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PubMed2002

Investigating the physician-patient relationship: examining emerging themes.

By extending Millar and Roger's (1976) relational theory, this study examined how the physician-patient relationship was negotiated in the context of a clinical visit. Analysis of observational data obtained during the clinical visits of 1 female family practice physician revealed 5 themes central to the construction of her relationships with patients. The 5 themes included control, role negotiation, trust, health care commitment, and interrelated issues of time and money.

Adolescent↗
PubMed2001

Radiotherapy equipment--purchase or lease?

Against a background of increasing demand for radiotherapy equipment, this study was undertaken to investigate options for equipment procurement, in particular to compare purchase with lease. The perceived advantages of lease are that equipment can be acquired within budget and cashflow constraints, with relatively low amounts of cash leaving the NHS in the first year, avoiding the necessity of capitalizing the equipment and providing protection against the risk of obsolescence associated with high technology equipment. The perceived disadvantages of leasing are that the Trust does not own the equipment, leasing can be more expensive in revenue terms, the tender process is extended and there may be lease conditions to be met, which may be costly and/or restrictive. There are also a number of technical considerations involved in the leasing of radiotherapy equipment that influence the financial analysis and practical operation of the radiotherapy service. The technical considerations include servicing and planned preventative maintenance, upgrades, spare parts, subsequent purchase of "add ons", modification of equipment, research and development work, commencement of the lease period, return of equipment at the end of the lease period and negotiations at the end of the lease period. A study from Raigmore Hospital, Inverness is described, which involves the procurement of new, state-of-the-art radiotherapy equipment. This provides an overview of the procurement process, including a summary of the advantages and disadvantages of leasing, with the figures from the financial analysis presented and explained. In addition, a detailed description is given of the technical considerations to be taken into account in the financial analysis and negotiation of any lease contract.

Hospital Costs↗
PubMed2003

The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and changing experience.

This thoughtful essay conveys a logically ordered series of concepts that may help develop a process to more fully integrate evidence into healthcare management decisions. In responding to this article we have tried to think broadly about what might be discovered if the ideas of Browman, Snider and Ellis were put into practice. We have chosen to focus on factors that could confound the five-point plan suggested by the authors. Browman, Snider and Ellis provide an interesting overview and advocacy for evidence-based medicine and its application. The authors recognize that the area under investigation, oncology, may lend itself more readily than others to the facilitation of evidence-based practice. They introduce the concept of healthcare as a negotiating environment and the healthcare manager as a potential catalyst for change. In their conclusions the authors offer healthcare managers a five-point plan: 1. Express the value that knowledge is a core resource. 2. Structure decision-making to involve the stewards of knowledge and stimulate negotiation while encouraging the parties to express shared goals. 3. Invest in strategies that support knowledge management, including arbitration. 4. Demonstrate leadership and develop organizational metaphors to encourage participation. 5. Share the results and experiences of evidence-based decision-making.

Decision Making, Organizational↗
PubMed2003

A culture of expertise, not conflict.

Browman, Snider and Ellis propose that managers act as catalysts to institute structures for the negotiation of differences between managers and clinicians, primarily around the perceived trade-offs between quality care and resource allocation. Evidence-based medicine and evidence-based management are required to level the playing field, so that quality of care will not suffer "at the expense of the business agenda which is easier to measure and manage." But implementation of evidence-based management and evidence-based medicine depends on the quality of knowledge production and the ability to adapt general knowledge to particular organizations. Agreement on guidelines for evidence-based management is problematic and complicated by the nature of management research itself. Rather than the metaphor of the negotiating environment, which assumes an adversarial relationship between management and clinicians, a more fruitful metaphor is the expert environment, which assumes a collaborative relationship between the two. Management should not only be a catalyst for change but should also assume the responsibility of cultivating clinical and managerial expertise at all levels of the organization, from custodian to surgeon.

Decision Making, Organizational↗
PubMed2003

Disrupting the sexual double standard: young women's talk about heterosexuality.

