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PubMed2001

Assessing the sustainability of agriculture: a case of Mae Chaem Catchment, northern Thailand.

Sustainability is not a new concept but rather a prominent concept at the present time. Researchers have categorized sustainability indicators into economic, social, and ecological aspects. Sustainability of agriculture in the context of development efforts has to meet production efficiency, resilience of ecosystems, appropriate technology, maintenance of the environment, cultural diversity, and satisfaction of the basic needs. The research objective of this study is to determine the critical indicators of agricultural sustainability in the Mae Chaem Catchment, northern Thailand. In assessing sustainability, the authors applied the sustainability indicator analysis developed by FAO. The results of the study show that food sufficiency in the Wat Chan subcatchment is the most sustainable aspect of agriculture. The least sustainable facets of agriculture in the Wat Chan subcatchment are land holding size, land tenure, and water shortage. While expansion of agricultural land in the watershed area is not legally permitted, a practice of agroforestry is recommended. Insecure land tenure may result in reduced incentives to improve land productivity. Thus, official recognition of land ownership is required. As the problem of water shortage is most critical in the lower reaches, increased participation in the allocation scheme by downstream villagers should be encouraged. Finally, the construction of a small-scale water storage in the lower part of the catchment to increase water supply should be considered.

Agriculture↗
PubMed2001

The welfare impact of HMO mergers.

This paper estimates the welfare consequences of HMO mergers using data from California's small-group market. The analysis estimates the parameters from a differentiated products demand system. The parameters are then used to simulate the effects of several HMO mergers by solving for the Nash equilibrium in prices under different ownership structures. Even small mergers in moderately concentrated markets can result in significant consumer surplus reductions. However, these welfare losses can be offset by large efficiency gains. The welfare consequences of HMO mergers turn less upon demand-side considerations than on the health plan's ability to realize efficiencies.

California↗
PubMed2003

Competitive spillovers across non-profit and for-profit nursing homes.

The importance of non-profit institutions in the health care sector has generated a vast empirical literature examining quality differences between non-profit and for-profit nursing homes. Recent theoretical work has emphasized that much of this empirical literature is flawed in that previous studies rely solely on dummy variables to capture the effects of ownership rather than accounting for the share of non-profit nursing homes in the market. This analysis considers whether competitive spillovers from non-profits lead to higher quality in for-profit nursing homes. Using instrumental variables to account for the potential endogeneity of non-profit market share, this study finds that an increase in non-profit market share improves for-profit and overall nursing home quality. These findings are consistent with the hypothesis that non-profits serve as a quality signal for uninformed nursing home consumers.

Aged↗
PubMed2001

Health care under transformation in Poland.

The general health insurance introduced in Poland in 1999 is essentially a social insurance. In this article, the main features of the present health care system are discussed, i.e. the sources and principles of financing, ownership relations, structures, entitlements to obtain medical services and the rules of access to services. Emphasis has been put on the operations of various entities operating within the health care sector, including opportunistic conduct of the providers of services financed from public sources, cost dumping, establishing provider alliances, methods of cost control, and the fact that some patients leave the publicly financed system. In Poland, a parallel private system has been developing for many years. Systemic transformations have not changed that direction, but increased considerably the significance of household income and education as the factors that differentiate patient in equality. This article is concluded with the note on the opportunities for the development of supplementary private insurance.

Financing, Government↗
PubMed1993

Property issues in practice.

This article discusses legal issues relating to property ownership. The primary focus is on land use control laws such as zoning ordinances. Cases involving legal questions over the location and operation of veterinary clinics are discussed. An explanation of how land use contracts work and how veterinarians may encounter them is included. The application of nuisance law is reviewed, and representative cases are discussed. Also included is a discussion of property liability issues and what veterinarians can do to avoid litigation.

Animals↗
PubMed1993

Estate planning for veterinarians.

A veterinarian has many tools from which to choose in forming an estate plan. This article defines the tools and explains the major concepts of which veterinarians should be aware in planning for the use and disposal of their assets. Augmented estates, probate and taxable estates, intestacy rules, trusts, and methods of ownership of property are examined as they relate to the practitioner. Included are possible options to consider with a qualified estate planner.

