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PubMed1996

[The Swiss health insurance carriers in managed care].

The Swiss health care system is currently undergoing radical changes. The balance of power is clearly shifting from the service-providers to the health insurers. Excessive patient demands combined with proliferation of medically unnecessary treatment have led to an inflation of cost equivalent to several billion Swiss francs. Managed Care is a new instrument that enables the insurers to influence patient behavior and, hence, the services offered in an integrated fashion. The key factors necessary for the success of this process are: Clear and timely information with the insured Product design based on precise segmentation Cost effective service-purchasing based on insured requirements Use of insurer-owned service providers to encourage competition The success of Managed Care in Switzerland will largely depend on the readiness of health care stake-holders to adapt, learn, and cooperate in a constructive, professional, and open-minded framework.

Cost Control↗
PubMed2004

National health data warehouse: issues to consider.

A national data warehouse that links public and private data could be used to monitor trends in healthcare costs, utilization, quality of care, and adherence to quality guidelines and changes in treatment protocols. The development of the data warehouse, however, would require overcoming a number of political and technical challenges to gain access to private insurance data. This article outlines recommendations from a national conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) on the private sector's role in quality monitoring and provides an operational outline for the development of a national private sector health data warehouse.

Confidentiality↗
PubMed1991

The impact of a community based health education program on the incidence of diarrheal disease in southern Thailand.

This study has demonstrated that additional training of service providers [village health volunteers (VHVs), village health communicators (VHCs)] in combination with the mobilization of village leaders and influentials to promote selective preventive health behavior, can have a marked impact upon the effective practice of these behaviors and diarrheal incidence. Further, this impact can be achieved through the existing staff structure, ie, VHV/VHCs of the national health program. For example, increased contact between these service providers and mothers of children under 5 years through home visits and attendance at meetings held by the service providers, contributed positively to the practice of selected preventive behaviors. If the national program provided similar training inputs on the promotion of selected preventive behaviors and increased service provider contacts, the program's impact upon diarrheal disease would be enhanced.

Child, Preschool↗
PubMed1987

Cancer prevention and control: from research through applications.

As the understanding of the magnitude and social impact of cancer has advanced, three major forces have shaped the current state of the art in cancer prevention and control: the maturation of organization approaches to solving the cancer problem; the accumulation of scientific evidence that justified and illuminated the concept of cancer as a controllable disease; and, most recently, the development of a systematic cancer control research process that provides efficiency and clearer direction to the planning of a national cancer control program. The National Cancer Institute, recognizing the need for goal setting and scientific accountability in the conduct of cancer control research, has established quantified mortality reduction objectives for the year 2000 related to smoking cessation, diet changes, early detection, and state-of-the-art treatment. The cancer control research process and these objectives will guide the allocation of cancer control resources toward the application of effective health promotion strategies.

Goals↗
PubMed1983

delta 9-Tetrahydrocannabinol and therapeutic research legislation for cancer patients.

The Controlled Substances Board evaluated the implementation of the National Cancer Institute (NCI) program in Wisconsin that distributes delta 9-tetrahydrocannabinol (delta 9-THC) to cancer chemotherapy patients with nausea and vomiting refractory to conventional antiemetic drugs. The board concluded that the distribution mechanism for delta 9-THC is appropriate and adequate in Wisconsin. The drug does relieve nausea and vomiting in some cancer chemotherapy patients, but adverse side effects are prevalent. Important questions about its safety and effectiveness remain and should be resolved through scientific research and within the existing framework for testing investigational drugs that are controlled substances. "Marijuana therapeutic research" legislation, similar to that passed in 32 states, was introduced in Wisconsin after implementation and evaluation of the NCI program, but failed to recognize the existing legal framework for approving new drugs and threatened to disrupt the NCI program. With assistance from the American Cancer Society, the State Medical Society, and volunteers and professionals in cancer research, the legislation was adapted to the existing legal and administrative framework.

Antineoplastic Agents↗
PubMed2000

Physicians' conflicts of interest in Japan and the United States: lessons for the United States.

