the rehabilitation of older people. SEARCH STRATEGY: The following databases were searched. The Cochrane Effective Practice and Organisation of Care Specialised Register, the Cochrane Rehabilitation Specialist Register; Cochrane Controlled Trials Register (CCTR); MEDLINE (1966-2000); EMBASE (1980-2000), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982-2000): Science Citation Index (1982-2000); Social Science Citation Index (1982-2000); Best Evidence (1991-2000); HMIC (1979-2000); PsycINFO(1967-2000); ASSIA (1987-2000); Ageline (1978-2000); AgeInfo (1971-2000); Sociological Abstracts (1963-2000); System for Information on Grey Literature (SIGLE) (1980-2000); UK National Research Registers Project Database( Issue 1 2001); Architecture Publication Index (1977-2000). The following Journals were hand searched: Disability and Rehabilitation (1992-2000); Disability and Society (1986-2000); Archives of Physical Medicine and Rehabilitation (1985-2000); Journal of the American Geriatric Society (1980-2000); International Journal of Rehabilitation Research (1980-2000); American Journal of Physical Medicine and Rehabilitation (1980-2000) and: Clinical Rehabilitation (1992-2000). The reviewers also consulted subject area experts and obtained full text review articles and forward tracked any references from these sources. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) that compared rehabilitation outcomes for persons 60 years or older who received rehabilitation whilst residing in a care home with those for persons 60 years or older who received rehabilitation in hospital or own home environments. Primary outcomes included functional outcomes using activities of daily living measurement (both personal and instrumental). Secondary outcomes included subjective health status; quality of life measures; return to place of usual residency; all cause mortality; adverse effects; readmission to an acute care facility; patient and carer satisfaction; number of days in facility and number of days receiving rehabilitation. DATA COLLECTION AND ANALYSIS: One reviewer (DW) completed the initial search and identified potential papers for inclusion. Abstracts for these papers were independently scrutinised by two reviewers (DW/MS) to assess their eligibility. Full text versions of potentially eligible papers were independently assessed by two reviewers (DW/MS). Papers that fulfilled the comparison inclusion criteria were then independently scrutinised by all reviewers to assess whether they met EPOC methodological criteria for inclusion. MAIN RESULTS: The total yield from the initial search strategy was 19,457. A total of 1,247 abstracts were independently scrutinised by two reviewers (DW/MS) to assess their eligibility. Full text papers for 99 studies were obtained to assess if they fulfilled the review's comparison inclusion criteria. This process resulted in 12 papers being assessed further for methodological validity. However, none of these studies met the inclusion criteria. REVIEWER'S CONCLUSIONS: There is insufficient evidence to compare the effects of care home environments, hospital environments and own home environments on older persons rehabilitation outcomes. Although the authors acknowledge that absence of effect is not no effect. There are three main reasons; the first is that the description and specification of the environment is often not clear; secondly, the components of the rehabilitation system within the given environments are not adequately specified and; thirdly, when the components are clearly specified they demonstrate that the control and intervention sites are not comparable with respect to the methodological criteria specified by Cochrane EPOC group (Cochrane 1998). The combined effect of these factors resulted in the comparability between intervention and control groups being very weak. For example, there were differences in the services provided in the intervention and control arms, due possibly to differences in dominant remuneration systems, nature of the rehabilitation transformation, patient characteristics, skill mix and academic status of the care environment.

Aged↗
PubMed1990

1983 occupational injury hospital admissions in Iowa: a comparison of the agricultural and non-agricultural sectors.

An occupational injury surveillance project was conducted in 15 of Iowa's 99 counties. Trained abstractors reviewed the medical records of persons admitted for trauma to hospitals during 1983. Based on these chart reviews, subsequent mail-out questionnaires and phone contacts were made, and rate estimates for occupational injury hospitalization for farmers and non-farmers were generated. The 1980 U.S. census data for occupation and market area data for the sample hospitals were used for the rate calculations. Approximately 14.7% of hospitalizations for trauma in the sample area were for work-related injuries. Farmers were hospitalized for occupational injuries at a rate of 1,521/100,000 compared to non-farmers at a rate of 497/100,000. There were no significant differences in the mean number of days per hospitalization for farmers versus non-farmers, (7.4 days for farmers and 6.7 days for non-farmers). Based on the questionnaire data, farmers were much less likely to receive any form of remuneration for injury, (odds ratio = 0.26, p less than 5 x 10(-6]. Farmers also reported less time off from work, with a mean of 79 days compared to non-farmers with a mean of 289 days.

Accidents, Occupational↗
PubMed1985

Training of health workers for developing countries.