Despite significant changes in the social landscape over the past two decades, much ethnographic research suggests that young women's negotiations of (hetero)sexuality remain dominated by the sexual double standard. Within the sexual double standard, an active, desiring sexuality is positively regarded in men, but denigrated and regulated by negative labelling in women. This article analyses young women's talk on the subject of negotiating (hetero)sexual relationships, drawn from focus-group interviews with six groups of young women aged 16-18 years. A feminist, post-structuralist form of discourse analysis is used to analyse the material, the aim being to examine young women's talk about (hetero)sexuality from the standpoints of agency and resistance. Analyses identified various ways in which the sexual double standard was disrupted, including challenging the language of the sexual double standard, articulating sexual desire, and positioning of self and (hetero)sex within alternative discourses. The findings also suggest, however, that voices of resistance to the sexual double standard may be muted and individual rather than collective, and that, accordingly, every effort should be made by those working with young women to recognize and support attempts to disrupt the sexual double standard.

Adolescent↗
PubMed1998

Legal considerations for periodontists in dealing with managed care organizations.

For well over a decade, increasing numbers of medical patients have transferred from traditional indemnity insurance to managed care organizations (MCOs). Increasingly, MCOs are enrolling dental patients as well. Consequently, it is important for periodontists to understand issues in negotiating with MCOs. This article attempts to advise periodontists regarding what they can and cannot do collectively about managed care and what considerations they should take into account in individually negotiating and dealing with managed care plans.

Antitrust Laws↗
PubMed2006

Making big tobacco give in: you lose, they win.

OBJECTIVES: To better understand how the tobacco industry responds to tobacco control activists, we explored Philip Morris's response to demands that consumers in developing countries be informed about smoking risks, and analyzed the implications of negotiating with a tobacco company. METHODS: We reviewed internal tobacco industry documents and related materials, constructed a case history of how Philip Morris responded to a shareholder campaign to require health warnings on cigarettes sold worldwide, and analyzed interactions between (1) socially responsible investment activists, (2) Philip Morris management, (3) institutional investors, and (4) industry competitors. RESULTS: After resisting for 11 years, Philip Morris unilaterally reversed direction, and proposed its own labeling initiative. While activists celebrated, Philip Morris's president detailed privately how the company would yield little and benefit disproportionately. Activists portrayed the tobacco industry as preying on the poor and uneducated and used delegitimization to drive a wedge between the industry and its financial and political allies. When Philip Morris "gave in" to their demands, it exchanged negative publicity for positive public relations and political credibility. CONCLUSIONS: Tobacco companies can appear to accommodate public health demands while securing strategic advantages. Negotiating with the tobacco industry can enhance its legitimacy and facilitate its ability to market deadly cigarettes without corresponding benefits to public health.

Community Participation↗
PubMed1993

Onsite psychological evaluation of a hostage taker.

Many law enforcement agencies have responded to the challenge of dealing with hostage situations by developing negotiation teams that include psychological consultants. These consultants are useful in determining whether the hostage taker is mentally ill and suggesting possible strategies for negotiation. The traditional psychological evaluation must be modified to fit the unique stresses and requirements of a hostage situation. Suggested is an onsite assessment that includes a mental status evaluation based on observation of a client and a selective history taken from collateral sources.

Crisis Intervention↗
PubMed2003

King and Miles' Equity Sensitivity Instrument: a cross-cultural validation.

To investigate the relation between equity sensitivity and negotiators' cooperative behaviors King and Miles' Equity Sensitivity Instrument was translated into Spanish and administered to 50 Mexican industrial exporters. Cronbach alpha was .86. Correlations between equity sensitivity scores and negotiators' perceptions of their own cooperative behaviors ranged from .36 to .71.

Adult↗
PubMed1993

Learning by mutual commitment: broadening the concept of learning contracts.

A learning environment where students may negotiate with the course directors on the objectives and contents of a course, and where the teachers from pre-stated teaching and pedagogical obligations, may also negotiate with the students on what realistic demands they can meet when adjusting to individual students' needs, could be regarded as a set-up where learning by mutual commitment takes place. In order to support and to elaborate on reported experiences from using contracts as a learning device (Solomon, 1992), experiences gained from the Medical School of Witten/Herdecke, Germany, will be presented.

