Attraction of MD-PhDs to dermatology.
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Capital Financing↗
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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.
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In search of evidence: is there the will and a way?
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Biomedical Research↗
The imperative for change in health care delivery. An ophthalmologist's viewpoint.
The increasing cost of American health care necessitates major adjustments in the systems for providing that care. Computerization has the potential for facilitating efficient, affordable, and high-quality care while maintaining a fee-for-service system. The development of model delivery systems for health care should receive research funding from private and government sources. For ophthalmology, a paradigm for technology-dependent specialties, mechanisms to streamline eye care are being explored via a nonprofit foundation.
Capital Financing↗
Do we understand the effects of 'managed care' in ophthalmology? A review and analysis.
Little has been published that directly assesses the effect of structures for providing managed care or the effects of capitated, prepaid financing on the cost and quality of eye care services. Managed care organizations use fewer ophthalmologists and may provide more screening for diabetic retinopathy. Studies of nonophthalmologic care show lower patient satisfaction with care, and mixed effects on cost, quality of care, and access to care, but are difficult to generalize to eye care. We reviewed the published peer-reviewed literature about this topic. Notable gaps exist in the knowledge of critical elements of the influence of managed care on providing eye care and on patient outcomes. Existing measures of quality, cost, satisfaction, and access could easily be adapted for use in evaluating the influence of managed care and guiding health care policy.
Cost Control↗
Research development in training programs.
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Capital Financing↗
An evaluation of surgery departments in community-based medical schools.
Since 1960, most newer medical schools have been community-based and have used existing community hospitals and a large number of volunteer faculty. As these schools have evolved, many have developed more traditional characteristics. To assess the positive and negative features of these new schools, chairs of departments of surgery from 21 community-based medical schools and 17 traditional schools were surveyed to acquire information on policies and practices related to faculty development, undergraduate and graduate education, hospital relationships, clinical activities, research, and relationships with community physicians. Responses were analyzed and compared. Most community-based schools have succeeded in their mission, partly at the expense of controls usually found in more traditional schools.
Attitude of Health Personnel↗
Sustainability of primary health care including expanded program of immunizations in Bamako Initiative programs in West Africa: an assessment of 5 years' field experience in Benin and Guinea.
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Benin↗
Commercialism in nonprofit hospitals.
The private nonprofit hospital is the dominant organizational form in the U.S. hospital industry. Various reasons have been advanced for its high market share. As hospitals undergo massive changes due in large part to changes in payment practices, there is widespread concern that nonprofit hospitals may become less committed to noncommercial activities. This may even be more likely when such hospitals convert to for-profit status. The empirical evidence indicates that, on average, hospitals of nonprofit and for-profit ownership are similar in the provision of uncompensated care, the quality of care, and the adoption of technology. Conversion of a nonprofit to for-profit status does not adversely affect the provision of uncompensated care on average. However, for-profits are more likely to be located in areas where consumers have the ability to pay for care. As hospital markets become more competitive and the opportunity for cross-subsidizing more unprofitable, collective-good activities will become increasingly difficult. Support for such activities, if they are to exist, will have to come from explicit public subsidies.
Capital Financing↗
The economics of food production.
Although world average food production per person is increasing there are many countries, particularly in sub-Saharan Africa, where production has fallen in recent decades. The economic analysis of the world food problem concerns the dynamics of production, income, growth, demand and trade. The 'law of diminishing returns' suggests that labour incomes fall as population density increases. Capital investment and technological change, particularly with a land-saving bias, can overcome this effect. Such land-saving innovations are less appropriate where population densities are lower, as in much of sub-Saharan Africa. Innovations which reduce risk, such as stress- and disease-resistant crop varieties, may be more attractive to farmers. Communal or government action is required to ensure sustainability of food production; to reduce risk, through price stabilization, possibly crop insurance and contingency plans for famine relief; to promote equity and to ensure competitive market conditions. Public funding of agricultural research is necessary to promote growth in food supplies. If increases in supply do not keep pace with growth in demand, food prices rise, attracting resources into food production. If supply grows faster, food prices and farm incomes fall, driving resources out of agriculture. Resources may not move fast enough to correct imbalances. Primary producers are likely to face deteriorating terms of trade. Linkages between food production and other sectors are weak, so primary exports are not a good basis for economic development. Import substitution strategies may damage agriculture. Structural adjustment regimes have been adopted in some countries to correct imbalances and provide an incentive for farmers to increase production. Associated reductions in public expenditure may have a contrary impact.
Agriculture↗
Economic comparison between conventional and disposables-based technology for the production of biopharmaceuticals.
