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PubMed1999

A survey of factors affecting the recruitment and retention of Medical Laboratory Scientific Officers in Pathology.

OBJECTIVE: To survey the perceptions and attitudes of Medical Laboratory Scientific Officer (MLSO) staff in Pathology to explain difficulties in recruitment and retention and inform attempts to solve the difficulties. DESIGN: Questionnaire to a defined group of MLSOs. SETTING: The Laboratory Medicine Directorate, Aberdeen Royal Infirmary. SUBJECTS: MLSO1 and MLSO2 staff currently or recently working in Pathology (histopathology) in Aberdeen. RESULTS: The survey return rate was 100%. Opportunities for career development in Pathology are poor, this being the worst feature of working in Pathology. Remuneration is poor and is a disincentive to remaining in the speciality. MLSOs feel undervalued in relation to other health care workers. Many have concerns about laboratory organisation, but find a sociable and supportive environment that provides job satisfaction. Staff seek work in other laboratories because of opportunities for promotion, learning new skills and increased pay, although pay in specialities other that Pathology is greater only because of shift working in these disciplines. There is a need to increase public awareness of MLSOs' central role in providing and maintaining excellence in Pathology services. CONCLUSION: MLSO staff have concerns about their career structure and salary scales. The responsibility of MSLOs in Pathology for quality assurance and managing MLAs is not recognised. These factors form a disincentive to working in Pathology laboratories and threaten our ability to staff the service and to maintain the turnover and quality of Pathology services. These issues require to be addressed nationally and rapidly to prevent the continuing decline in MLSO numbers. Matters of local organisation might be addressed by trusts and departments, but recognition of the need to resource changes would require reflection in budgets.

Career Mobility↗
PubMed2003

Addressing the problems associated with general practitioners' workload in nursing and residential homes: findings from a qualitative study.

BACKGROUND: Caring for older people in residential and nursing homes makes major demands on general practitioners (GPs). AIM: To investigate the perceptions and experiences of home managers and GPs of the provision of general medical services for older residents. DESIGN OF STUDY: In-depth qualitative study. SETTING: Forty-two nursing and residential homes in five locations in England, interviewing home managers and eight of their residents' GPs. METHOD: Semi-structured face-to-face and telephone interviews. RESULTS: Most homes endorse principles of continuity of care and patient choice. Although many homes therefore deal with a large number of GPs, with the inherent difficulties of coordinating care and duplication of GP effort, limitations in residents' choice of GP result in the majority of residents in many homes being registered with only one or two practices. Contracts between homes and GPs may provide opportunities for improving medical care but do not guarantee additional services and have implications for patient choice and residents' fees. Visits on request form the bulk of GPs' workload in homes but can be hard to obtain for residents and may not be appropriate. Regular weekly surgeries are preferred by many homes but may have additional workload implications for GPs. CONCLUSION: The assumption that patient choice and continuity in medical care are paramount for older people in nursing and residential homes is questioned. While recognition of the additional workload for GPs working in these settings is necessary, this should be accompanied by additional NHS remuneration. Further research is urgently required to identify which models of GP provision would most benefit both residents and GPs.

Aged↗
PubMed1992

[Hepatitis C virus antibodies in patients and the normal population].

With regard to the controversial issue of a reduction of transfusion-associated infections by non-remunerated donations, epidemiological data on the prevalence of HIV-1, HIV-2 and hepatitis C virus (HCV) are of particular interest in our country. We investigated four sample categories: (1) healthy employees and workers from Hamburg; (2) hemodialysis patients; (3) hemato-oncological patients, and (4) blood donors, and tried to differentiate between the three disputed vectors of community-acquired (sexually or pregnancy-transmitted), nosocomial and transfusion/transplantation-associated HCV infections. We conclude from our results that--prior to the implementation of blood screening--our carefully selected 'paid blood donors' conferred no higher HCV risks than the general (working) population (0.66 vs. 0.82% HCV antibody prevalence). Besides transfusions/transplantations, significant nosocomial risks apparently exist in hemodialysis units (21.0 vs. 9.5% HCV seroprevalence in polytransfused patients). Preventive measures, e.g. separate dialysis machines for HCV-positive patients, seem to be advisable.

Blood Transfusion↗
PubMedDate not supplied

[The key task of human ecology in Russia].

All major medical and demographic indices changed for the worse in the country during the reform years. Due to the prevalence of mortality over the birth rate, the country's population has been decreasing at a growing pace topping, now, one million people annually. Therefore, the overcoming of the medical-and-demographic crisis alongside with searching for ways of how to preserve the ecological balance must now be on the top of the agenda of human ecology in Russia. An improvement of health and of demographic processes is possible only if there emerges a profound labor motivation in people, i.e. conditions will be provided, which would ensure the possibility to earn by honest labor. The promotion of small business, democratization of private property and changes of the governmental policy in respect to remuneration of labor are needed for this. The biological mechanisms of an extremely increased mortality level among the able-bodied population comprise, obviously, three key pathological processes, i.e. impaired functioning of the central nervous system (break-down of the dynamic stereotype, I.P. Pavlov), an over-tension in the neuro-endocrine regulation (an excessive stress, H. Selye), activation of formation of free radicals (triggering of phenoptosis, V.P. Skulachyov).

