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Results for “Managed Competition”

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PubMed1993

Issues confronting medicine.

Our representatives in Washington are attempting to deceive the American public with a giant prevarication. The electorate is being told that more patients can obtain better health care at a lower cost. The practicing dermatologist is caught between opposing forces that are demanding improved care in the face of dwindling reimbursements. Concomitantly, the inexorable forces and constraints of escalating office overhead, tort liability, bureaucratic red tape, and managed competition hang like a sword of Damocles over the head of the practicing dermatologist. The independent practitioner stands alone as the only advocate for his patient; however, the physician's plea to maintain the sanctity and dignity of the doctor-patient relationship is being sacrificed on the altar of cost containment.

Cost Control↗
PubMed1996

A critical review of personnel standards.

Qualified personnel are necessary to ensure quality results, but there is no evidence on what minimal educational requirements are necessary. In the future, cost-effectiveness analysis may be useful for policy questions such as the utility of personnel regulations. CLIA '88 regulations require explicit assessment of personnel competency. Survey evidence suggests that previously regulated laboratories tend to have highly formalized competency assessment programs, while physician office laboratory programs are minimal. Responding laboratory supervisors had no uniform definition of competency, but technical abilities, productivity, and professionalism were regarded as essential. Suggestions for contemporary strategies by laboratory professionals and their organizations in the current increasingly competitive managed care environment are described. Faced with limited empirical evidence on personnel, laboratory directors and supervisors should focus on the total testing process, the needs of clinicians, and the uses of testing information to guide personnel assignments.

Cost-Benefit Analysis↗
PubMed1996

Effect of changes in the health care system on the career outlook of University of Washington, Seattle, medical students.

We describe how market-oriented and governmental reforms were shaping students' career choice and outlook toward future clinical practice during the 1993-1994 academic year. A random sample of a third of University of Washington, Seattle, medical students (n = 212) was surveyed regarding attitudes toward health care reform, specialty choice, and future clinical practice; 171 responded (81%). Most students (90%) thought that the health care system required fundamental change. An equal proportion favored managed competition and single-payer proposals (40% and 39%, respectively). Most (72%) were confident that they would be able to practice medicine in a professionally satisfying environment. More than half the students interested in specialty careers thought that they might not be able to practice in their chosen field, but only 21% of these were more likely to choose a career in primary care in light of anticipated reforms. Most students were optimistic about their future medical careers. Knowledge of market-oriented reforms exerted little influence on the career decisions of students interested in nonprimary care fields. Medical schools should play a more active role at the undergraduate level so that those students who apply to medical school have a better understanding of the changing nature of health care delivery in this country.

Career Choice↗
PubMed1996

Selling high quality and low cost: market conditions and successful quality improvement projects.

Many potentially useful health care improvement projects fail to achieve much improvement. Even a technically excellent project can fail because, under certain conditions, economic factors in the health care market do not support high quality and low cost. Most health care markets evolve from the traditional fee for service market through a consolidation phase into risk shared market. At each phase, payment mechanisms will support specific quality and productivity improvement projects and discourage others. For example, the implementation of critical paths/clinical protocols is not supported until the majority of payers pay a fixed cost per illness or covered life. Prior to that point, loss of income for the hospital and/or physicians will inhibit successful implementation. Maximum quality and productivity improvements outcomes can be achieved with minimum efforts when project leaders understand the maturity of their organization's market, and strategic needs. This paper will review the types of payment systems (fee for service, discounted fee for service, and risk shared payments) and identify the types of projects that maximize benefit to the stakeholders involved.

Cost-Benefit Analysis↗
PubMedDate not supplied

Delegation skills and nurse job satisfaction.

In this study, the mean age was 41 and these nurses had been out of school for approximately 13 years. Over half of these RNs had never been taught delegation skills in nursing school. Of those who were exposed to the concept of delegation, their skills were not adequate to meet the patient care demands in the restructured health care system. During these challenging periods in health care, it is imperative that nursing service administrators provide RNs with the continuing education necessary to develop delegation strategies to adapt to their evolving professional roles. Continuing education classes on delegation skills are requisite for RNs practicing in a competitive managed care environment. As we approach the year 2000, the economic climate will dictate that RNs be skilled not only as clinicians, but also as leaders of the health care team. The findings of this study support that delegation decision-making skills enhance job satisfaction in the areas of decision making and promotional opportunity. Delegation knowledge is crucial to the successful direction of the health care team in the managed care environment.

Adult↗
PubMed1998

[Evaluation of results after arthroscopic reconstruction of the anterior cruciate ligament with a free graft of the patellar ligament].