Education, Medical↗
PubMed2001

Resolving conflict realistically in today's health care environment.

Conflict is a natural part of human interaction, and when properly addressed, results in improved interpersonal relationships and positive organizational culture. Unchecked conflict may escalate to verbal and physical violence. Conflict that is unresolved creates barriers for people, teams, organizational growth, and productivity, leading to cultural disintegration within the establishment. By relying on interdependence and professional collaboration, all parties involved grow and, in turn, benefit the organization and population served. When used in a constructive manner, conflict resolution can help all parties involved see the whole picture, thus allowing freedom for growth and change. Conflict resolution is accomplished best when emotions are controlled before entering into negotiation. Positive confrontation, problem solving, and negotiation are processes used to realistically resolve conflict. Everyone walks away a winner when conflict is resolved in a positive, professional manner (Stone, 1999).

Adaptation, Psychological↗
PubMed1995

Arranged marriages, unlikely partners. How will their offspring look?

In the new era of managed care, many religious healthcare providers are making "arranged marriages"--permanent partnerships with secular organizations. As they do so, the religious partners naturally ponder how best to ensure that their values permeate the new entity and thus prevail in later organizational "offspring." The organizations most likely to perpetuate their values are those with ethical corporate cultures and climates. These include religiously based healthcare providers, but such providers seem to lack confidence today in their ability to maintain culture and climate in newly formed partnerships. That may be fortunate because it prevents them from trying to impose their values on secular partners. Nevertheless, such values are often attractive to a prospective partner. A religious healthcare provider will need market leverage, as well as attractive values, to make a good "marriage." Even so, religious providers and secular investor-owned organizations are unlikely partners, because their motives and incentives differ radically. But religious providers can form solid relationships with secular, not-for-profit healthcare organizations if they take care to negotiate a binding commitment to maintain an ethical culture and climate. However, Catholic providers are at a disadvantage in such negotiations because Catholic religious congregations are unlikely to continue as owner-sponsors much beyond another decade. It is crucial that a stable source of influence develop to ensure a religious presence in the offspring of new partnerships.

Ethics, Institutional↗
PubMed1996

How PHOs can avoid price-fixing charges.

Last fall, the U.S. Department of Justice (DOJ) sent the message to PHOs that when negotiating with third parties, they need to be careful not to break antitrust laws, or they could face heavy monetary damages--or even criminal liability. In settlements with PHOs in Danbury, Connecticut, and St. Joseph, Missouri, the DOJ said that PHOs could not become involved in pricing decisions unless they acted in one of two ways: as a qualified managed care plan in which providers share financial risk or as a messenger between providers and third parties. The two cases show how networks may and may not engage in negotiations with payers.

Antitrust Laws↗
PubMed1996

Disease management: a contracting primer.

This article provides an understanding of the issues and steps that are required for negotiating a disease management contract. Because most of the author's experience derives from representing pharmaceutical companies and other provider driven entities, the tenor of the comments often reflects that perspective on negotiations. This article focuses on disease management contracting whereby a provider network or case manager assumes risk relating to the cost of providing care to a certain type of patient.

Budgets↗
PubMed1997

Tax-exempt/proprietary partnerships: how the deal gets done.

Joint venture partnerships between tax-exempt healthcare providers and proprietary companies represent a type of provider-sponsored network. Tax-exempt /proprietary partnerships can help tax-exempt providers attain their strategic objectives and, at the same time, retain some governance involvement and healthcare decision-making authority. Proprietary companies that enter into such partnerships are able to expand their market presence and revenue potential without spending capital on an acquisition. Proprietary companies also gain the tax-exempt partners' goodwill, which could take them years to develop on their own. Before negotiating a partnership agreement, potential partners must assess their respective financial, cultural, organizational, and strategic strengths and weaknesses as well as their overall compatibility. Then they must develop contract terms to bring into the partnership negotiations. These terms include purpose, legal structure, assets/liabilities, governance, management, valuation, profit/loss sharing, capitalization/working capital, human resources, withdrawal from the partnership, noncompete covernants, and tax exemption issues.

