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Health Care Sector (health + care_sector)
Selected AbstractsHealth Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally,DECISION SCIENCES, Issue 2 2009Kingshuk K. Sinha ABSTRACT This article is motivated by the gap between the growing demand and available supply of high-quality, cost-effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences,including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end-to-end, supply chain,centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain,centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A-framework, that is founded on three constructs,affordability, access, and awareness,to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device,based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high-quality, cost-effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article. [source] Wage policy in the health care sector: a panel data analysis of nurses' labour supplyHEALTH ECONOMICS, Issue 9 2003Jan Erik Askildsen Abstract Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labour supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993,1998 to estimate wage elasticities. The data set includes detailed information on 19 638 individuals over 6 years totalling 69 122 observations. The estimated wage elasticity after controlling for individual heterogeneity, sample selection and instrumenting for possible endogeneity is 0.21. Individual and institutional features are statistically significant and important for working hours. Contractual arrangements as represented by shift work are also important for hours of work, and omitting information about this common phenomenon will underestimate the wage effect. Copyright © 2003 John Wiley & Sons, Ltd. [source] The dynamics of the health labour marketINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2006Marko Vujicic Abstract One of the most important components of health care systems is human resources for health (HRH),the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour,doctors, nurses and other providers,those who demand labour, and how these actors respond to incentives when formulating health workforce policy. Copyright © 2006 John Wiley & Sons, Ltd. [source] A stratified first order logic approach for access controlINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 9 2004Salem Benferhat Modeling information security policies is an important problem in many domains. This is particularly true in the health care sector, where information systems often manage sensitive and critical data. This article proposes to use nonmonotonic reasoning systems to control access to sensitive data in accordance with a security policy. In the first part of the article, we propose an access control model that overcomes several limitations of existing systems. In particular, it allows us to deal with contexts and to represent the two main kinds of privileges: permissions and prohibitions. This model will then be formally encoded using stratified (or prioritized) first-order knowledge bases. In the second part of the article, we discuss the problem of conflicts due to the joint handling of permissions and prohibitions. We show that approaches proposed for solving conflicts in propositional knowledge bases are not appropriate for handling inconsistent first-order knowledge bases. © 2004 Wiley Periodicals, Inc. Int J Int Syst 19: 817,836, 2004. [source] Strategic giving and the nursing shortage,INTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 1 2006Steven G. Ullmann Health care organizations in the United States face a significant nursing shortage, which seriously impacts the quality and availability of health care. Confronting this challenge requires involvement from organizations beyond the public sector. This paper explores an initiative by Blue Cross and Blue Shield of Florida, exemplifying the concept of ,strategic philanthropy,' to contribute their financial resources and strong institutional ties to respond to the current and future shortage of nurses in Florida. Through this intervention, the company and partnering organizations hope to benefit the health care sector, the public, and themselves from the outcomes associated with the generation of a greater supply of nurses. Copyright © 2006 John Wiley & Sons, Ltd. [source] Downsizing and reorganization: demands, challenges and ambiguity for registered nursesJOURNAL OF ADVANCED NURSING, Issue 2 2004Anna Hertting MD Background., The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments. Objective., The aims of this study were to explore registered nurses' experiences of psychosocial ,stressors' and ,motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization. Method., Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content. Results., Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: ,distrust towards the employer', ,concurrent demands and challenges', ,professional ambiguity, ,a wish for collaboration', and ,efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions. Conclusions., The concurrence of ,ever-growing job demands' and ,work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The ,waste of human resources' and ,competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex ,deference-dominance' doctor,nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a health-promoting resource. This study demonstrates the importance of analysing feelings relating to professional ambiguity and gaining influence in a gender-related, hierarchical environment, and the need to support professional assertiveness in relation to superiors and doctors. It is also important to stress considerations that relate to differences in the age, care philosophy, and psychosocial health conditions of nurses. [source] Models of Quality-Adjusted Life Years when Health Varies Over Time: Survey and AnalysisJOURNAL OF ECONOMIC SURVEYS, Issue 2 2006Kristian Schultz Hansen Abstract., Quality-adjusted life year (QALY) models are widely used for economic evaluation in the health care sector. In the first part of the paper, we establish an overview of QALY models where health varies over