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PubMed1995

Restructuring wages and benefits to gain a competitive edge.

Healthcare organizations that are able to develop a cost advantage in their wage-and-benefit programs will have a competitive edge as managed care continues to become more pervasive. Organizations can gain an edge by developing pay systems that reward quality, productivity, and cost containment, and by developing benefit systems that provide cost-containment incentives while meeting organizational recruitment and retention objectives.

Child↗
PubMed1994

Parasitic control in intensive vs. non-intensive systems--ruminants.

The acquisition and intensity of infection with gastrointestinal nematodes and with Oestrus ovis are compared over 2 years in sheep grazed intensively (26-36 sheep ha-1) or non-intensively (12 sheep ha-1) in the winter rainfall Overberg region of South Africa. Sheep grazing intensively on grass/legume pastures, spray irrigated in summer, acquired massive mixed infections of Trichostrongylus, Haemonchus and Teladorsagia. Infections were fatal for sucking lambs. Lambs from ewes grazed non-intensively on dry land lucerne in winter became infected with Nematodirus and then with Teladorsagia and Trichostrongylus spp.; resistance to Nematodirus was apparent after 12 weeks; spontaneous cure of Teladorsagia began in hoggets grazing on safe wheat stubble pasture; but Trichostrongylus survived in the sheep. Helminth-induced host mortality was not observed on the non-intensive farm. The efficacy of various methods of control was examined in the intensively managed sheep. Removal from pasture, mixed grazing (cattle before sheep) and an albendazole slow release bolus all significantly (P < 0.05) reduced levels of infection in animals so treated, compared with control sheep which were treated periodically with anthelmintics as standard farm management practice. Removal of sheep from the pasture for 30 days in the summer seemed to have beneficial effects. Treatment of sheep weekly with albendazole increased levels of infection in the sheep over controls. The status of vaccination is described and the potential of intergenic competition in grazing management and perhaps vaccination is discussed. Resistance of nematodes to anthelmintics was relatively wide-spread. In both intensive and non-intensive systems. Oestrus ovis larvae were present in flock sheep for 10-12 months per year. Imagines failed to develop from 27 April-9 August and it was concluded that larvae had to overwinter in sheep to survive. Recommendations for integrated control are made for both intensive and non-intensive systems.

Animal Husbandry↗
PubMed1990

Capitated Medicaid and St. Joseph's Hospital.

This case study presents the initial reactions of St. Joseph's Hospital and Medical Center, a large nonprofit hospital in Phoenix, Arizona, to the creation of a competitively bid, prepaid, managed care Medicaid program in 1982. It also presents the events in the first year of the Medicaid experiment and the subsequent reactions of the hospital. It illustrates the diverse set of issues that a hospital faces when it moves toward greater vertical integration in health care.

Arizona↗
PubMedDate not supplied

The politics of health sector reform in developing countries: three cases of pharmaceutical policy.

This paper examines the political dynamics of health sector reform in poor countries, through a comparative study of pharmaceutical policy reform in Sri Lanka, Bangladesh, and the Philippines. The paper first reviews five reasons why policy reform is political. It then presents three political economic models of the policy reform process: the political will, political factions, and political survival models. Next, the paper describes the three cases of national pharmaceutical policy reform, and identifies common conditions that made these reforms politically feasible. The paper's analysis suggests that health sector reform is feasible at certain definable, and perhaps predictable, political moments, especially in the early periods of new regimes. The most important and manipulable political factors are: political timing, which provides opportunities for policy entrepreneurs to introduce their ideas into public debate, and political management of group competition, which allows leaders to control the political effects of distributional consequences and protect the regime's stability. A strong and narrow political coalition improves the capacity of political leaders to resist the pressures of concentrated economic costs (both inside and outside national boundaries). The paper argues that for reform to succeed, policy-makers need effective methods to analyze relevant political conditions and shape key political factors in favor of policy reform. The method of Political Mapping is briefly introduced as a technique that can help policy-makers in analyzing and managing the political dimensions of policy reform and in improving the political feasibility of reform.

Bangladesh↗
PubMed1995

Practicing pathology as a health care contractor. Business planning for managed care.

Managed care requires a pathology practice to take on the role of a health care contractor whose existence depends on obtaining, managing, and renewing competitively bid contracts for the group's services. This presentation is a primer on how to write a formal business plan for a pathology practice using a model case study to illustrate, among several business issues, the differences between and the key elements for success in operating a pathology practice in both fee-for-service and capitated managed care environments.

