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PubMed2002

[On the control of professional ethics].

Professional colleges lost the ethical control of their members in 1980, when a free market economical model was implemented in Chile. Courts of justice have failed to accomplish this task. To recover such control, the Chilean Medical Association would need to modify its internal organization, separating its functions as a union from those required to control professional ethics. The health reform that is being set forth in the country, proposes a "new instance" for the control of professional ethics, within the Health Services and forming part of the Health Care Authority.

Chile↗
PubMed2002

Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry.

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

Administrative Personnel↗
PubMedDate not supplied

[Use of artificial neural networks in clinical psychology and psychiatry].

Artificial neural networks make a highly specialised tools in data transformation. The human brain has become an inspiration for the makers of artificial neural networks. Although even though artificial neural networks are more frequently used in areas like financial analysis, marketing studies or economical modelling, their application in psychology and medicine has given a lot of promising and fascinating discoveries. It is worth that artificial neurol networks are successfully used in the diagnosis and etiopathogenesis description of various psychiatric disorders such as eating disorders, compulsions, depression or schizophrenia. To sum up, artificial neural networks offer a very promising option of research methodology for modern clinical psychology and psychiatry. The aim of this article is only an illustration of the applications of artificial neural networks in clinical psychology and psychiatry.

Diagnosis, Computer-Assisted↗
PubMed2003

EBRI research highlights: health benefits.

The Employee Benefit Research Institute (EBRI) is a nonpartisan, nonprofit public policy research organization based in Washington, DC, that has been researching economic security issues for almost 25 years. Founded in 1978, its mission is to contribute to, encourage, and enhance the development of sound employee benefit programs and sound public policy through objective research and education. EBRI does not lobby and does not take positions on legislative proposals. EBRI receives funding from individuals, employers of all types, unions, foundations, and government. EBRI's research work has focused on retirement- and health-related issues, particularly involving pension/retirement plan coverage and health insurance coverage in the employment-based benefits system. EBRI is a major source of unbiased data on the uninsured and current trends involving 401(k), IRA, and traditional pension-type retirement plans. EBRI research programs also include economic modeling of Social Security reform proposals and development of the EBRI/ICI 401(k) database, the largest and most detailed of its kind. This EBRI Special Report/Issue Brief (May 2003) synthesizes highlights of recent EBRI research on health issues. The next Issue Brief (June 2003) will present recent EBRI research on retirement benefits. It should be stressed that this document contains only highlights of EBRI's collection of research and analysis; for greater detail and information, visit EBRI's Web site (www.ebri.org) or contact EBRI directly.

Adolescent↗
PubMed2003

[Search for medical care and determinants of the health services utilization].

There are four different conceptual approaches to assess the factors that explain, condition and determine the use of health services. This article discusses the epidemiological, psychosocial, sociological and economical models. The stages and determinants of the health service use process are described and a cross study is made with each of the four models, using a contingency matrix. A holistic analysis is proposed, as a starting point, for the search of a model that will allow the identification of factors that determine the use of health services. This analysis should be used as a conceptual framework for future work on health services utilization.

Decision Making↗
PubMed2003

Clinical ROI: not just costs versus benefits.

Although sophisticated economic modeling can be used to quantify intangible benefits, ROI calculations for clinical information systems are driven more by the values and strategic direction of an organization than by any other considerations. But investing in clinical information tools to ensure quality and patient safety is, in reality, required as a cost of doing business and functioning as a safe hospital.

Cost-Benefit Analysis↗
PubMed2003

Is ambulatory blood pressure monitoring cost-effective in the routine surveillance of treated hypertensive patients in primary care?

Achieving target levels of office and/or ambulatory blood pressure readings among treated hypertensive patients is an important aspect of cardiovascular disease prevention. Although office blood pressure measurement is simple and convenient, ambulatory blood pressure monitoring is especially useful for identifying patients with 'white coat' hypertension, in whom falsely raised office blood pressure recordings often lead to unnecessary return visits and additional treatment. Office and ambulatory blood pressure control was compared in 374 treated hypertensive patients in a single general practice, and the costs of performing annual ambulatory blood pressure measurements were compared with potential clinical savings. Ambulatory blood pressure monitoring detected 115 (31%) patients who fulfilled the British Hypertension Society target for ambulatory but not office blood pressure, i.e. white coat hypertension, and 21 patients apparently controlled by office but not ambulatory blood pressure criteria. In economic modelling, the capital, maintenance and user costs of ambulatory blood pressure monitoring (13,790 Pounds per year) were partly offset by fewer follow-up visits and second-line treatments in the group with white coat hypertension (there were modelled savings of 10,178 Pounds). Thus, ambulatory blood pressure monitoring identified a much larger number of treated hypertensive patients with adequate blood pressure control at an extra net cost of 3612 Pounds per year.