Capital Financing↗
PubMed1997

Avoiding managed care pricing pitfalls.

Healthcare providers, concerned about competing as managed care proliferates, have attempted to negotiate as many contracts as possible to secure market share. Economic theory suggests that, in the short run, any contract that yields incremental revenues in excess of incremental costs is desirable. However, the marginal costs associated with managed care contracts can have serious financial consequences. Maimonides Medical Center (MMC), New York, New York, had negotiated a variety of payment terms and methods for inpatient healthcare services--including discounts off the Federal DRG rate, discounts off the state-regulated case-payment rate for managed care companies, global pricing, per-diem rates, and capitation--with more than 15 managed care companies. As market incentives changed, however, contract decisions that had been made either "on the margin" or in response to market-driven prices did not always improve financial performance over the long term. Some of the unexpected pitfalls MMC encountered were dual discounting and adverse risk selection.

Capitation Fee↗
PubMed1998

Combating silent PPOs.

A silent PPO is a contracting entity that negotiates discounts with providers but sells access to the discounts to other, nonrelated parties after services are provided to individuals covered by the nonrelated parties' insurance policies. Healthcare financial managers should be alert to the presence of silent PPOs when entering into contract negotiations. To combat silent PPOs, a two-pronged approach--prevention and detection--is advisable. Factors to consider include appropriate contract language stating that all clients with access to the discounts have a contract with the PPO, presence of the PPO's logo on a patient's insurance card, and the PPO's willingness to limit the number of providers in its network. Warning signs that indicate the presence of a silent PPO include a high volume of retroactive reclassifications, single employers taking discounts from multiple PPO networks, or payments for services provided to single individuals coming from multiple PPO networks.

Contract Services↗
PubMed1999

Factors affecting bargaining outcomes between pharmacies and insurers.

OBJECTIVE: To model the bargaining power of pharmacies and insurers in price negotiations and test whether it varies with characteristics of the pharmacy, insurer, and pharmacy market. DATA SOURCES/STUDY SETTING: Data from four sources. Pharmacy/insurer transactions were taken from Medstat's universe of 6.8 million pharmacy claims in their 1994 Marketscan database. Sources Informatics, Inc. supplied a three-digit zip code-level summary database containing pharmacy payments and self-reported costs for retail (cash-paying) customers for the top 200 pharmaceutical products by prescription size in 1994. The National Council of Prescription Drug Programs supplied their 1994 pharmacy database. Zip code-level socioeconomic and commercial information was taken from Bureau of the Census' 1990 Summary Tape File 3B and 1994 Zip Code Business Patterns database. STUDY DESIGN: The provider/insurer bargaining model first employed in Brooks, Dor, and Wong (1997, 1998) was adapted to the circumstances surrounding pharmacy and insurer bargaining. DATA COLLECTION/EXTRACTION METHODS: The units of observation in this study were single Medstat claims for each unique insurer/pharmacy combination in the database for selected pharmaceutical products. The four products selected varied in the conditions they treat, whether they are used to treat chronic or acute conditions, and by their sales volume. Used in the analysis were 9,758 Zantac, 2,681 Humulin, 3,437 Mevacor, and 1,860 Dilantin observations. PRINCIPAL FINDINGS: We find statistically significant variation in pharmacy bargaining power. Pharmacy bargaining power varies significantly across markets, insurers, and pharmacy types. With respect to market structure, pharmacy bargaining power is negatively related to pharmacies per capita and pharmacies per employer and positively related to pharmacy concentration at higher concentration levels. In addition, the higher the percentage of independent pharmacies in an area, the lower the pharmacy bargaining power. With respect to socioeconomic conditions, pharmacy bargaining power is higher in areas with lower per capita income and higher rates of public assistance. CONCLUSIONS: The bargaining power of pharmacies in contract negotiations with insurers varies considerably with exogenous factors. Local area pharmacy ownership concentration enhances pharmacy bargaining. As a result, anti-trust law prohibiting the collective bargaining of independent pharmacies with insurers leaves independents at a disadvantage with respect to chains.

Commerce↗