PubMed Health⌕ Search

Biomedical subjects

Mukesh Chawla

Publications and source records attributed to Mukesh Chawla.

6 recordsLinked to original sources
PubMed2006

The impact of hospital management reforms on absenteeism in Costa Rica.

The reduction of high levels of absenteeism among health care workers was one the objectives of the reforms undertaken to improve public hospital performance during the 1990s in Costa Rica. This paper attempts to assess the impact of changes in reimbursement methods and organizational reform on absence rates among health care personnel in Costa Rican public hospitals for the period 1995-2001. Our results show the reforms to have had a negative impact on absenteeism, which increased throughout the considered period. Results further indicate that the policy of not substituting absentee workers, which was introduced through the reforms, did not work as expected in a permissive environment in which peer pressure mechanisms were lacking. In addition, the explicit incentives for workers included in the reforms were retained and used at facility level. There is a pressing need in the future for control and disciplinary mechanisms for health care personnel and for the introduction of absence rates as an explicit goal to be monitored and evaluated.

Absenteeism↗
PubMed2006

The impact of aging on long-term care in Europe and some potential policy responses.

The article examines recent data on the impact of increasing numbers of elderly people in Europe on expenditures for long-term care services. After reviewing recent and projected future costs of long-term care, the authors examine current national strategies for long-term care as well as potential policy options that could reduce future expenditures due to aging. Although long-term care expenditures in Europe will rise over the next several decades, countries can adopt a variety of strategies--many of them in social sectors outside the health system--to reduce or mitigate the overall effects of likely long-term care needs.

Aged↗
PubMed2004

Provision of ambulatory health services in Poland: a case study from Krakow.

This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.

Ambulatory Care↗
PubMedDate not supplied

Ascites due to pacemaker syndrome.

We describe a 65-year-old man who had had a permanent cardiac pacemaker implanted in 1994 and presented now with ascites. He was investigated for 3 months without finding any cause. He was admitted with a colonic bleed due to a polyp; on cardiac evaluation he was found to have pacemaker syndrome. After adjusting the pacemaker settings his ascites and pleural effusion (which had developed later) disappeared.

Aged↗
PubMedDate not supplied

Autoimmune hepatitis: a study of 50 patients.

INTRODUCTION: Autoimmune hepatitis (AIH) is a well-defined entity in the West but there are sparse Indian data on this disease. AIM: To study the clinical profile and response to treatment of Indian patients with AIH. METHODS: This is a part retrospective and part prospective study of 50 patients (median age 48 years, range 11-82; 43 women) seen between 1995 to 2001, diagnosed to have AIH as per the revised scoring system. Clinical and laboratory profile, response to treatment, and complications of treatment were analyzed. RESULTS: AIH accounted for 6% of all patients with liver disease seen during the period. The presenting symptoms were gastrointestinal in 43 and non-gastrointestinal in 7, with median symptom duration of 6 months (range 2 weeks to 40 years). Forty patients (80%) had chronic liver disease. Associated illnesses were present in 28 patients. Twenty-six patients were classified as definite and the rest as probable AIH. Forty-nine patients had Type 1 AIH. Five patients had overlap syndrome. Forty-five patients (90%) received immunosuppressive therapy. Twelve of 18 patients receiving only prednisolone and 21 of 27 patients receiving prednisolone and azathioprine combination responded. Thirteen (26%) patients had therapy-related complications (infectious 5, non infectious 8) with two treatment-related deaths. CONCLUSION: Type 1 AIH was the predominant type of AIH. The majority of patients with AIH presented with chronic liver disease. There was good response to immunosuppressive therapy. Therapy-related complications occurred in one-fourth of patients.

Adolescent↗