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At least 19 recordsLinked to original sources
PubMed1995

The patient as the pivot point for quality in health care delivery.

Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed.

Models, Organizational↗
PubMed1996

[Current models in health insurance and health care delivery].

Health care organizations similar to American HMOs have recently appeared in Switzerland. They elicit many reactions, both in the general public and among the medical profession. In contrast to traditional health insurance, HMOs organize and actively manage health care delivered to their members. This paper reviews the historical background of similar organizations in Europe and in the United States, and focuses in particular on the recent evolution and fragmentation of the concept of "managed care". Follows a discussion of the mechanisms and the side-effects of various tools used to manage care, both in managed care settings and by traditional health insurance plans. It appears that all of health care is managed, that all management tools have potential side effects, and that use of some management tools implies a redistribution of the respective roles of plan members, administrators, and physicians. The authors suggest that the complexity of health care management requires a more active implication of the health professions in that process.

Delivery of Health Care↗
PubMed1996

The role of reengineering in health care delivery.

Health care reengineering is a powerful methodology that helps organizations reorder priorities, provide more cost-effective care, and increase value to customers. It should be driven by what the customer wants and what the market needs. Systemwide reengineering integrates three levels of activity: managing community and health plan partnerships; consolidating overlapping delivery system functions among participating providers and vendors; and redesigning administrative functions, clinical services, and caregiving programs to improve health status. Reengineering is not a panacea; it is a critical core competency and requisite skill for health care organizations if they are to succeed under managed care in the future.

Chronic Disease↗
PubMed1982

Pharmacy in the health care center: a model for health care delivery.

Health care consumers use a plethora of services which are accessible on an ambulatory basis. These include the services of pharmacists, optometrists, nurses, dentists, audiologists, orthotics, and so forth. Since many of these services are provided in physically and financially separate facilities and often are not located in close proximity to one another, consumers may spend a large amount of time traveling between locations. Economic inefficiencies due to the size and dispersion of separate and independent facilities may produce an increase in the cost of ambulatory health care services. Thus, the concept of a health care center, an ambulatory health care analog to the multispecialty shopping center, is proposed as a potential alternative and improvement in the delivery of these services. Space, location, personnel, and initial capital requirements for a model health care center are projected based on existing data for the establishment of each separate auxiliary health care facility. Projections are made to determine the appropriate and necessary site for the health care center's trade area. Potential revenues are calculated by examining some pharmacy operations which are beginning to pioneer these areas and utilizing revenue figures for the various individual services. The results indicate that the pharmacy, as a frequently visited health care facility, may be an excellent choice around which to develop the health care center concept in metropolitan areas.

Ambulatory Care Facilities↗
PubMed1973

Small area variations in health care delivery.

Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health.

Clinical Laboratory Techniques↗
PubMed2002

Evaluating new health information technologies: expanding the frontiers of health care delivery and health promotion.

The modern health care system is being irrevocably changed by the development and introduction of new health information technologies (such as health information systems, decision-support tools, specialized websites, and innovative communication devices). While many of these new technologies hold the promise of revolutionizing the modern health system and facilitating improvements in health care delivery, health education, and health promotion, it is imperative to carefully examine and assess the effectiveness of these technological tools to determine which products are most useful to apply in specific contexts, as well as to learn how to best utilize these products and processes. Without good evaluative information about new technologies, we are unlikely to reap the greatest benefits from these powerful new tools. This chapter examines the demand for evaluating health information technologies and suggests several strategies for conducting rigorous and relevant evaluation research.

Biomedical Technology↗
PubMed2001

The role of wireless technology in home care delivery.

Health care delivery is changing drastically. In its current state it tends to use the home care model in order to increase quality of life, to rationalize costs and to achieve wellness. Pivotal to these purposes are contact centers, which act as mediators between the medical staff and the citizens seeking advice and/or therapy. Main platforms used for the development of such applications are the INTERNET and PCs, and the telecommunication networks, including mobile solutions. In this paper, a generic contact center model shall be presented, which is under development in the context of an IST European project in health telematics entitled â Distance Information Technologies for Home care. The Citizen Health System (CHS)'. After the description of this generic contact center, an application for health care delivery to diabetic patients shall be described. In this application we shall see the possible use of the Wireless Application Protocol (WAP) scheme. This application proves the usefulness of wireless technology in providing health care services all around the clock and everywhere the citizen is located, it shows the necessity for restructuring the medical knowledge for education delivery to the patient, and it shows the virtue of interactivity by means of using the limited, yet useful browsing capabilities of the WAP technology.

Computer Communication Networks↗
PubMed1994

Home health care: the pivotal link in the creation of a new health care delivery system.