Financing, Personal↗
PubMed2000

Future of the emergency physician: subject or citizen?

Seventy-seven percent of emergency physicians (EPs) work as either employees or independent contractors (ICs). In contrast, other hospital-based physicians such as radiologists and anesthesiologists have a much higher percentage of ownership in their medical practices. The development of a high percentage of nonownership arrangements among EPs finds a useful historical comparison in the industrialization of nonhealth care workers over the past 100 years. Unless significant changes occur in emergency medicine (EM) organization and practice structures, EPs will have less self-determination over their practice compared with other specialties. This will inevitably result in less self-determination for their future. Combined with the great strides EM has achieved as a specialty, EPs' brightest future lies in being citizens of a broader, more expansive, all encompassing EM practice.

Contract Services↗
PubMed1993

The concept of intellectual property and its implication for oncology.

Oncologists and scientists in oncology centres work in an environment that seeks and promotes innovation and are under an ethical obligation to disseminate new knowledge for the benefit of society. That knowledge (which may give rise to intellectual property rights) may have substantial commercial value, and with it comes the need to protect employers' and employees' legitimate interests through patents and copyright. Employers and employees may not fully appreciate the legal and ethical obligations surrounding ownership of such knowledge, so both should co-operate in formulating policies which balance the need for disseminating new knowledge and the need to protect institutional interests. This is particularly appropriate for the new NHS trusts which may undertake research jointly with commercial organizations. This article outlines the important issues for consideration.

Copyright↗
PubMed1995

Survey of radiographic practices of general dentists for the dentate adult patient.

OBJECTIVE: The purpose of this study was to assess the radiographic practices of general dentists with emphasis on the influence of education on these practices. METHODS: Data were obtained from a mail survey of a stratified random sample of 963 general practitioners in Ontario, Canada, who graduated from the two provincial dental schools. Descriptive statistics were used, and associations were tested by Pearson's chi 2 analysis. RESULTS: The adjusted response rate was 80%. For the new patient, 62% of respondents chose a type of predetermined protocol with the panoramic/bite-wing survey as the predominant choice. Only 37% of respondents chose to prescribe selectively according to the patient's needs. For recall patients, 55% of dentists used selective radiography, and of those who chose a protocol, the vast majority preferred bite-wing radiographs only. CONCLUSIONS: Three influences on the dentists' choice of radiographic examination as suggested by the data were dental education, ownership of a panoramic unit, and who exposed the radiographs. These associations were statistically significant.

Adolescent↗
PubMed1998

Overcoming the barriers: national to European to G7.

An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general public. This revolution offers enormous potential benefits to global health but there is also potential for harm. There are a wide range of barriers to realising the potential benefits. They lie in areas such as the protection of personal information; ownership and legal accountability; data meanings: structures and database navigation; deficiencies in the global Internet and lack of access by many communities. This paper considers the nature of those barriers. In 1994, the Group of Seven Nations launched an initiative to stimulate a global information society. Theme 8 deals with healthcare and therein Sub-project 5 'Enabling Mechanisms', which the author leads, is seeking to identify barriers and the authoritative international sources of advise and good practice. It is conducting an international survey, the results of which should be published by the end of 1997. This paper describes the aims of this Sub-project.

Computer Communication Networks↗
PubMed2000

Role of education in reducing child labour: evidence from rural Bangladesh.

This paper explores the hypothesis that the level of education of children and their parents plays a major role in reducing child labour. Data were generated from a sample survey of 3809 children aged 10-14 years living in 150 villages in two rural districts of Bangladesh. A significant inverse relationship was found between child labour and years of schooling. Age and education of children, parental education, land ownership of household and fathers' occupation were the determinants of child labour force participation. Child's years of schooling is the variable that has most influence on the probability of participation in the labour force, followed by father's and mother's education.

Adolescent↗
PubMed2000

A comparison of the stress-strain process for business owners and nonowners: differences in job demands, emotional exhaustion, satisfaction, and social support.