Capitation Fee↗
PubMed1999

Primary care in the United States and its precarious future.

Primary care has not secured a firm place within the US health services system. Since primary care lacks a strong research base, is not institutionalized in medical education or in policy-making and is marginalized in both proposed and actual reforms, it has not developed into a central component of the health care infrastructure. We discuss recent efforts that promised modest improvements, including the Clinton health care reform proposals and subsequent federal and state actions, in the role of primary care within the health services system. We also assess the likely fate of primary care given the accelerated growth of managed care and market competition, the dissatisfaction of large segments of the population with managed care and misperceptions of managed care as synonymous with primary care. We highlight how managed care fails to achieve the cardinal functions of primary care and summarize initiatives that, at a minimum, would be required to secure a stronger position for primary care in the future.

Journal Article↗
PubMed2005

Healthcare facility valuation: don't forget the physician factor.

A fair market valuation of healthcare facilities should take into account the impact of physician customers. The "physician factor" affects the facility's competitive environment. Healthcare financial managers need to ensure that analysts understand the facility's competitive alternatives before determining its fair market value.

Economic Competition↗
PubMed1996

[The national health service in the United Kingdom-past, present and future].

Britain's National Health Service (NHS) came into existence in 1948. It was the first comprehensive health system in any Western society to be based on the national provision of services and to offer free medical care to the entire population. The NHS has gone through several developments since, in particular the reorganisations of 1974 and 1982 and the general management overhaul of 1984. Until 1991, however, the NHS kept to the following principles: health service for everyone; sharing of financial costs and free at the point of use; geographical equality; the same high standard of care for everyone; selection on the basis of need for health care; and encouragement of a non-exploitative ethos. Britain's achievement with respect to health care has generally received high praise. Nevertheless, Mrs. Thatcher's government was convinced that the NHS contained a number of serious weakness. This view sprang from the government's belief that, because the NHS did not have a competitive market structure, it lacked an incentive for efficient behaviour. The reforms that were introduced in 1991 were designed to overcome these perceived flaws by creating a limited or internal market in health care, in which multiple providers of services compete with each other for the custom of independent purchasers. Competitive pressures now focus greater attention on patient needs, and the separation of purchasing functions has placed resource allocation under greater scrutiny. Making hospitals financially dependent on general practitioner (GP) referrals has resulted in consultants establishing closer contact with GPs. More is being done in GP surgeries and this has the effect not only of widening the range of general practice but also of raising GP standards. However, there are also some internal problems. Administrative costs have increased steeply, and new inequalities are developing as a consequence of competition. To reduce management costs and to allocate as much of the NHS budget as possible to direct patient care, the government produced and made public its plans for the future structure of NHS management in 1993 and a simplified structure is expected to go into effect by 1996. The Labour Party's document on health and health services in Britain was made public in 1994. The plan rejects the use of competition in the NHS and promises to reverse recent developments, reasserting the importance of the original principles of the NHS. It is too early to reach a verdict on the British experiment. Given the direction of change in Labour's thinking and the fact that the current reforms by the Conservatives are becoming more and more firmly embedded, almost anything is possible.

Forecasting↗
PubMed1996

The new era of hospital epidemiology: what you need to succeed.

Managed care and competition are creating pressures to control costs and prevent adverse outcomes in health care. These forces are also creating a new era in hospital epidemiology, one in which there are many opportunities for the infectious disease physician. The ability to create and administer a hospital epidemiology program is a valuable asset in this environment. Included in hospital epidemiology programs are activities such as infection control, quality management, employee health, risk management, and microbiology and clinical pharmacy consultations. The hospital epidemiologist must be prepared to take advantage of the opportunities created.

Epidemiology↗
PubMed2004

[Paradoxical situation in the organization of work: a threat for workers' mental health].

For the past decades, in a world of high competition, firms struggle to regain an advantage over foreign competition. Thus, new management trends, usually based on price reduction, high quality products and speed production are now part of strategic reorganization plans of high impact on work organization particularly in terms of large demands put on workers, and take a heavy toll on workers. Thus the incidence of mental health problems in the work place has risen sharply in recent years and currently counts as one of the leading causes of work absenteeism. A study based on the psychodynamic of work was conducted among machine operators working in a high-technology company in the aviation sector. Important management and technological transformations were recently introduced in the factory. The content analysis of the study shows that the work organization places the operator in a double bind situation. They are caught between an injunction where the capacity of making a high quality product is directly opposed to that demanding speed production. Moreover, severe and arbitrary sanctions are applied when the operators do not comply with either injunction. The operators are put in a deadlock situation that creates fear and anxiety. They are obliged to turn to defensive psychological strategies such as individualism and cheating. Those defensive strategies have negative impacts on social relationships.