Health care reform has challenged the home care industry to reemerge as the primary site for the delivery of health care, just as it was in the beginning of the 20th century. The factors driving the growth in this industry are discussed in this article, with an overview of what can be expected in a managed care environment. An analysis of the current marketplace and predictions for the expanded role of the home health care industry in the future are outlined.

Capitation Fee↗
PubMed1994

Special report on health care delivery systems. Trends in the integrated delivery of health care and the corporate practice of medicine.

The prospects for federal legislation preempting state corporate practice restrictions are unclear. The health care reform bill originally introduced by President Clinton contained a provision that would have preempted "any state law related to the corporate practice of medicine" insofar as it applied to the arrangements between non-fee-for-service health plans and their participating providers. H.R. 3600/S. 1757, 103d Cong., 1st Sess. 1407(b) (1993). Whether and in what form a preemption provision may survive the legislative process and see a Presidential signature remains to be seen. The particular fate of the federal legislation notwithstanding, however, health care executives can nevertheless remain confident that the legal treatment of the "corporate practice" of medicine will continue to be of vital concern as the various forms of health care organizations evolve in the ongoing struggle to deliver quality medicine at affordable prices.

Commerce↗
PubMed2006

The impact of subspecialty services on health care delivery--a community health centre based study.

OBJECTIVES: The objective was to evaluate the role of a paediatric surgical consultant at a primary health care facility. DESIGN: Descriptive and prospective. SETTING: In the process of planning and implementation of the 2010 health plan of the Provincial Government of the Western Cape, a shift occurred in the delivery of health care to children from a provincially based hospital system to a municipally based primary health care system. To contribute towards enabling this process, the Department of Paediatric Surgery at Red Cross War Memorial Children's Hospital established a paediatric surgical day clinic at a local community health centre during 2001. SUBJECTS: Information was obtained from patient data sheets containing details of consultations at the sub-specialist surgical clinic at Michael Mapongwana Community Health Centre. RESULTS: Over a 58-month period 1 171 children were seen, of whom 655 were male and 427 female. Their ages ranged from 0 to 19 years, the largest group being under 1 year. Eighty per cent of patients were accompanied by their mothers. The correct diagnosis was established by the nurse practitioners in 71%. General paediatric surgical conditions predominated, followed by medical, dermatological, orthopaedic, trauma, otolaryngo-pharyngology, infectious diseases, ophthalmology, urology, neurosurgery, malignancy and maxillofacial conditions. The details are set out in the report. In total 597 patients were referred directly to an appropriate care facility and 574 patients could be managed entirely at the clinic level. CONCLUSIONS: This study demonstrated the significant public health problem of paediatric surgical disease. It emphasized the preventative and cost-effective role of a surgical clinic at primary health care level. The clinic allowed for timely surgical intervention in 65% of surgical cases, thereby decreasing inappropriate tertiary referrals. We believe that bringing specialists into the community can only strengthen the 2010 health care plan.

Adolescent↗
PubMed1989

Rural America. Unique opportunities for health care delivery and health services research.

A general deterioration is occurring in the quality of life of rural Americans, and it is affecting the quality of health and mental health service delivery. About 24% of the U.S. population lives in nonmetropolitan areas where the citizens are older, less well educated, have lower incomes, and are more homogeneous in terms of race and ethnicity. Medicare and private insurance discriminate against rural services in their reimbursement policies, and there is a shortage of health personnel in rural areas. However, there has been renewed congressional action to meet rural needs. Both the House and Senate have established rural caucuses, and an Office of Rural Health Policy has been established in the federal executive branch. Legislative successes were achieved between 1985 and 1988. Rural initiatives will provide psychology with unique opportunities in the next several years.

Delivery of Health Care↗
PubMed1994

Reforming the health care delivery system.

The health care delivery system is evolving rapidly. There have been changes in the way health care is financed, the types of treatments available, the sites of care, and the physician patient relationship. These changes have resulted primarily from reactions to health care cost inflation. Health care reform is likely to accelerate some of these changes. The threat/promise of health care reform has already accelerated the consolidation of the health care services market. Health care reform is likely to reduce the number of insurers, increase the number of Americans in managed health care plans, increase the number of physicians in group practice, change provider income, and in general make the health care delivery system more concentrated and vertically integrated.

Cost Control↗
PubMed1995

General hospital psychiatry and the new behavioral health care delivery system.

Mental health care delivery has undergone substantial changes in recent years. This article reviews the evolution of managed care in the mental health care field and outlines managed behavioral health care techniques used in providing access to high-quality, cost-effective care. The expansion of general hospital psychiatry over the last 25 years is also reviewed. Current strengths of general hospital psychiatry which make it well positioned for an expanded role in behavioral health care delivery are examined. Recommendations are made for further improvements in the clinical, administrative, and financial aspects of general hospital psychiatry care delivery to prepare it for the integrated behavioral health care systems of tomorrow.

Behavior Therapy↗