Biomedical subjects

I Zmora

Publications and source records attributed to I Zmora.

5 recordsLinked to original sources

PubMed1996

The influence of budget-holding on cost containment and work procedures in primary care clinics.

In 1990, Kupat Holim Clalit (KHC), Israel's largest health insurance fund, initiated a demonstration program for transforming primary care clinics in the Negev district of southern Israel into autonomous budget-holding units. Four program components were implemented in nine clinics: allocation of a fixed budget; expansion of day-to-day decision-making authority; establishment of a computerized information system for producing monthly reports on expenditure; and provision of incentives for budgetary responsibility (returning part of a clinic's savings for use at its discretion). The demonstration program had three objectives: budgetary control and cost containment; improvement of services and increased client satisfaction; and improvement in the motivation, initiative, responsibility, and satisfaction of clinic staff. This report presents interim findings from an evaluation study of the budget-holding program conducted in 1991-1992. The report considers three questions: How was the demonstration program implemented? Did work procedures in the clinics change following implementation of the program? How did budget-holding influence levels of expenditure in the clinics? The program components were implemented gradually in the nine clinics during 1991-1992. Not all, however, were fully implemented. The staff survey conducted after implementation of the program identified a number of changes in the work procedures of the clinics: heightened cost consciousness, discussion of the monthly expenditure reports, emphasis on the need to economize, and attempts to economize. Data on expenditure in the budget-holding clinics were analyzed and compared to data on expenditure in primary care clinics in the Negev district as a whole. It was found that while the average quarterly per capita expenses in the district increased in real terms from 1991-1992, expenses in the budget-holding clinics remained stable or, in some cases, actually decreased. While we cannot conclude categorically from the existing data that the budget-holding program is responsible for the unique patterns of expenditure in the nine clinics, we can confidently state that work procedures in the nine clinics changed following implementation of the program and that the clinics achieved cost containment relative to the district as a whole. Findings from the various research tools support one another, and reinforce the conclusion that budget-holding can potentially promote cost containment.

Budgets↗

PubMed1993

[An autonomous primary care clinic within a health maintenance organization].

The health system in Israel, as elsewhere in the world, is facing crises of organization and economics. Israel's largest HMO, which insures some 70% of the population, is a highly centralized body that makes policy decisions without consulting the community-based primary care teams. We describe the process of extending autonomy to a primary care clinic with the object of lowering costs and allowing its staff to prioritize the problems of the patient population and the community they serve.

Ambulatory Care Facilities↗

PubMed1992

[Quality control in primary care: an instrument for constructing a database].

An instrument for constructing a database and defining standards for quality control in primary care medicine is presented. A questionnaire adapted from a U.S. Department of Health and Human Services form will be used randomly at least twice a year for screening all patient-staff contacts in most Kupat Holim clinics in the Negev Region (small rural clinics excepted). Analysis of the responses will enable definition of standards for measuring the quality of primary care. The tool is simple, inexpensive, not too time-consuming, and can provide the required data. A pilot study to test the tool was carried out in 3 primary care clinics serving an insured population of 17,763. The study surveyed 474 patient visits to the clinics, of which 57% were consultations with a physician. The younger patients usually saw the physician, while the older tended to visit the nurse. The most common reason for clinic visits was an acute condition, and only 4% of visits were for administrative reasons. 28% of the patients were not prescribed any medication and 27% were prescribed only 1 drug. The majority of problems were dealt with at the clinic level and only a few were referred to specialists or to external diagnostic services.

Adolescent↗

PubMed1991

[Utilization of emergency services in primary care clinics].

Utilization of emergency services (ES) by primary care physicians was retrospectively surveyed in a regional hospital. Referrals and self-referrals from an urban university clinic, a community clinic, a smalltown clinic and a rural community clinic were included. There was an average referral and self-referral rate of 38/100/year. Both referrals and proportion of self-referrals were inversely related to the distance between primary care clinic and the ES. Most referrals and self-referrals occurred on week-days during the hours primary care clinics were open. About 13% of ES visits resulted in hospitalization, with no significant differences between the different types of clinic or the hour of referral. We conclude, that hospital-based ES are utilized not only to provide emergency care, but also as support systems for primary care clinics, especially those readily accessible to the ES.

Ambulatory Care Facilities↗

PubMed1986

A hedonic prices approach to hospitalization costs. The case of Israel.

The paper suggests a hedonic prices approach to estimate the cost of hospital services. It applies this approach to Israeli data as a first approximation of hospitalization costs in that country. In the absence of accounting data, this approach enables us to estimate the relative cost of basic hospital services, how hospital characteristics affect cost and how cost changes with time. Moreover, it provides for a standardized measure to view the relative efficiency of a cross section of hospitals. Several findings based on Israeli data demonstrate the potential of the approach and may be of general interest. First, controlling for department mix, bigger hospitals, which are usually also teaching hospitals and may have a different case-mix, incur higher cost per admission than smaller hospitals. Second, by institution, General Sick Fund hospitals are more expensive, but also experience, in terms of budget allocations, less discrimination than Government hospitals. Hence, provision of equitable service may be less efficient than in services where there is budgetary discrimination to induce specialization, etc. Third, hospitals have been subject to inflationary pressures over and above the general inflation level in Israel, as may be the case in most other western countries. Fourth, a comparison of cost per admission across hospitals and over time shows that cost has been consistently increasing in particular hospitals and falling in others, beyond the average increases warranted by growth in size, changes in composition, and hospitalization-specific inflation. More research is needed in order to explain these unexplained but consistent trends.

Costs and Cost Analysis↗