Anxiety Disorders↗
PubMedDate not supplied

The seven deadly sins of physician practice management. How to stop committing them to gain a competitive edge.

Many words have been written about how the marketplace is changing--and hurting--medical group practice. However, not all problems are external. Physicians and managers are doing some of the harm to themselves. "Deadly sins," including a lack of urgency, copycat strategies, trend chasing and the creation of meaningless networks, inhibit growth. Avoiding these mistakes can make it easier to handle those changes group practices can't control.

Economic Competition↗
PubMed1991

Faculty practice plans: the organization and characteristics of academic medical practice.

The contemporary academic medical center is a complex organization providing medical and other professional health education, biomedical and behavioral research, and a comprehensive range of patient care services. This paper presents data from the Association of American Medical Colleges' 1989 survey of 125 member faculty practice plans. The survey data showed that 62% of the 74 responding plans were units or associations within the medical school corporate structure. Plans were organized along a broad continuum from the autonomous, departmental model with decentralized governance and management to the group model with centralized governance and management. The growth of managed care, increased competition, and a greater reliance by the medical school on clinical practice income as a financing source are causing the practice plan to expand beyond billing of professional fees. The survey data showed that 75% of the practice plans operated satellite centers, and 61% planned to build new ambulatory care facilities in order to expand and improve services to patients. The practice plans also have adapted to changes in third-party reimbursement and are establishing mechanisms to negotiate managed care contracts involving multiple clinical departments to increase referrals and maintain patient shares; 86% of the plans participate in at least one managed-care organization. The role of the practice plan will continue to evolve in response to the needs of the academic medical center for a cooperative and supportive environment in which to conduct its traditional missions of teaching, research, and patient care.

Academic Medical Centers↗
PubMed1999

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.

Codes of Ethics↗
PubMed1986

Status of the Medicaid competition demonstrations.

In 1982, the Health Care Financing Administration approved funding for demonstration programs in six States to test a variety of alternative delivery strategies for Medicaid recipients. A number of innovative health service delivery features have been used in these programs, including competition, capitation, case management, and limitations on provider choice. These strategies have been tried in order to address the key Medicaid problems of cost containment and access to appropriate and high quality care. This article provides an overview of how the demonstration sites have approached the task of designing, developing, and implementing their various programs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Recent pre-harvest supplementation strategies to reduce carriage and shedding of zoonotic enteric bacterial pathogens in food animals.

Food-borne bacterial illnesses strike more than 76 million North Americans each year. Many of these illnesses are caused by animal-derived foodstuffs. Slaughter and processing plants do an outstanding job in reducing bacterial contamination after slaughter and during further processing, yet food-borne illnesses still occur at an unacceptable frequency. Thus, it is imperative to widen the window of action against pathogenic bacteria. Attacking pathogens on the farm or in the feedlot will improve food safety all the way to the consumer's fork. Because of the potential improvement in overall food safety that pre-harvest intervention strategies can provide, a broad range of preslaughter intervention strategies are currently under investigation. Potential interventions include direct anti-pathogen strategies, competitive enhancement strategies and animal management strategies. Included in these strategies are competitive exclusion, probiotics, prebiotics, antibiotics, antibacterial proteins, vaccination, bacteriophage, diet, and water trough interventions. The parallel and simultaneous application of one or more preslaughter strategies has the potential to synergistically reduce the incidence of human food-borne illnesses by erecting multiple hurdles, thus preventing entry of pathogens into the food chain. This review emphasizes work with Escherichia coli O157:H7 to illustrate the various strategies.

Animal Feed↗
PubMed1997

Key moral principles applied to managed care.

Although MCOs pose many challenges to the ethics of healthcare delivery, they also have the potential to minimize some previously existing unethical practices. The focus on maximum quality and cost-effectiveness places more demands on the provider with increased accountability. In the old unstructured, noncompetitive healthcare environment, providers were not as accountable to the patient for providing the best quality care at the best price. As home care agencies integrate with managed care networks, outcome measurement becomes increasingly important (National Association for Home Care, 1996). In the managed, integrated market, competition is strong and quality becomes a benchmark when alliances and mergers occur. Home care is in a prime position to be a major player in this new healthcare system and continue to expand services in a capitated environment while being challenged to uphold the ethical practice philosophy outlined in the basic moral principles discussed in this article.

Community Health Nursing↗