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Biomedical subjects

R B Saltman

Publications and source records attributed to R B Saltman.

33 records · Page 2Linked to original sources
PubMed1988

National planning for locally controlled health systems: the Finnish experience.

The World Health Organization considers Finland's health planning system to be among the most successful in the developed world. Despite tight resource constraints--symbolized by total health expenditures held consistently to less than 7 percent of gross domestic product--the Finns have built up a strong primary care sector and dramatically improved the overall availability and accessibility of needed services. This article compares the official health planning system with the actual planning process as experienced within one Finnish central hospital district. The official planning system seeks to integrate national strategic goals with local municipal ownership, administration, and funding of service delivery. The actual planning process within the studied district suggests that technically oriented civil servants at the regional level may be at least as important in the overall decisionmaking structure. The article concludes with a brief exploration of this finding's potential consequences for the long-term development of the Finnish health care system and for national health planning efforts generally.

Cost Control↗
PubMed1987

Management control in a publicly planned health system: a case study from Finland.

Implementing improved management control systems has become a high priority within publicly planned health care systems in recent years. This article explores present management control practices and dilemmas within the Finnish health care system. Based upon an intensive case study of one central hospital district, the article analyzes current intra-institutional and cross-institutional management efforts. Subsequently it evaluates implications from the study's findings for both the Finnish and other publicly planned health care systems.

Capital Expenditures↗
PubMed1987

Re-vitalizing public health care systems: a proposal for public competition in Sweden.

This article examines the health policy opportunities presented by building market-style incentives into the structure of a national public health system. The goal is to develop a service delivery model which can achieve simultaneously high levels of patient service, economic efficiency and social responsibility. The article develops its "public competition" approach implicitly, through a detailed case study of the Swedish health care system. The broad theory appears to hold promise for a variety of existing and emerging national public health systems in Europe.

Economic Competition↗
PubMed1986

Resource planning and control in health care.

Properly designed and administered, this three-part program has the potential both to plan effectively for the use of resources and to control the underlying forces that drive health care expenditures. Through the media of spreadsheet and data base technology, the program has the capacity to analyze and present the data necessary to more effectively plan and control the delivery of health care services in an attempt to assure universal access to quality care at a reasonable cost. And through its reliance on a series of meaningful professional sanctions, including financial rewards and penalties, the program has the potential to create more orderly and cost-effective behaviour in the delivery of health care--an assurance that reality will more closely approximate planning objectives than it has in the past.

Cost Control↗
PubMed1985

The capital decision-making process in regionalized public health systems: some evidence from Sweden and Denmark.

This paper evaluates health capital policy in two regionally structured delivery systems, those of Sweden and Denmark. After a short overview of each nation's health care system, the paper examines the decision-making process for capital equipment and major capital construction in each country. By comparing aspects of system design and subsequent policy outcome, the paper highlights the degree to which capital policy can vary within an apparently similar regionalized framework.

Capital Expenditures↗
PubMed1985

Building primary health care systems: a case study from Sweden.

Health policy planners have discussed for some years how to transform existing hospital-based health delivery systems into primary-care-driven systems. Although this policy goal has been adopted in a number of western European nations, the actual process of implementing such a major change has proven stubborn and complex. In particular, efforts to transfer existing resources out of the hospital sector for use in building primary care activities have proven difficult. This paper examines the effort to design and implement a primary health care strategy in Sweden. It is divided into two segments. The first section sketches the broad health system context within which the Swedish primary care effort is being conducted. The second section focuses directly on Sweden's primary care strategy, detailing both its conceptual foundation and the organizational obstacles that have impeded the policy's implementation. This discussion is punctuated with findings from a 1981 survey of county council administrators' attitudes toward this primary care strategy. The paper concludes with a short discussion of several alternative organizational approaches that might speed the development of a primary-care-driven health system.

Health Policy↗
PubMed1985

Power and cost containment in a Danish public hospital.