Ecology↗
PubMed2003

[Disease management programs from the statutory health insurance physicians' point of view ].

The advantage of DMPs is that they can be used to define target criteria that are legally binding and thus allow for the control of core issues of our health care system. Legal security is to be established by evidence-based guidelines. At present, however, DMPs are still being dominated by economic aspects. From the point of view of the associations of statutory health insurance physicians, further criticism relates both to the transferral of highly sensitive data to health insurance funds and the remuneration for medical services in respect of DMPs. At least, extra-budgetary allotments are claimed after a transitional phase. And finally, the considerable administrative efforts involved are pointed out.

Disease Management↗
PubMed1992

Back to direct payment: German dentists lobby to leave the national sickness fund scheme.

Oral health care in Germany is delivered by private dentists working predominantly in solo practice. Services are financed indirectly by sickness funds for 89 percent of the population. With caries rates declining, dentists' numbers increasing, and federal policies changing the remuneration regulations to enhance preventive behavior in consumers, dentists are concerned about their shrinking incomes. In an attempt to secure their professional interests, a faction among dentists advocates to return to direct payment and to opt out of the sick fund scheme. Their strategy and professional goals are described and the chances of succeeding discussed.

Dentists↗
PubMed1992

[The need for national transfusion services].

Continuing advances in medical and surgical treatment have resulted in increasing demands for blood and blood derivatives. In most developed countries and in many developing ones, the blood transfusion services are organised centrally either as National Blood Transfusion Services or under the auspices of organisations such as the League of Red Cross or Red Crescent Societies. Centrally organised services have been shown clearly to be superior to hospital based transfusion services. Although hospital based services may be a convenient alternative under certain circumstances, in most cases there is inefficient use of resources and difficulties in setting, achieving and enforcing quality standards. This is so particularly in developing countries. The need to change from a remunerated or replacement donor system is emphasised, with the ultimate goal being national self-sufficiency in blood and blood derivatives. Attention is also drawn to the importance of education and motivation of staff working in the blood transfusion services if these objectives are to be met.

Blood Banks↗
PubMed2003

[Evaluation of a long-distance data transmission network in foot and ankle surgery].

PURPOSE OF THE STUDY: This prospective work was designed to evaluate the concordance of the opinions of four experts interrogated via a long-distance inter-hospital data transmission system by an orthopedic surgeon seeking advise on foot and ankle surgery patients. MATERIAL AND METHODS: The surgeon requested advice concerning patients presenting difficult diagnostic or therapeutic situations. The requests were submitted via email to four experts working in regional referral centers. A standardized method defined by pathological categories was used for case description and imaging. RESULTS: Requests concerning 30 among 450 patients presenting surgical foot and ankle disorders were addressed to the experts. The surgical problem involved the forefoot (46%), the mid foot (16%), the hind foot (7%) and the ankle (31%). Mean delay to response was 11 days. The index of diagnostic agreement was 3.2/4 and the index of therapeutic agreement was 2.6/4. DISCUSSION: This study was designed to analyze the operating procedures involved (respective responsibility of the requesting surgeon and the regional experts, remuneration due to the different participants) and the potential patient benefit. The appropriateness of the email transmission system was also examined. For this type of study, email transmission was indicated because of the low cost, easy use, and image quality. This work illustrated the very good diagnostic and therapeutic concordance between experts in foot and ankle surgery and thus demonstrated the potential usefulness of long-distance expert systems. Furthermore, implication of several experts provided greater precision and complementary information facilitating management of difficult cases.

Adult↗
PubMed1992

[The results and prospects of preventing arterial hypertension in Ukraine].

An analysis is presented of the status of arterial hypertension prophylaxis in the Ukraine. Drawbacks in solution of this problem are discussed: diagnosis is incomplete, prophylactic management of hypertensive disease is inadequate. Ways and means of improving the diagnosis and prophylaxis of hypertensive disease in the Ukraine including better remuneration of the medical personnel and interests of the population in preserving their health are discussed.

Age Factors↗
PubMed2003

OIG targets contractual joint ventures.

A recent OIG Special Advisory Bulletin raises questions for providers involved in joint ventures. The Bulletin describes several characteristics that the OIG views as potentially suspect, including a referral stream controlled by the provider initiating the joint venture and the use of a wholly owned subsidiary of the provider to bill and collect for services. According to the OIG, profits paid by the subsidiary to the provider owner in such "suspect contractual joint ventures" could constitute illegal remuneration for referrals.