From among 312 patients treated with arthroscopic anterior cruciate ligament reconstruction (one-incision, transtibial with the use of ipsilateral bone-patellar tendon-bone autograft) between 1992 and 1994 256 (82%) were reviewed with a mean follow-up of 26.4 months. An aggressive rehabilitative protocol advocated by Shelbourne has been employed. Stability of the knee has been assessed with KT-1000 arthrometer and IKDC and OAK forms served to evaluate the results. In 77% of the cases nearly normal function of the knee has been restored (87% excellent and good results in OAK form). Arthroscopic technique and aggressive rehabilitation decreased the number of patients with peripatellar pain and improved patient's acceptance of the management. Competitive athletes seem to achieve best end-results.

Adolescent↗
PubMed1994

Managed cooperation, not competition: a proposal for implementing national health reform.

National health reform should be implemented in a policy framework that encourages cooperation--not competition--to promote efficiency while extending universal coverage. "Managed cooperation" is defined here as a national health system built on collaborative efforts between purchasers, providers, consumers, and government through voluntary collective action, like the structural cooperation seen in the Japanese economy between government and the private sector. Six partnerships are encouraged: (1) government-industry, (2) purchaser-provider, (3) physician-hospital, (4) public-private data sharing, (5) consumer-provider, and (6) community health. Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform.

Antitrust Laws↗
PubMed1999

Concussion in sport: diagnosis, management, return to competition.

Concussions can occur in any sports activity. Although no standards for grading and managing concussions exist, many sets of guidelines have been proposed. Therefore, physicians should be familiar with at least one set to assist in diagnosing and managing concussions.

Athletic Injuries↗
PubMedDate not supplied

"Power quality system," a new system of quality management for globalization: towards innovation and competitive advantages.

Knowledge Management (KM) addresses the critical issues of organizational adoption, survival and competence in the face of an increasingly changing environment. KM embodies organizational processes that seek a synergistic combination of the data and information processing capabilities of information and communication technologies (ICT), and the creative and innovative capacity of human beings to improve ICT In that role, knowledge management will improve quality management and avoid or minimize losses and weakness that usually come from poor performance as well as increase the competitive level of the company and its ability to survive in the global marketplace. To achieve quality, all parties including the clients, company consultants, contractors, entrepreneurs, suppliers, and the governing bodies (i.e., all involved stake-holders) need to collaborate and commit to achieving quality. The design based organizations in major business and construction companies have to be quality driven to support healthy growth in today's competitive market. In the march towards vision 2020 and globalization (i.e., the one world community) of many companies, their design based organizations need to have superior quality management and knowledge management to anticipate changes. The implementation of a quality system such as the ISO 9000 Standards, Total Quality Management, or Quality Function Deployment (QFD) focuses the company's resources towards achieving faster and better results in the global market with less cost. To anticipate the needs of the marketplace and clients as the world and technology change, a new system, which we call Power Quality System (PQS), has been designed. PQS is a combination of information and communication technologies (ICT) and the creative and innovative capacity of human beings to meet the challenges of the new world business and to develop high quality products.

Benchmarking↗
PubMed1998

Competition and quality among managed care plans in the USA. Boston University Health Care Management Program Group.

This paper examines the popular idea that competition among managed care plans will lead not only to lower prices, but also to improved quality. We explore the likelihood that competition based on quality will occur and that better quality care will result. First, we discuss key elements of competitive theory and then we attempt to apply them to markets for health care coverage and care. We identify the conditions necessary for competition to have the desired effects and assess the extent to which those conditions do or can exist. We conclude that in the USA, many consumers have no choice among plans and, therefore, cannot select one based on quality. Moreover, the evidence suggests that as long as price varies among health plans, consumers who do have a choice will tend to emphasize price, not quality, in making their selections. We conclude with suggestions to increase the likelihood that quality can improve as a result of competition.

Consumer Behavior↗
PubMed1990

Achieving competitive advantage through information management.

Healthcare organizations exist to deliver quality services at appropriate prices. The issue, of course, is how to define quality services and appropriate prices--or, in other words, how to compete. To ignore this question is to invite erosion of market share and deterioration of margins--the twin components of superior performance.

Catchment Area, Health↗
PubMed1987

Competition, capitation, and case management: barriers to strategic reform.

Political support for competition, capitation, and case management in health services has come from successive Congresses and presidents. Benefits attributed to these organizational/financing strategies are consistent with society's preference for a private market approach. Yet, the promise has not been pursued in effective public policy or program. The systemic barriers to implementation of alternative delivery systems are examined in the context of Medicaid; they are neither trivial nor intractable.

Capitation Fee↗
PubMed2002

Managing blisters in competitive athletes.

Friction blisters can have a negative effect on an individual's ability to perform his or her sport or duties. In a recent study, 69% of soldiers participating in a 20-km road march were found to have blisters, 10% of whom required medical intervention. Blistering of the feet is one of the most common injuries sustained by runners while training and racing. Although most blisters are minor and can be treated conservatively, others can lead to intense pain, cellulitis, and even sepsis. The best way to treat friction blisters is to prevent them; however, if they do occur, timely and effective treatment will help prevent the complications that can impede athletic performance.

Blister↗