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At least 739 records · Page 41Linked to original sources
PubMed2003

Models for future delivery of care in infertility: the role of the private sector.

An estimated 85% of infertility treatment at the tertiary level in the UK currently is funded by the infertile couples themselves. Of the 15% of couples who receive NHS funding for assisted reproductive technology (ART), a sizeable proportion is provided by private clinics. If the National Institute of Clinical Excellence (NICE) decides that the National Health Service (NHS) should provide funding for an increased number of treatments, then it is unlikely that wholly NHS ART clinics will be able to provide the extra number of cycles required. Those private clinics in the UK that bid to provide treatment funded by the NHS through primary care trusts (PCT) generally provide a cost-effective service in a 'patient friendly' environment. The case is made in this article that ART clinics in the private sector that wish to bid for PCT contracts, should be allowed to compete on an equal basis with NHS or NHS-private combined clinics. PCTs awarding contracts should be wholly driven by good evidence of clinical effectiveness, cost effectiveness and the provision of a quality service to patients.

Adult↗
PubMed2026

Probiotic supplementation improves body composition, lipid profiles, and fatty acid metabolism in combat sports athletes during the weight reduction phase.

PURPOSE: Pre-competition weight control for combat sports athletes may alter body composition and fatty acid metabolism. Probiotics have shown potential to regulate overall metabolism; however, their specific effects on fatty acid metabolism during weight control in athletes remain unclear. METHODS: Thirty-two combat sports athletes participating in the 4-week weight reduction period were assigned to either the probiotic group (Group E) or the placebo group (Group C). Body composition, lipid profiles, and fatty acid metabolism were measured before and after the 4-week weight reduction phase. RESULTS: All the athletes experienced a decrease in body weight, body mass index (BMI), body fat percentage, and muscle mass following the 4-week weight loss intervention. Notably, a more significant reduction in body fat percentage (p&#x2009;<&#x2009;0.05) was observed, along with lower levels of triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C), specifically in Group E. Weight loss intervention resulted in increased levels of short-chain fatty acids (SCFAs), specifically acetic acid, propionic acid, and butyric acid. Notably, Group E exhibited higher mean values for SCFAs compared to Group C (p&#x2009;<&#x2009;0.05). Additionally, the serum levels of &#x3b3;-linolenic acid and 8,11,14-eicosatrienoic acid were significantly reduced in Group E (p&#x2009;<&#x2009;0.05). In contrast, the majority of free fatty acids (FFAs) showed significant increases, with greater magnitudes of change observed in Group C (p&#x2009;<&#x2009;0.05). CONCLUSION: Probiotic supplementation can improve body composition, enhance SCFAs levels, and decrease circulating FFAs in combat sports athletes, suggesting that probiotics may have a beneficial impact on pre-competition weight management. TRIAL REGISTRATION NUMBER: chiCTR2400079908 (Reg Date:2024-01-16).

Humans↗
PubMed2006

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

BACKGROUND: There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. METHODS: In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. RESULTS: Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. CONCLUSION: The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

Cities↗
PubMed1997

Gender and equity in health sector reform programmes: a review.

This paper reviews current literature and debates about Health Sector Reform (HSR) in developing countries in the context of its possible implications for women's health and for gender equity. It points out that gender is a significant marker of social and economic vulnerability which is manifest in inequalities of access to health care and in women's and men's different positioning as users and producers of health care. Any analysis of equity must therefore include a consideration of gender issues. Two main approaches to thinking about gender issues in health care are distinguished--a 'women's health' approach, and a 'gender inequality' approach. The framework developed by Cassels (1995), highlighting six main components of HSR, is used to try to pinpoint the implications of HSR in relation to both of these approaches. This review makes no claim to sociological or geographical comprehensiveness. It attempts instead to provide an analysis of the gender and women's health issues most likely to be associated with each of the major elements of HSR and to outline an agenda for further research. It points out that there is a severe paucity of information on the actual impact of HSR from a gender point of view and in relation to substantive forms of vulnerability (e.g. particular categories of women, specific age groups). The use of generic categories, such as 'the poor' or 'very poor', leads to insufficient disaggregation of the impact of changes in the terms on which health care is provided. This suggests the need for more carefully focused data collection and empirical research.

Cost-Benefit Analysis↗
PubMed2001

Strengthening user participation through health sector reform in Colombia: a study of institutional change and social representation.

The challenge of achieving community participation as a component of health sector reform is especially great in low- and middle-income countries where there is limited experience of community participation in social policy making. This paper concentrates on the social representations of different actors at different levels of the health care system in Colombia that may hinder or enable effective implementation of the participatory policy. The study took place in Cali, Colombia and focused on two institutional mechanisms created by the state to channel citizen participation into the health sector, i.e. user associations and customer service offices. This is a case study with multiple sources of evidence using a combination of quantitative and qualitative social science methods. The analysis of respondents' representations revealed a range of practical concerns and considerable degree of scepticism among public and private sector institutions, consumer groups and individual citizens about user participation. Although participation in Colombia has been introduced on political, managerial and ethical grounds, this study has found that health care users do not yet have a meaningful seat around the table of decision-making bodies.

Attitude to Health↗
PubMed1998

Using health outcomes data to compare plans, networks and providers.

