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PubMed2001

The impact of legislative versus non-legislative quality policy in health care: a comparison between two countries.

UNLABELLED: An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown. This article explores that relationship by comparing two countries with different quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Finland, QM is not required by law and the responsibilities for organizing health care are delegated to the municipalities. The question is whether or not these differences in national policy are reflected in the extent and effectiveness of QM in health care organizations in the two countries. A cross sectional survey was conducted in late 1999. Data about QM in both countries were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health care organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and more patient participation were found in Dutch health care organizations compared with the Finnish ones. However, contrary to our expectations, the Finnish organizations reported more perceived effects of their QM-activities. Further analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvement procedures, human resource management and the flexible attitude of employees showed the strongest relationship with the perceived effects of QM. The difference between the national approach in The Netherlands and the decentralized approach in Finland did not, as we had assumed, result in more regional variation in QM in Finland. CONCLUSIONS: a government's quality policy may have some influence on the extent of QM in health care organizations. However, more QM-activities do not necessarily imply more effects. RECOMMENDATIONS: since QM-activities differ in the degree to which they bring about changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care.

Aged↗
PubMed1991

Medicare program; legislative changes concerning payment to hospitals for federal fiscal year 1991--HCFA. Notice of legislative changes.

This notice describes changes to the Medicare prospective payment system for inpatient hospital services concerning the hospital wage index and the regional payment floor resulting from the provisions of the Continuing Resolution of October 1, 1990 (Pub. L. 101-403). Also described in this notice are those self-implementing portions of sections 4001 (a) and (c), 4002 (e) and (f), 4007, 4151, and 4158 of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508) that affect Federal fiscal year 1991 payments to prospective payment hospitals and hospitals and units excluded from the prospective payment system. The changes required by these sections affect the following: 15 percent capital payment reduction, use of the regional payment floor, offset for physician assistant services, market basket percentage increase, standardized amounts, hospital-specific rates for sole community hospitals and Medicare-dependent small rural hospitals, target rate of increases for excluded hospitals and units, hospital wage index, payments for graduate medical education, and Part B payment reduction.

Capital Expenditures↗
PubMed1988

Medicare program; fiscal year 1988 legislative changes to the inpatient hospital prospective payment system--HCFA. Notice of legislative changes with comment period.

This notice describes those portions of sections 4002, 4005, 4008, and 4009 of the Omnibus Budget Reconciliation Act of 1987 that affect Federal fiscal year 1988 payments to prospective payment hospitals and hospitals excluded from the prospective payments system. The changes required by this law affect the prospective payment rates; the rate-of increase limits for hospitals excluded from the prospective payment system; the definition of a large urban area; the establishment of a new "regional floor;" the criteria for classification of rural referral centers; and outlier payments for burn cases.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Medicare program; legislative changes concerning payment to hospitals for federal fiscal year 1990--HCFA. Notice of legislative changes.

This notice describes those portions of sections 6001, 6002, 6003(a), (b), and (d), 6004(a) and (b), 6021, 6101, 6110, and 6205(b) of the Omnibus Budget Reconciliation Act of 1989 that affect Federal fiscal year 1990 payments to prospective payment hospitals and hospitals excluded from the prospective payment system and that are self-implementing. The changes required by these sections affect the prospective payment rates, rural referral centers, payments for capital-related costs, periodic interim payments, cancer hospitals, and payments for nursing and allied health education.

Centers for Medicare and Medicaid Services, U.S.↗