Time to market, cost effectiveness, and flexibility are key issues in today's biopharmaceutical market. Bioprocessing plants based on fully disposable, presterilized, and prevalidated components appear as an attractive alternative to conventional stainless steel plants, potentially allowing for shorter implementation times, smaller initial investments, and increased flexibility. To evaluate the economic case of such an alternative it was necessary to develop an appropriate costing model which allows an economic comparison between conventional and disposables-based engineering to be made. The production of an antibody fragment from an E. coli fermentation was used to provide a case study for both routes. The conventional bioprocessing option was costed through available models, which were then modified to account for the intrinsic differences observed in a disposables-based option. The outcome of the analysis indicates that the capital investment required for a disposables-based option is substantially reduced at less than 60% of that for a conventional option. The disposables-based running costs were evaluated as being 70% higher than those of the conventional equivalent. Despite this higher value, the net present value (NPV) of the disposables-based plant is positive and within 25% of that for the conventional plant. Sensitivity analysis performed on key variables indicated the robustness of the economic analysis presented. In particular a 9-month reduction in time to market arising from the adoption of a disposables-based approach, results in a NPV which is identical to that of the conventional option. Finally, the effect of any possible loss in yield resulting from the use of disposables was also examined. This had only a limited impact on the NPV: for example, a 50% lower yield in the disposable chromatography step results in a 10% reduction of the disposable NPV. The results provide the necessary framework for the economic comparison of disposables and conventional bioprocessing technologies.
Antibodies, Bacterial↗
The demand for health: an empirical reformulation of the Grossman model.
Previous tests of Grossman's model of the demand for health have been based on Grossman's own empirical formulation. This paper argues that this formulation fails to capture the dynamic character of the model. It proposes an alternative formulation, which appears to be more consistent with Grossman's theoretical model and which may also explain the apparent rejections of the model by the data in the author's earlier empirical work. The paper also presents some empirical results obtained using the new formulation, which are, on the whole, consistent with the predictions of Grossman's theoretical model.
Capital Financing↗
Managed care physician organizations: next generation of healthcare reform.
This article focuses on the evolution of physician-sponsored organizations in the managed care continuum. Given the amount of influence that physicians have on the overall level of healthcare expenditures within the U.S. economy, physician commitment to the managed care process is critical to truly drive the next round of managed care initiatives. The capital markers have recognized this and have contributed significant amounts of capital to fuel the development of for-profit models called physician practice management companies.
Capital Financing↗
How well is debt managed by nonprofits?
Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.
Capital Financing↗
Structure and adequacy of human service facilities: challenges for nonprofit managers.
Findings from a statewide survey of nonprofit human service organizations in Illinois show great diversity in access to and use of facilities. Large proportions have facility-related problems that will require substantial investments beyond the financial capacity of the organizations themselves. The findings also point to major shortcomings in attention to or knowledge about facility-related problems among managers of these organizations. The findings have important policy implications for nonprofit managers, as well as for public and private funders and policy makers.
Capital Financing↗
Supporting older youth: what's policy got to do with it?
The nonschool hours are an underused tool in supporting older youth in their transition to adulthood. Given competing demands on many teens' time and a host of other developmental realities, effective strategies for engaging high schoolers look much different from those of their younger counterparts, and those differences have programmatic and policy implications. Effective youth policies reflect an overarching vision that is about changing lives--a vision that addresses a range of risk and protective factors, simultaneously supports discrete programs and builds coherent pathways to success, and recognizes that children and youth grow up in families and communities. This chapter highlights policy innovations related to teens' involvement in out-of-school-time activities and then looks at three principles that can help ensure that youth policy supports the full range of older youth's unique developmental, social, and economic needs.
Adolescent↗
Survival strategies for community mental health organizations: a conceptual framework.
Changing conditions call for each Community Mental Health Center (CMHC) to develop a survival strategy based on its own standards and values. The strategy must contain political, funding, programmatic, structural and role change components. A CMHC must orchestrate its strategy as part of an overall survival plan, but may be constrained by the degree of control it has over programs and resources. Major types of risks associated with entrepreneurial (viz., high control over programs and resources) and restricted models (viz., low control over programs and resources) are reviewed.
Capital Financing↗
Trends in Department of Defense hospital efficiency.
This study employs a simple cross sectional design using longitudinal data to explore the underlying factors associated with differences in hospital technical efficiency using data envelopment analysis (DEA) in the Department of Defense (DOD) sector across three service components, the Army, Air Force and Navy. The results suggest that the services do not differ significantly in hospital efficiency. Nor does hospital efficiency appear to differ over time. With respect to the efficient use of input resources, the services experienced a general decline in excessive usage of various inputs over the three years. Analysis of the returns to scale captures opportunities for planners of changing the relative mix of output to input slacks for increasing a hospital's efficiency. That is, policy makers would get more immediate "bang per buck" with emphasis on improving the efficiencies of hospitals with higher returns to scale than other hospitals. Findings also suggest a significant degree of comparability between the DEA measure and these measures often used to indicate efficiency.
Ambulatory Care↗
The development of property rights in biotechnology.
The translation of biological theory into engineering (biotechnology) has resulted in the development of novel products and processes. Some of these products are living organisms, usually containing unique genetic arrangements not found in nature. The extension of legal protection to products and processes was required in order for biotechnology to become an unexceptional way in which to do business. The American experience with biotechnology, repeated elsewhere, is demonstrated to have proceeded first through the negotiation of obstacles in administrative law and second through challenges to property law. This outcome for the regulatory management of biotechnology and the legal protection of its products may be interpreted as a function of a cultural bias for scientific authority and progress ideology.
Biotechnology↗