PURPOSE: To analyze the challenge of using health outcomes data to compare plans, networks and providers. ANALYSIS: Different questions require different designs for collecting and interpreting health outcomes data. When evaluating effectiveness of treatments, tests or other technologies, the question is what processes improve health outcomes? For this purpose, the strongest evidence comes from a double-blind randomized controlled trial. In program evaluations, the question is 'what is the impact of this policy and related programs on health outcomes?' For this purpose, we may be able to randomize subjects, but are more likely to have a quasi-experimental or an epidemiological design. When we compare plans, networks and providers for quality improvement purposes the question is 'do these specific plans perform differently from one another?', or, 'are these specific plans improving their performance over time?' We want to isolate for study the effects attributable to specific plans. Designs that yield strong evidence cannot be applied because we lack experimental control. CONCLUSIONS: When we already have strong evidence linking specific processes of care with specific outcomes, comparing process data may reveal more about performance of plans, networks and providers than comparing outcomes data. Comparisons of process data are easier to interpret and more sensitive to small differences than comparisons of outcomes data. Outcomes data are most useful for tracking care given by high volume providers over long periods of time, targeting areas for quality improvement and for detecting problems in implementation of processes of care.

Benchmarking↗
PubMed1998

The outcomes utility index: will outcomes data tell us what we want to know?

PURPOSE: To propose an approach to the evaluation of the utility of an outcome measure for use in making comparisons among health plans, hospitals, networks, or other accountable entities. METHOD: Seven components are recommended for evaluation: whether the outcome is a health outcome; the extent to which expectations for performance can be defined; the role medical care plays in achieving the outcome; the relative complexity of events that produce the outcome; the degree to which attribution can reasonably be made; the suitability of risk adjustment for limiting external sources of variation; and the likelihood that the measure provides perverse behavioral incentives. RESULTS: Illustrative examples are given in each area for scoring the performance of measures on the component. CONCLUSION: Outcomes measurement is of great interest to a variety of potential users. The approach proposed here is intended to provoke discussion and more rigorous development of tools that will help to identify the measures that are likely to produce the most useful information for making comparisons among accountable entities in the health system.

Benchmarking↗
PubMed1998

Accountability for health outcomes and the proper unit of analysis: what do the experts think?

BACKGROUND: An invitational conference was held in Dearborn, MI, in April of 1998 to discuss technical and conceptual issues related to the general topic of using outcomes data to compare plans, networks, and providers. Approximately 150 researchers, clinicians, purchasers, and representatives of accreditation bodies and government agencies attended. SURVEY OF PARTICIPANTS: At the opening session, attendees participated in an electronic survey exercise designed to identify areas of agreement or disagreement on controversial issues related to the main conference topic. MAIN FINDINGS: There was general agreement about the basic concept of health plan and provider accountability for health outcomes, and about the need for further development of data sources and case-mix adjustment models. There was disagreement about other issues, including questions of who should bear the cost of collecting outcomes data and whether results should be analyzed at health plan, network, or individual clinician level. CONCLUSION: A group of experts agreed on the importance of reporting comparative outcomes data, but disagreed on many of the technical details of how that could best be done.

Attitude of Health Personnel↗
PubMed2000

Volume growth and survival graphs: a method for evaluating process-based forest growth models.

We investigated the relationships within forest stands between tree size and (a) stem volume growth rate and (b) risk of mortality for individual trees. Values of both x and y variables were plotted relative to the largest value in the stand. We refer to the resultant presentations as relative volume growth and relative survival graphs (VGSs). A pair of VGSs can be produced readily from an individual-tree growth model. It can also be constructed from consecutive sets of field measurements. Comparison of VGSs derived from model and measurement data provides a test of the validity of the components of the growth model. We have analyzed VGSs based on measurement data for Scots pine (Pinus sylvestris L.) in central Finland and for beech (Fagus sylvatica L.) in southern Germany. The graphs based on measurement data varied as a consequence of differences in competition, stand management, and tree species. We analyzed the relationship between VGSs and stand dynamics using a simple growth model. We found that different features of the VGSs imply characteristic tree size distributions in subsequent years. Thus, we conclude that if the VGSs generated by a model do not correspond to those based on field measurements, the model cannot be relied on to reproduce the development of tree-size distribution correctly. Relative growth and survival graphs thus provide a tool for evaluating complicated growth models.

Journal Article↗
PubMed1996

News from the future: health care summit caps decade of transformation, 1996-2005.

Many in academic medicine agree that its future will be very different from its past. Transformation, not tinkering, is needed if academic health science centers are to survive the challenges posed by federal and state budget constraints, the intense price competition of managed care, and the wide dispersion of information via the Internet. Academic medicine is like an ocean liner, stately and slow to turn from its charted course. But those who captain the huge, slow ship have seen the tip of the iceberg that looms in its path, and must turn to a new course now. The author presents a possible scenario of the future that describes new relationships among academic health centers, new roles for deans and department chairs, and a more collaborative approach to learning. In the scenario, set in the year 2002, the writer looks back on the changes of the period 1996-2005 and describes the relationships, management, priorities, and reward systems of the institutions responsible for health care, medical education, and biomedical research.

Academic Medical Centers↗
PubMed2001

A time for change: for the road to excellence for health care professionals.

This article addresses the changes affecting all of health care. Change should first be driven by data--data are what will be used to make clinical and business decisions that will result in better quality care. Employees should be held accountable for results, and celebrations should be provided for these changes. Customers have needs and goals that must be met, and if we do not meet the needs, our competition will. Management must understand the principles of quality and must encourage growth in employees. To bring change to your health care organization, you must embrace and encourage change.

Decision Making, Organizational↗
PubMed2003

Managing costs, managing benefits: employer decisions in local health care markets.

OBJECTIVES: To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. DATA SOURCES/STUDY SETTING: Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. STUDY DESIGN: This is an observational study with data collection over a six-year period. DATA COLLECTION/EXTRACTION METHODS: The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. PRINCIPAL FINDINGS: The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. CONCLUSIONS: General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.

Cost Control↗