One hundred sixty licensed morticians were surveyed to examine differences among business owners, managers, and employees on the relations proposed by G. F. Koeske and R. D. Koeske's (1993) stressor-strain-outcome model. Forty-eight percent of the morticians were owners, 16% were managers, and 36% were employees. Owners had less social support from work-related sources and perceived lower levels of role ambiguity and role conflict, less emotional exhaustion, and higher levels of job satisfaction and professional satisfaction than did nonowners. Social support from work-related sources and ownership each moderated the relationship between emotional exhaustion and job satisfaction but not between emotional exhaustion and professional satisfaction. Emotional exhaustion partially mediated the effect of stressors on job satisfaction and professional satisfaction.

Adult↗
PubMed2001

Organizational attractiveness of firms in the People's Republic of China: a person-organization fit perspective.

The authors investigated factors related to firm attractiveness as an employer in the People's Republic of China. The organizational attributes of type of ownership, nationality of the supervisor, and firm familiarity in organizational descriptions were manipulated and their effects were measured on firm attractiveness. In addition, the authors adopted a person-organization fit perspective to investigate how individual difference characteristics moderated the effects of these organizational attributes on attractiveness. Although, in general, participants were more attracted to foreign than state-owned firms and to familiar than unfamiliar firms, results provided support for the person-organization fit perspective in that the individual differences moderated the effects of the organizational attributes on firm attractiveness. For example, participants were more attracted to state-owned versus foreign firms when they were more risk averse and had a lower need for pay. Thus, the results provide initial support for the generalizability of the person-organization fit perspective to a non-Western setting.

Adult↗
PubMed2000

A study of the career development of male and female dental practitioners.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the positions they occupy within their employment, and to analyse the correlates of such differences. METHOD: Postal questionnaire survey of a 1 in 10 sample of individuals taken from the General Dental Council register. RESULTS: Female dental practitioners occupy lower positions in the employment hierarchies of the Community Dental Service and the Hospital Dental Service. Women general dental practitioners are significantly less likely to be sole proprietor of, or a partner in, a general practice. Ownership of a general practice is related to: sex, age, number of years qualified, number of children, and hours worked. Consultants in the Hospital Dental Service are more likely to be male, older, to have been qualified longer and (obviously) to hold more additional qualifications than their non-consultant colleagues. Senior Dental Officers and Directors of the Community Dental Service are more likely to be male, work longer hours and (again obviously) to hold more additional qualifications than Community Dental Officers. CONCLUSIONS: Differences exist between male and female dental practitioners in the positions they occupy within employment hierarchies. Age, length of time since qualification and the acquisition of additional qualifications are consistently found to differentiate dental practitioners' status.

Adult↗
PubMed1998

Managing genetic material to protect intellectual property rights.

One of the most important policy instruments for the promotion of further biotechnology development is intellectual property right (IPR) protection. However, one cannot improve upon a biotechnological invention without physical access to the germplasm, making exchanges of genetic material necessary. A formal transfer agreement, which addresses the key issues of ownership, access, use, and equitable benefit-sharing, is a powerful legal instrument for intellectual property. Other restrictions are generally imposed as a result of national and international safety regulations. Forming strategic alliances, such as joint ventures, collaborative research agreements, joint research and development agreements, and manufacturing and distribution alliances to exploit the economic value of genetic material, provides scientists with the mechanisms they need to bring their research material and products to the marketplace.

Biotechnology↗
PubMedDate not supplied

Profit-making in the treatment of chronic kidney disease: truth and consequences.

Many have speculated that the quality of dialysis care differs for patients treated in for-profit and not-for-profit facilities. In 1999 we published a study that demonstrated poorer survival and lower rates of listing for renal transplant for patients in for-profit rather than not-for-profit, freestanding centers. While these findings generated substantial discussion, few have commented on their implications. In this article we first discuss potential sources of bias that could impact on the study's results and place the findings in context. We conclude that these disparities are likely to be real, as they are consistent with theorized differences between for-profit and not-for-profit health care organizations and with other evaluations of dialysis facility ownership. We then discuss several policy options for addressing the quality differences we identified. Reducing the outcome discrepancies will not be easy. Upon considering several policy alternatives, we conclude that a widespread effort to link processes of dialysis care to patient outcomes is best suited to reduce the quality differences between for-profit and not-for-profit dialysis units and improve outcomes in both types of facilities.