Aged↗
PubMed1992

Time costs and informal social support as determinants of differences between black and white families in the provision of long-term care.

This paper presents an economic model that predicts the observed racial difference in the mix of informal home and nursing home services used for long-term care by black versus white families. A cause of this difference in services used is a difference between black and white families in the relative prices they pay for particular services. Each group uses relatively more of the relatively less expensive (for that group) form of long-term care. The model indicates three specific hypotheses. The empirical analysis focuses on the Differential Opportunity Cost of Informal Caregiver Time hypothesis. Based on data from the 1982 and 1984 National Long-Term Care Surveys, two sets of results consistent with though not direct tests of this hypothesis are presented.

Black or African American↗
PubMedDate not supplied

[The development of needs and income security in the elderly--some general comments].

The development of the requirement of private persons (by households) is discussed by micro-economic models, legal regulations, and cross-section-data, and is represented in stylized figures. These hypothetical longitudinal profiles are compared to those of income. The analysis supplies evidence of increasing requirement and decreasing income during retirement.

Aged↗
PubMed2005

Uncertainty, imprecision, and the precautionary principle in climate change assessment.

Statistical decision theory can provide useful support for climate change decisions made under conditions of uncertainty. However, the probability distributions used to calculate expected costs in decision theory are themselves subject to uncertainty, disagreement, or ambiguity in their specification. This imprecision can be described using sets of probability measures, from which upper and lower bounds on expectations can be calculated. However, many representations, or classes, of probability measures are possible. We describe six of the more useful classes and demonstrate how each may be used to represent climate change uncertainties. When expected costs are specified by bounds, rather than precise values, the conventional decision criterion of minimum expected cost is insufficient to reach a unique decision. Alternative criteria are required, and the criterion of minimum upper expected cost may be desirable because it is consistent with the precautionary principle. Using simple climate and economics models as an example, we determine the carbon dioxide emissions levels that have minimum upper expected cost for each of the selected classes. There can be wide differences in these emissions levels and their associated costs, emphasizing the need for care when selecting an appropriate class.

Air Pollution↗
PubMedDate not supplied

Remote surgicenter experience with hernia repair.

A remote outpatient surgicenter was planned and constructed with three partner groups-76 physicians and two competing hospitals. The CFS was opened in July 1994 and has since performed a large volume of procedures: >124,800 total and, in 2003, 14,900 cases. This multispecialty center during that same period of time (1994 to date) has performed 2659 hernia operations. Patients were discharged home in 1-2 hours after surgery to be followed as outpatients in the physician's office. Only six patients were admitted to the hospital. This efficient and economic model is well suited for hernia repair in the selected adult and pediatric patient population without a significant number of adverse events. The community has readily accepted this program for adult and pediatric hernia repair. Patients, family members, referring physicians, and participating physicians have endorsed and recommended the program.

Adolescent↗
PubMed2005

Modeling participation in the NHII: operations research approach.

Regional health information organizations (RHIOs) form the core building blocks of any approach to creating the National Health Information Infrastructure. RHIOs are computer-supported information sharing alliances composed of health care institutions that need to exchange clinical, financial or administrative data. Many uncertainties, including institution conversion costs, price-to-participate, and RHIO governance decisions make estimating the cost consequences difficult to establish. Current approaches to health information technology investment rely on a net-present-value analysis, which is inadequate to capture the dynamic, uncertain course likely to occur in the RHIO environment. Methods from operations research provide decision makers robust tools for exploring the cost and consequences of RHIO structures. We present here an initial modeling approach that allows explicit examination of RHIO structure and pricing options. Once refined, these models will provide the core of a suite of decision support tools for evaluation of RHIO pricing options, discount rates, and optimal organizational structures.

Community Networks↗