Contract Services↗
PubMed2003

The Umgeni bridge, a resin bonded pontic using a preformed fibre post an aesthetic procedure of low biological and fiscal cost.

A missing anterior tooth or open embrasures destroys the aesthetics of a smile. The replacement of a missing anterior tooth is one of the most rewarding and challenging aspects of restorative dentistry. There are a number of techniques to do this, however, most involve the use of a technician, which means additional cost to the patient and multiple visits. In today's financial climate with practice expenses climbing and medical aid remuneration dwindling, one must seek methods to reduce costs and provide patients with more affordable dentistry. In addition, in crisis situations such as the traumatic loss of a tooth an immediate replacement technique albeit temporary is necessary. To replace a missing anterior tooth directly and immediately presents a rewarding challenge to the clinician. The Umgeni bridge named after the river that flows on the north side of Durban, is particularly useful in replacing congenitally missing laterals after completion of orthodontic treatment in the case of congenitally missing laterals and cleft palates.

Acid Etching, Dental↗
PubMed1992

Systematic care of diabetic patients in one general practice: how much does it cost?

This study examines the costs of running a method of systematic care for diabetic patients in one general practice--the monthly 'diabetic day'. Doctor, nurse, chiropodist, dietitian, clerical officer, building and stationery costs were included in the evaluation. The study took place in an inner city practice of seven partners based in a health centre. The cost per year of running the diabetic days was 1854.53 pounds to the practice and 4465.69 pounds to the National Health Service (1989 prices). The cost to the practice included family health services authority reimbursements and excluded the cost of the chiropodist and dietitian. The cost per attendance was 38.17 pounds to the NHS and 15.85 pounds to the practice while the cost per patient per year was 58.00 pounds to the NHS and 24.08 pounds to the practice. The practice suffered a net loss after taking into account health promotion clinic payments received from the family health services authority. The cost to the NHS of each attendance at the practice was considerably greater than estimates of the cost of attendance at the outpatients department of a local trust hospital. However, it is argued that general practice has an essential role in the improvement of diabetic surveillance, and that an adequate remuneration package could transform the care of many patients with diabetes.

Diabetes Mellitus↗
PubMed2003

[Quality development and quality assurance in allergology].

Since the incidental finding of the anaphylactic reaction allergology has progressed from the empirical medicine emanating from Blackley into a scientifically founded interdisciplinary subject. This development and the resulting improvement of patient care was fundamentally influenced by the research findings and quality efforts of the allergological societies. Quality assurance is solely meant to ensure a certain quality standard. Due to the structural health care reform quality control has been given special emphasis. A deficiency analysis reveals that allergology in the sense of an additional specialisation is limited way too much by the boundaries of the clinical disciplines concerned. Continuing medical education is lacking a standardised subject index. Quality guidelines have been developed under the guidance of the Agency for Quality in Medicine, but have not been passed until the present day. Despite exponentially increasing case numbers allergology further suffers from a lack of quality criteria that would adjust the distribution of remunerations to the actual demand for health care delivery to the general population.

Allergy and Immunology↗
PubMed2003

The influence of bonus payments to doctors on hospital revenue: results of a quasi-experimental study.

There is wide consensus that the ways in which providers are reimbursed by third parties will affect their behaviour and, hence, the efficient use of limited resources and the performance of health systems. However, there seems to be little evidence on how payment to hospital-based doctors affects hospital performance. This paper reports a case study conducted in China on the effects of different types of bonus payment to doctors, with a focus on how bonus payment might have affected hospital revenue growth. This has been an increasingly important goal of public hospitals as they have gained increased autonomy. A set of longitudinal quasi-experimental data, and a set of cross-sectional data, both derived from 108 public hospitals, were used for the analysis. It was found that, when a bonus system was introduced, and when the bonus model switched from one with a weaker incentive to provide services to one with a stronger incentive, there was a consistent sudden increase in the rate of growth of hospital revenue. Bonus type was also associated with the size of hospital service revenue. The results highlight the potential risks of linking remuneration too closely with revenue generation, and the need to ensure adequate attention to mechanisms of control and accountability when hospitals are given greater autonomy.

Budgets↗
PubMed2003

Alternative arrangements for the delivery of eye care services within staff model managed care organizations.