Japanese health policy shows that even with physician ownership and the absence of for-profit, investor-owned health care, physicians' conflicts of interest thrive. Physician dispensing of drugs and ownership of hospitals and clinics were justified in Japan as ways to avoid commercialization of medicine. Instead, they create physicians' conflicts and fuel patient overuse of services. Japan's Ministry of Health and Welfare (MHW) has responded by introducing per-diem payment, thereby creating incentives to decrease services in ways similar to those of American managed care organizations, but with none of their benefits, such as coordination of care, oversight of physicians practices, and quality assurance. Although the United States and Japanese health care systems are organized and financed differently there is convergence in the source of their physicians' conflicts and the way they are addressed. The United States is starting to integrate institutional and physician payment and align their incentives, in a traditional Japanese way. In so doing, the United States creates new physicians' conflicts and reduces the role of countervailing incentives and power, an advantage of previous policy. Japan, in turn, has combined incentives to increase and decrease services, thus moving closer to the U.S. policy.

Codes of Ethics↗
PubMed2005

Introducing hepatitis B virus vaccine into the Expanded Programme on Immunization in Bangladesh: a proposed method to evaluate whether the existing infrastructure has the capacity.

To determine whether the existing Expanded Programme on Immunization (EPI) in Bangladesh has the capacity to introduce the hepatitis B virus (HBV) vaccine, this study was carried out in all the nine health facilities, which maintain a cold-chain, in Chandpur district of Bangladesh. The research, focusing specifically on cold-chain equipment, aimed at developing and applying an indicator of the use of cold-chain equipment. A structured questionnaire, developed and field-tested, was used for collecting information on cold-chain equipment and their use-rate. Data were used for estimating the resources needed to introduce the HBV vaccine and for increasing the coverage of measles and DPT vaccines. The findings of the study showed that the use-rate of cold-chain equipment in this district was low, suggesting that the district has sufficient spare capacity to introduce and sustain the storage of an increased quantity of vaccines. This paper suggests an approach to study capacity in relation to infrastructural facilities. By measuring the capacity of capital equipment, the study has illustrated that the measurement of resource-use rates provides useful information about the burden that a new vaccine places on the EPI.

Bangladesh↗
PubMed1977

Postdoctoral research training in cariology: an opportunity initiated by the National Caries Program at the University of Minnesota School of Dentistry.

In response to the need for development of measures to effectively control human dental caries, a postdocroral research training program in cariology has been established at the University of Minnesota School of Dentistry. This article discusses the concept of cariology, the background leading to the development of the program, and the goals and structure of the program. The recruiting and training of individuals to perform and direct multidisciplinary basic and applied research in cariology are explained. A didactic and clinical program is presented which gives a comprehensive introduction to cariology to trainees with a Ph.D degree and little previous knowledge of the multifactorial nature of dental caries.

Curriculum↗
PubMed2000

The cost of integrating hepatitis B virus vaccine into national immunization programmes: a case study from Addis Ababa.

National programmes of hepatitis B virus (HBV) vaccination are recommended by the World Health Organization for all countries. Countries suffering the highest burden of HBV disease are those most needy of universal vaccination, but are frequently of very low income and resources for health care are scarce. The introduction of HBV vaccination would inevitably stretch these resources further even with support of donor agencies. Thus an assessment of the cost-effectiveness of HBV vaccination is desirable to assist in decision making about resource allocation. We describe here a method for estimating the additional costs of introducing HBV vaccination into the Expanded Programme on Immunization (EPI) at a national level. Of fundamental importance is that this method enables costs to be assessed prior to the introduction of vaccination. We illustrate the method using a study carried out at the sub-national level, in the city of Addis Ababa, Ethiopia, but which can be expanded countrywide. The method, in brief, involved the use of a number of questionnaires which could be used to estimate the costs associated with the EPI programme from a large sample of the static clinics as well as from central sources. Since unit costs were collected along with the quantities of resources used and estimates of the capacity used for certain facilities (such as refrigerators), the additional cost of introducing HBV vaccine could be estimated largely by extrapolation of the resources used in vaccinating against diphtheria/pertussis/tetanus vaccine (which, similar to HBV vaccine, requires three doses). The estimation of costs is only part of the information required to make decisions on resource allocation, and should be used in association with measures of the burden of disease due to the infection in the community and effectiveness of the control programme at reducing this burden. The prediction of the latter, based upon a sound epidemiological understanding of the infection, is the subject of a forthcoming paper.

