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PubMed1995

Achieving and sustaining full employment.

Human rights and public health considerations provide strong support for policies that maximize employment. Ample historical and conceptual evidence supports the feasibility of full employment policies. New factors affecting the labor force, the rate of technological change, and the globalization of economic activity require appropriate policies--international as well as national--but do not invalidate the ability of modern states to apply the measures needed. Among these the most important include: (I) systematic reduction in working time with no loss of income, (2) active labor market policies, (3) use of fiscal and monetary measures to sustain the needed level of aggregate demand, (4) restoration of equal bargaining power between labor and capital, (5) social investment in neglected and outmoded infrastructure, (6) accountability of corporations for decisions to shift or reduce capital investment, (7) major reductions in military spending, to be replaced by socially needed and economically productive expenditures, (8) direct public sector job creation, (9) reform of monetary policy to restore emphasis on minimizing unemployment and promoting full employment. None are without precedent in modern economies. The obstacles are ideological and political. To overcome them will require intellectual clarity and effective advocacy.

Economic Competition↗
PubMed1993

Canadian Bacterial Diseases Network: a new approach to university-industry relationships.

Bacterial diseases are a substantial problem worldwide. Their diagnosis and therapy form the basis of a multibillion dollar industry. This industry is dynamic and is continuously revitalized by research. The Canadian Bacterial Diseases Network (CBDN) was established to capitalize on the enhanced opportunities that now exist for the rapid progression of an idea from conceptualization to implementation and, ultimately, commercialization. CBDN is one of 15 Networks of Centres of Excellence, a Federal Government initiative whose intention is to improve Canada's economic competitiveness in the global market. CBDN research involves fundamental science, is broadly-based, and encompasses all aspects of bacterial diseases. Current projects include the investigations of strategies to block Pseudomonas aeruginosa binding to epithelial cells and a novel anti-toxin approach for Escherichia coli. Also CBDN is investigating the basis for antibiotic resistance in Gram-negative bacteria, and is devising improved procedures for overcoming such resistance mechanisms. CBDN is only 28 months into its first 4-year mandate; however, considerable successes have been enjoyed to date.

Academies and Institutes↗
PubMed1993

Recognizing physicians' rights under exclusive contracts.

As hospitals attempt to position themselves as competitive economic units with selected physicians, economic credentialing of hospital medical staff will accelerate. What recourse do physicians on staff have when a hospital enters into an exclusive contract with another group? Do the due process provisions in the medical staff bylaws apply? Is there a right to due process and to a hearing even when no quality issues are involved? This article discusses recent court decisions on this topic, focusing on Texas statutes and case law.

Contract Services↗
PubMed1993

Why us?

Explore the source record for details and available documents.

Canada↗
PubMed1996

Quality assessment in anatomic pathology in the cost-conscious era.

In this cost-conscious era, quality assessment activities in anatomic pathology are required not only to assure that quality practices result in satisfaction of accreditation standards but also to focus quality management to improve services in an economically competitive manner. Selected high yield monitoring activities that provide comparison to reference databases for benchmarking performance and adoption of practice variables effective in the best laboratories are recommended.

Autopsy↗
PubMed1996

A portfolio approach to strategic hospital analysis: exposition and explanation.

Hospital planners rely on a number of graphic and quantitative devices to facilitate hospital strategic planning and each has its place. It is the comprehensive, user-friendly, environmental assessment models that are missing, however. This article seeks to remedy this condition through the introduction of a portfolio approach to strategic analysis. The authors review the analytical tools currently used by hospital planners to place this model in context and provide an exposition of the model and an explanation of how it is constructed and interpreted.

Catchment Area, Health↗
PubMed1996

Physician productivity measurement, methodology and implementation.