BACKGROUND: Eye care services, though accounting for only a small fraction of healthcare costs, encompass a unique spectrum of professional staffing options that can enhance efficiency and decrease costs within staff model managed care organizations. METHODS: This study was designed to describe and assess alternative staffing arrangements and cost implications for the delivery of eye care services by optometrists, ophthalmologists, and primary care physicians within staff model managed care organizations. The clinical records of individual patients--rather than administrative and billing files--at three managed care organizations are the principal source of information. Clinical auditors extracted data on ambulatory eye care services provided for conjunctivitis, corneal abrasion/erosion, cataract, diabetic retinopathy, glaucoma, and macular degeneration. RESULTS: Our findings document the substantial role optometrists play in the delivery of eye care, whether they provide the care independently or in collaboration with an ophthalmologist. The levels of remuneration for optometrists are roughly one third to one half the annual rate for ophthalmologists. Staffing arrangements that use optometrists to the full extent of their professional training can provide significant cost savings. CONCLUSIONS: The cost-effectiveness of using the services of optometrists capable of delivering high-quality eye care can be demonstrated. Potential cost savings for staff model managed care organizations may accrue if the roles, functions, and availability of eye providers are adjusted.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Policy and management of human resources in the health care system of Portugal].

Portugal has adopted the Beveridgian model of National Health Service after the revolution of 1974. However, certain principles have been proclaimed long before that date. In particular, equity in access to and solidarity in financing of health care have been emphasized since many decades, although not yet completely implemented nowadays. The NHS is managed by the Ministry of Health who employed in 1999 approximatively 115,500 professionals. In 1998, the Portuguese NHS had 245 medical doctors and 334 nurses per 100,000 population. As concerns ambulatory care, the NHS deploys throughout the country health centers where GPs act as gatekeepers. The NHS is plagued by several chronic shortcomings: politics and politicians are deeply involved in its decision-making process, its information system is weak, manpower planning is lacking, the medical careers outside hospitals are not appreciated, continuing education of health workers is neglected, the working conditions and skill-mix are deteriorating and, finally, the remuneration system is outdated.

Decision Making↗
PubMed2003

[Legal aspects of conflict situations from the hospital physician's perspective].

The majority of hospital physicians have already adapted to "normal conflict situations". Standards in patient information, diagnosis, treatment and follow-up have become established practice as have the resultant consequences of the failure to observe these standards, possibly on the basis of guidelines and directives. The legal developments in recent years make organisational shortcomings and mistakes in taking on patients without any requisite specialisation a liable offense. Similarly, faulty documentation is a much-discussed medical and legal issue. New fields of legal dispute arise from the growing financial pressure and the increasing managerial responsibilities placed on senior physicians. Likewise, budgeting requirements and legal claims of employees based on working time legislation may also bear legal consequences. With the introduction of a flat-rate remuneration system for hospital services (DRGs: diagnosis related groups), liability claims against senior physicians due to coding errors have been included in the contractual agreements. Serious new conflicts essentially arising from time pressure and the overloading of physicians with bureaucratic, financial and administrative tasks can only be satisfactorily resolved if doctors are allowed to do what they are intended to do and if they are provided with the time and financial resources their every day work and continuing medical education require.

Conflict, Psychological↗
PubMed2004

The physician-scientist in Canadian psychiatry.

OBJECTIVE: The objective of the study was to determine whether physician-scientists in psychiatry in Canada are in decline, as was reported for medicine overall during the 1990s in the United States. DESIGN: Federal databases were searched to study grant applications in the area of mental health submitted by physician-scientists compared with PhD-scientists for the period 1985-2001. A survey of Canadian Residency Training Program Directors was carried out for the graduating class of 2000. SETTING: The Canadian publicly funded university system. PARTICIPANTS: Applicants to the Medical Research Council of Canada and its successor, the Canadian Institutes of Health Research, for operating grant support and Residency Training Program Directors. INTERVENTIONS: None. OUTCOME MEASURES: Comparison over time between MD and PhD applicants regarding the number of grant applications submitted, the proportion of applications funded and the number of new applications submitted, with separation of applications submitted to a predominantly "biomedical" peer review committee and to a predominantly "clinical research" peer review committee. The survey obtained information about a number of variables related to research training. RESULTS: The situation for physician-scientists in psychiatry in Canada appeared remarkably similar to general findings in US studies. Relative to PhD applicants, fewer grant proposals were being made by physicians (paired t16 = 7.08, p < 0.001) and, in consequence, fewer proposals were funded. The proportion of proposals funded was similar for MD and PhD applicants (paired t16 = 0.27, p = 0.79). Grant applications made to the predominantly biomedical committee were more likely to be funded than applications to the committee with an orientation toward clinical research (paired t7 = 5.53, p < 0.001). Applications by PhD-scientists to the biomedical committee showed the largest increase over time and were the most successful. From the survey of graduating classes, close to one-third of residents had authored or co-authored a publication during residency. Only 7% were proceeding to research fellowship training. The remuneration available for fellowship training was about one-third of what graduating classmates could expect to earn in the first year of practice. CONCLUSIONS: Quantitative data indicate that physician-scientists in psychiatry in Canada are experiencing the same pressures and challenges as physician-scientists in the United States. A plan of action tailored to the needs of the psychiatric community in Canada needs to be developed.

Canada↗