Cost Allocation↗
PubMed2006

[Bitter pills].

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1995

[Hospital structure and control measures].

A new legislation concerning financial matters of hospitals in Germany requires fundamental changes and adjustment. Formerly grown structures of a high-grade centralization erode into a process of change. Despite hospitals will maintain their non-profit character in public health services, modifications of medical care processes will promote elements of cost-centres. All medical care units as well as hospital management are confronted with rising requirements concerning performance and transparency. Increasingly patients and social health insurances behave like self-confident customers not willing to accept rising costs. Public health services loose their character of a planned economy. Hospitals with features of health-entrepreneurship are on the incline. A process of quality-planning and efficient management has been evoqued.

Cost Control↗
PubMed2002

[Intramural hearing protection program as a response to health needs of working populations in the region of Swietokrysk].

The program of health promotion in the area of hearing protection (IHPP) is proposed as a part of Operational Target 8 of the National Health Program "Reducing exposure to harmful factors in the living, working and educational environment and mitigating their health effects" and corresponds with the aims of the Strategic Governmental Program on Health Protection and Safety at Work. Both in Poland and in the region of świetokrzyskie there is an urgent need to undertake appropriate steps to protect the hearing organ in the working population against harmful effects present in the work environment. It is estimated that 25% of diagnosed occupational diseases is associated with occupational hearing loss. The program is addressed to workers exposed to noise at work. To achieve the main goal of the program it is necessary: to reduce noise emissions and exposure to noise in the work environment; to promote behavior conducive to hearing protection among workers exposed to noise; to improve the quality of prevention in the occupational health services responsible for hearing protection. The Regional Center of Occupational Medicine in Kielce (coordinator) and primary units of occupational health service are involved in the implementation of the program, whereas, employers, occupational safety and health services, the State Labor Inspectorate and Sanitary Inspectorate participate in its implementation. It is expected that the program in the region of świetokrzyskie will yield the following expected results: the reduction of noise emission to safe levels; the increased awareness of using optimal hearing protectors among noise-exposed workers; the decreased number of workers with diagnosed noise-induced hearing loss, and the decrease in the number of new cases of occupational hearing impairment.

Deafness↗
PubMedDate not supplied

A national action plan to meet health care quality information needs in the age of managed care.

Concerted national action is needed to meet the growing demand for health care quality information among all health care stakeholders. We propose a coordinated national network of independent, public-private quality measurement alliances established through strong purchaser and consumer leadership at the state, regional, or local levels. These independent alliances could assume a variety of organizational forms, but all would undertake specific quality measurement and consumer information projects to meet local health care market needs by drawing on various combinations of the emerging national standardized quality measures. Local implementation of quality measures based on national standards will facilitate cross-market benchmarking and multistate comparisons useful not only to state and local market constituencies, but to national employers, health plans, provider organizations, and the federal government as well. Successful models of such alliances already exist that demonstrate the feasibility of this national strategy, but concerted national leadership and federal matching funding will be needed to meet the scope of implementation required in markets across the country.

Benchmarking↗
PubMed1995

[Implementation of the public health reform law--experiences with diagnosis related case payment in surgery].

According to new German health care laws (Gesundheitsstrukturgesetz, Bundespflegesatzverordnung) hospital payment will be given a new basis. Abandoning the "length of stay"--related compensation in the future surgical services should be refunded either by special payments for a given surgical procedure (covering anesthesia, surgery, instruments), or by case-related payments (including all costs of stay, medical as well as room-and-care and administrative). This should lead to a more equitable payment getting a transparent insight into the relation service/cost. Calculations for the so far 103 special payment and 40 case related payment items have been obtained by a nationwide analysis in reference hospitals. Besides numerous problems introducing these new refund systems in very different hospital structures, our own 3-year experience using case related payment on our surgical department (based on individual calculation) shows promising results. The main intention still has to be--by setting free economic resources--to avoid rationing though rationalization.

Cost Control↗