time and provide a theoretical analysis of model identification and parameter estimation from time trade-off (TTO) and standard gamble (SG) scores. We investigate deterministic and probabilistic models and consider five different families of discounting functions in all. The second part of the paper discusses four issues recurrently debated in the literature. This discussion includes questioning the SG method as the gold standard for estimation of the health state index, re-examining the role of the constant-proportional trade-off condition, revisiting the problem of double discounting of QALYs, and suggesting that it is not a matter of choosing between TTO and SG procedures as the combination of these two can be used to disentangle risk aversion from discounting. We find that caution must be taken when drawing conclusions from models with chronic health states to situations where health varies over time. One notable difference is that in the former case, risk aversion may be indistinguishable from discounting. [source] Collaborative partnerships for nursing faculties and health service providers: what can nursing learn from business literature?JOURNAL OF NURSING MANAGEMENT, Issue 3 2006DIANE BROWN PhD Collaborative partnerships between nursing faculties and health service providers are the cornerstone of successful clinical experience for nursing students. The challenge of providing an optimal learning environment can be enormous given the turbulent and rapidly changing environment in health. The present study uses the business literature to examine what nursing can learn from business about the development of successful collaborative partnerships. The characteristics of sound partnerships are described and a set of best practice guidelines is developed. The guidelines summarize the factors considered to be essential for the effective development of collaborative partnerships. In these times of nursing shortages and high turnover high quality, collaborative partnerships between nursing faculties and the health care sector are seen as a possible solution to optimize clinical learning and therefore graduate preparedness. [source] Changing GPs' prescription patterns through guidelines and feedback.PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007Intervention study Abstract Purpose To investigate whether and how a multi-dimensional intervention including clinical guidelines on the choice of medical treatment in the primary and the secondary health care sector, and individual feedback to general practices about their own and other practices' prescription patterns in five Anatomical Therapeutic Chemical classification system (ATC)-groups was followed by changes in the practices' prescription pattern. Methods Prospective historical registry study and a questionnaire study of GPs' self-reported use of guidelines and feedback. Results In every ATC-group the number of prescribed defined daily doses (DDDs) kept growing after the intervention, while potential savings by DDD decreased. Individual practices' changes in the prescription pattern differed by ATC-group and practices with high potential savings/DDD before the intervention showed the greatest relative reduction in potential savings/DDD. The county's average cost/DDD for the five ATC-groups declined from above the Danish average before the intervention to a level below the average cost/DDD after the intervention. In the questionnaire study (response rate: 79%), 69% of respondents had read the guidelines and 78% reported that the feedback influenced their prescription of drugs. Conclusions The observed changes in drug costs and potential savings were not due to volume effects but a combination of price effects, including generic substitution and choice of less expensive analogues, demonstrating that it is possible to change GPs' prescription patterns without interfering with patients' access to treatment or with GPs' clinical freedom.' Copyright © 2007 John Wiley & Sons, Ltd. [source] Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and CollaboratorsPUBLIC ADMINISTRATION REVIEW, Issue 3 2008Carolyn Berry Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services. [source] Relationships between the health care sector and the mediaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2006Daryl Pedler No abstract is available for this article. [source] Predictors of Chain Acquisition among Independent Dialysis FacilitiesHEALTH SERVICES RESEARCH, Issue 2 2010Alyssa S. Pozniak Objective. To determine the predictors of chain acquisition among independent dialysis providers. Data Sources. Retrospective facility-level data combined from CMS Cost Reports, Medical Evidence Forms, Annual Facility Surveys, and claims for 1996,2003. Study Design. Independent dialysis facilities' probability of acquisition by a dialysis chain (overall and by chain size) was estimated using a discrete time hazard rate model, controlling for financial and clinical performance, practice patterns, market factors, and other facility characteristics. Data Collection. The sample includes all U.S. freestanding dialysis facilities that report not being chain affiliated for at least 1 year between 1997 and 2003. Principal Findings. Above-average costs and better quality outcomes are significant determinants of dialysis chain acquisition. Facilities in larger markets were more likely to be acquired by a chain. Furthermore, small dialysis chains have different acquisition strategies than large chains. Conclusions. Dialysis chains appear to employ a mix of turn-around and cream-skimming strategies. Poor financial health is a predictor of chain acquisition as in other health care sectors, but the increased likelihood of chain acquisition among higher quality facilities is unique to the dialysis industry. Significant differences among predictors of acquisition by small and large chains reinforce the importance of using a richer classification for chain status. [source] Public and Private Provision of Health CareJOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 1 2002Pedro Pita Barros One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states. [source] | |||||||||||||