The training of health workers for developing countries should include emphasis on preventive as well as curative medicine. It should also include the inculcation of concern for the feelings and needs of patients including their own beliefs and practices relating to disease, time constraints in coming either alone or with young children for clinic visits and the limited funds available to them for purchase of medicine. They must also be given the chance to work in a well organized system and must be adequately remunerated.

Cultural Characteristics↗
PubMed2007

Public versus private health care in a national health service.

This paper studies the interaction between public and private health care provision in a National Health Service (NHS), with free public care and costly private care. The health authority decides whether or not to allow private provision and sets the public sector remuneration. The physicians allocate their time (effort) in the public and (if allowed) in the private sector based on the public wage income and the private sector profits. We show that allowing physician dual practice 'crowds out' public provision, and results in lower overall health care provision. While the health authority can mitigate this effect by offering a higher wage, we find that a ban on dual practice is more efficient if private sector competition is weak and public and private care are sufficiently close substitutes. On the other hand, if private sector competition is sufficiently tough, a mixed system, with physician dual practice, is always preferable to a pure NHS system.

Health Care Rationing↗
PubMed1993

Financial incentives for physicians: the Quebec experience.

This paper presents an empirical investigation of physician labour supply, based on a two-stage budgeting model, drawing on an analogy with consumer theory. Physicians' trade-offs between income and leisure constitute the first stage of the decision-making process. In turn, choices are made in the second stage concerning the choice of particular activities (hospital versus office care, for example) or procedures (ordinary versus complete medical examinations), given the total medical care activity chosen in the first stage. The objective of the study is to identify physicians' responses to exogenous shocks in the remuneration system. The focus of analysis is shifted away from the identification of Supply-Induced Demand (SID) to a more pragmatic analysis of some of the determinants of physicians' choices. The study uses monthly activity data on a panel of 677 Québec GPs between 1977 and 1983. Quantity adjustments and drifts to more complex (and therefore better paid) procedures are evidenced, mainly in response to a fifteen month tariff-freeze. Physicians' ability to control their own work loads is also documented, both in terms of timing and level of complexity, and expenditure caps (in the form of an individual ceiling on GPs' quarterly gross income) are found to be effective at curbing high activity rates.

Budgets↗
PubMed2001

Effects of cost sharing on physician utilization under favourable conditions for supplier-induced demand.

The effects of cost sharing on the demand for ambulatory care in experimental circumstances are well understood since the Rand Health Insurance Experiment (HIE). However, in a non-experimental real-world context, supplier-induced demand of doctors might erode some of the significant negative out-of-pocket price elasticity identified in the HIE. Belgium is an interesting test case for this hypothesis because it has relatively high rates of patient cost sharing in its public health insurance system and a very high density of physicians, all remunerated fee-for-service. We have exploited the price variation generated by a substantial increase in patient co-payment rates in 1994 to estimate out-of-pocket price elasticities for three groups of users, and for three types of services using a fixed-effects model in levels and in differences. We obtain significant out-of-pocket price elasticities for the general population in the range from -0.39 to -0.28 for GP home visits, -0.16 to -0.12 for GP office visits and -0.10 for specialist visits. The estimates were generally lower and less significant for the groups of elderly and disabled. The differences we find in price responsiveness appear to be fairly robust and consistent with the HIE predictions. These results suggest that--at least in the short run--non-experimental utilization effects of cost sharing are very similar to the experimental evidence, even in a situation of favourable conditions for supplier-induced demand.

Ambulatory Care↗
PubMed2003

The changing public/private mix in dentistry in the UK--a supply-side perspective.

This paper examines the factors beyond NHS dentists' remuneration which may explain the variations in the public/private mix in general dental practitioners' workload in the UK. Given that NHS dentistry is subject to a fixed price system, the study focused mainly on non-income supply-side factors. Using data from a postal survey of a national random sample of dentists practising in the NHS in England in 1997, the study found that the strategies adopted by dentists in the management of NHS lists and the evidence that dentists spent significantly more time in private consultations compared with NHS consultations support concerns over equity of access to dental care and the quality of NHS dentistry. Dentists' attitudes to NHS and private dentistry revealed considerable ambiguity towards the NHS. While, on the one hand, the lack of sufficient demand for private dentistry emerged as a strong reason for remaining in the NHS, on the other, there was evidence that equity in access to dental treatment is still seen as an important principle. The implications of these findings in the context of recent discussion of the future of NHS dentistry are considered.

Adult↗
PubMedDate not supplied

Crossing the public-private sector divide with reproductive health in Cambodia: out-patient services in a local NGO and the national MCH clinic.

Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.

Adult↗