Biomedical subjects

H Maarse

Publications and source records attributed to H Maarse.

7 recordsLinked to original sources

PubMed1997

The reform of hospital care in the Netherlands.

OBJECTIVES: This article provides a short overview of the structure of hospital care in the Netherlands. It discusses a number of hospital reform programs that have been started since the early 1980s and others more recently proposed. Attention has also been given to the potential impact of hospital reform. METHODS: Descriptions of hospital structure, planning, financing, payment of medical specialists, and hospital workforce and services provide a context for a discussion of current hospital reform programs. Trends in hospital care delivery, strategic management, and internal organization are examined. RESULTS: The relationships between the hospital and other health-care providers, health insurers, employers, and patients are found to have a significant impact on the future of the hospital. The interconnections of these four factors will help form the basis for an understanding of ongoing hospital change. CONCLUSIONS: Hospital care has been subject to rapid change during the last two decades, as hospitals become centers for acute specialized medical care. This development has important consequences for the position of hospitals in the health-care delivery network, as they become one of a number of providers in a more integrated delivery system. It should be noted that the changes in hospital care cannot be understood as the results of a single reform program, but rather as the result of a long series of reform efforts.

Economics, Medical↗

PubMed1995

Negotiating fees for medical specialists in The Netherlands.

This article presents an analysis of the negotiations on fees for medical specialists in the Netherlands since the introduction of the Law on Health Care Charges (WTG) in 1982. The peculiar position of the medical specialists and the institutional setting of the negotiations have produced a complex decision making process. Negotiations between the government and the health insurers on the one hand and the association of medical specialists on the other hand have been dominated by deep conflicts which were sometimes settled by temporary "peace contracts'. Attention is paid to the policy network, to the participants in the network and their principal goals, to the strategic use of the WTG by each participant and to the political effectiveness of the WTG. The article ends with a short overview of some recent developments and a sketch of three alternative scenarios on the future of the payment for specialist care.

Decision Making↗

PubMed1994

Dutch home care: towards a new organization?

As in all western countries the demand for home care in the Netherlands is rapidly growing. Reduced institutionalization in hospitals and nursing homes, combined with an increasing number of elderly people, have led to new groups of patients, with complex and diverse problems, to be cared for in their home settings. To meet this new demand, it is argued, comprehensive home care arrangements are needed. Development of such arrangements was the target of 12 demonstration projects that were part of the 'National Home Health Care Programme'. This article presents the results of an evaluation study of the Programme, with special attention to factors favouring the development of comprehensive home care arrangements and its effectiveness.

Comprehensive Health Care↗

PubMed1993

Institutional responses to Medicare's prospective payment system.

The introduction of Medicare's prospective payment system (PPS) meant an important change in the environment of US hospitals. The new payment system was expected to improve clinical and non-clinical efficiency in hospitals. A case study in a non-profit Pennsylvania hospital was performed to analyse the impact of PPS on hospital services. The hospital responded to PPS by a twofold strategy. First, attempts were made to achieve effective cost containment by improving the efficiency of intermediate and final outputs. Here special attention is paid to the activities of the DRG coordinator and the Utilization Review Committee and to the activities of nurses in their role as case manager. The second strategy was directed at revenue enhancement, initially mainly by shifting more costs to non-Medicare patients and later by trying to strengthen the position of the hospital in the local health care market. This second strategy was considered more important than the strategy of cost containment. With respect to organizational structure and policy-making, the following changes can be observed: a growing importance of strategic management; more integrated hospital-physician relationships; and the development of an adequate medical information system and a medical records department.

Cost Control↗

PubMed1992

Going Dutch.

Explore the source record for details and available documents.

Delivery of Health Care↗

PubMed1976

Reaction of hydrogen sulphide with 2-alkenals.

Depending on the types of solvent and catalyst, different products are formed in the reaction of hydrogen sulphide with 2-alkenals. The structures of many of these products have been elucidated, and the reaction sequences leading to them are proposed.

Aldehydes↗

PubMed1976

Formation of odorous compounds from hydrogen sulphide and 2-butenal.

Strongly odorous compounds may be formed upon addition of hydrogen sulphide to unsaturated carbonyl compounds. The reaction between hydrogen sulphide and 2-butenal was studied, and the characteristics of the flavour, the structure and some of the physical chemical characteristics of the reaction products were determined. The influence of the pH on the type of components formed in dilute aqueous solution was investigated.

Aldehydes↗