These components are integrated into a single monthly report and distributed to all departments in the health system. Figures 2 and 3 illustrate the four main reports the system can generate. Shown are the overall facility report and the six month trend; the departmental report showing each department as compared to the facility; an individual department report that clearly illustrates each physician's contribution; and finally an individual provider report with trend analysis. These reports are modified slightly as required by each department, but the core information of RVUs/hour remains the basic comparative element. Each report contains comparisons of individual providers within their specialty, department or group, and at the facility and system level. Each department with specific needs has the report prepared to meet these needs, yet the entire facility follows a single standard to make inter-department comparisons meaningful. The information available on each individual report includes: Month. Number of patient visits. Number of unique patients. Average Number of visits per patient. Charges. Part A and Part B worked hours. Paid hours. RVUs generated per worked hour. Productivity measured against. The providers department average. The total group average. Year to date averages. Graphical depiction of RVUs. Hour with trend line. The department summary contains similar information while the department detail report provides a means to easily compare providers within the department against each other and the group as a whole. The overall BMERF report uses summary information from each department and provides a graphical indication of how each department is performing.

Delivery of Health Care, Integrated↗
PubMed1997

The two cultures and the health care revolution. Commerce and professionalism in medical care.

The current trend toward the invasion of commerce into medical care, an arena formerly under the exclusive purview of physicians, is seen by the authors as an epic clash of cultures between commercial and professional traditions in the United States. Both have contributed to US society for centuries; both have much to offer in strengthening medical care and reducing costs. At the same time, this invasion by commercialism of an arena formerly governed by professionalism poses severe hazards to the care of the sick and the welfare of communities: the health of the public and the public health. Some of these hazards are briefly listed and reviewed, together with a brief outline of standards that might be established nationally to abate these hazards. A national agency in the private sector is proposed, the National Council on Medical Care, to set standards and provide an approval mechanism that would then be the basis for state enforcement through licensing. Two models for such an initiative are outlined, one based on the National Academy of Sciences as the initiating force, and the other on an initiative provided by a consortium of national charitable foundations interested in health policy. In both cases, wide support from the national foundations would be essential. In the case of the academy model, some government funds might also be available without loss of the freedom of a private-sector initiative. Some operational options for such a national council, its membership, and the conduct of its affairs are briefly outlined as a basis for further discussion.

Accreditation↗
PubMedDate not supplied

Trends in medical care cost--revisited.

Market forces have had a greater influence on the health care sector than anticipated. The increased use of managed care, particularly HMOs, has been largely responsible for a sharp deceleration in the rise of medical care costs. After recording double-digit growth for much of the post-Medicare/Medicaid period, national health expenditures rose just 5.1 percent and 5.5 percent in 1994 and 1995, respectively. The medical care Consumer Price Index (CPI) rose 3.5 percent in 1996-just 0.5 percent above the overall CPI. The delivery and financing of health care continues to evolve within a framework of cost constraints. As such, mergers, acquisitions and provider alliance groups will remain an integral part of the health industry landscape. However, cost savings are likely to become more difficult to achieve, especially if the "quality of care" issue becomes more pronounced. National health expenditures, which surpassed the $1 trillion mark in 1996, are projected to rise to $1.4 trillion by the year 2000--representing a 7.2 percent growth rate from 1995. In any event, demographics and technological advances suggest that the health sector will demand a rising share of economic resources. The ratio of health care expenditures to gross domestic product is forecast to rise from 13.6 percent in 1995 to 15 percent by the year 2000.

Economic Competition↗
PubMed1998

Medical education in a changing world: thoughts from California.

BACKGROUND AND OBJECTIVES: Medical education has been buffeted by the frenetic changes in our health care delivery system. This commentary focuses on six major issues facing family practice training programs caring for underserved populations in California: 1) The patient base for training programs is eroding. 2) There is no or limited funding for graduate medical education (GME) in Medicaid managed care programs. 3) There are barriers to using residents in managed care systems. 4) Disproportionate share funding from Medicaid for hospitals caring for poor and underserved patients does not support medical education. 5) Capitated Medicare and Medicaid programs are siphoning off dollars meant for GME. 6) Consolidation in the health care market is threatening medical education training sites. To address these issues, primary care GME programs should work with community-based sites so both can increase patient care, educational activities, and revenue in this managed care era. At the same time, community-based training sites in primary care GME programs must redesign their delivery systems to provide efficient, cost-effective care. The result will be better access for primary care patients and more appropriate training for our residents. Family medicine educators should become increasingly involved at the local, state, and national levels to ensure that GME funding directly supports training and is not relegated to being a by-product of patient care.

California↗