Ethics, Institutional↗
PubMed2006

Factors influencing route of administration for epoetin treatment among hemodialysis patients in the United States.

BACKGROUND: Published clinical guidelines advocate subcutaneous (SC) administration for epoetin therapy, although this is practiced among only 7% of all hemodialysis patients. Despite this disparity, few studies have examined factors associated with route of epoetin administration in hemodialysis patients. METHODS: Data from the Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project were used to identify 13,854 patients receiving hemodialysis in 3,069 dialysis facilities from October to December in 1999 and 2000. Unadjusted associations were examined by using t-test and chi-square test. Adjusted associations were estimated by using generalized estimating equations to control for clustering of patients within the same dialysis facility. RESULTS: In the United States, use of the SC route of epoetin administration varies widely across the country. After adjusting for patient sociodemographics and comorbidities, the greatest rates of SC therapy are found in the Midwest and West, in providers not affiliated with chains, and in hospital-based and not-for-profit freestanding units. Previous exposure to SC administration (as a predialysis or peritoneal dialysis patient) predicted subsequent SC use, for-profit and large chains were significantly less likely to use SC administration, and increased use of injectable drugs overall (to maximize income) was associated with less SC use. CONCLUSION: In addition to regional variation in SC use, study findings indicate that physician decision making for epoetin administration route is influenced primarily by type of ownership and financial incentives. Adherence to published clinical guidelines was not a consistent predictor of SC use. Given the similar effectiveness, but significantly decreased dose associated with SC epoetin, these findings suggest an enormous opportunity for cost savings for the Medicare program.

Adult↗
PubMed1992

Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians.

BACKGROUND: There is widespread concern that ownership by physicians of testing or treatment facilities to which they refer patients leads to overuse of such facilities. We determined the patterns of use of three services--physical therapy, psychiatric evaluation, and magnetic resonance imaging (MRI)--among physicians treating patients whose care was covered under workers' compensation. We then compared the rates of use among physicians who referred patients to facilities of which they were owners (self-referral group) with the rates among physicians who referred patients to independent facilities (independent-referral group). METHODS: We used a large data base to analyze claims under workers' compensation in California from October 1, 1990, through June 30, 1991, to determine the frequency and cost of these three selected services and determined whether the referring physicians were practicing self-referral or independent referral. We evaluated the cost per case for all three services, measured the frequency with which physical therapy was initiated, and evaluated the medical appropriateness of MRI. RESULTS: We found that physical therapy was initiated 2.3 times more often by the physicians in the self-referral group (68 percent) than by those in the independent-referral group (30 percent; P < 0.01). The mean cost per case for physical therapy was significantly lower in the self-referral group ($404 +/- 102) than in the independent-referral group ($440 +/- 167; P < 0.01). The mean cost of psychiatric evaluation services was significantly higher in the self-referral group than in the independent-referral group (psychometric testing, $1,165 +/- 728 vs. $870 +/- 482; P < 0.01, psychiatric evaluation reports, $2,056 +/- 1,063 vs. $1,680 +/- 578; P < 0.01). The total cost per case of psychiatric evaluation services was 26.3 percent higher in the self-referral group ($3,222 +/- 1,451) than in the independent-referral group ($2,550 +/- 742; P < 0.01). Of all the MRI scans requested by the self-referring physicians, 38 percent were found to be medically inappropriate, as compared with 28 percent of those requested by physicians in the independent-referral group (P < 0.05). There was no significant difference in the cost per case between the two groups. CONCLUSIONS: This study demonstrates that self-referral increases the cost of medical care covered by workers' compensation for each of the three types of service studied.

Ambulatory Care Facilities↗