The assumption that hospital decision-making is hierarchical in character underpins the policy formulation process in public as well as pluralist national health care systems. This article's analysis of decision-making in a Danish public hospital reinforces the contrary assertion: that effective authority in acute-care hospitals rests in an amorphous power relationship among the hospital's several occupational groups, in which physicians clearly have the upper hand. After a brief introduction to this Danish hospital, the article develops a detailed portrait of its informal power structure and of the different occupational groups' permanent power-maximizing strategies. Subsequently, the article assesses the impact of these strategies upon two recent efforts to contain the hospital's costs: a decision to close an expensive specialty clinic, and an attempt to shrink the hospital's size by transferring less sick elderly patients to a newly created rehabilitation facility. The study's findings suggest that efforts to impose hospital cost containment by exclusively political means are unlikely to succeed.

Cost Control↗
PubMed1985

Health capital policy in the United States: a strategic perspective.

Health capital policy is strategically important not only because of the long-term nature of capital commitments but also because capital requirements often drive institutional behavior far out of proportion to dollars expended. The authors offer a framework for analyzing U.S. health capital policy, much of which is indirect and not always understood to be health capital policy. They emphasize the complex interaction between capital policy and health system configuration and performance, and highlight the long-term effects of current capital policy. They conclude with a likely configuration of the future U.S. health care system and with a discussion of the strategic role of capital policy in creating that future.

Capital Financing↗
PubMed1983

Prospective reimbursement and the hospital power equilibrium: a matrix-based management control system.

Prospective rate-setting programs have not yet made significant inroads in containing hospital cost inflation. Because these programs are essentially hospital management control systems, they must be conceptually grounded in general management control theory if they are to succeed. Specifically, a rate-setting agency must: 1) perceive itself as "top management" of the hospitals being controlled, 2) incorporate hospital physicians into a matrix-based control structure that assigns physicians financial as well as clinical responsibilities, and 3) develop hospital budgeting and reporting systems that disaggregate costs according to their controlling forces, thereby permitting the alignment of responsibility with controllability.

Costs and Cost Analysis↗
PubMed1982

Medical practice, case mix, and cost containment. A new role for the attending physician.

Present political pressures for hospital cost containment appear to make some form of case-specific reimbursement system inevitable. For such a system to be able to control hospital costs effectively, however, its design must reflect the fundamental and traditional principles of management control systems. Although the diagnostic-related group (DRG) approach is the most frequently discussed form of case-mix-sensitive reimbursement, DRGs do not satisfy basic management control principles. Under a more appropriate hospital control system, however, physicians would be incorporated directly into the hospital's management structure. Consequently, to ensure that this new control system is medically as well as financially appropriate, physicians should seize the initiative in determining the standards against which their performance will be measured.

Cost Control↗
PubMed1981

The hospital power equilibrium: an alternative view of the cost containment dilemma.

In-patient hospital costs have grown at an annual rate of 15 percent for the last fifteen years, and the cumulative impact of these increases has created tremendous political pressure to contain this growth. Yet despite numerous attempts to pinpoint the causes of this inflation-and nearly as many recommended policy approaches-the outlines of an effective cost containment program still elude us. Previous approaches to cost containment have tended to emphasize the mechanics of how hospital costs are incurred rather than seeking to explain the underlying causal factors that generate these costs. This analytic focus appears to reflect the lack of a political theory of the hospital which can comprehend the unique character of the hospital's internal decision-making process. One suitable basis for such a theory is Crozier's model of a "conflictive equilibrium." In this model, the hospital's decision-making authority is lodged in a complex power relationship which reflects the respective intra- and extra- institutional resources of its occupational groups, and particularly of physicians and administrators. This analysis of hospital behavior can both explain the hospital's reaction to present cost containment program as well as predict its response to other likely policy approaches. It also may enable us to begin to design more effective programs through which to control the financial consequences of hospital decisions.

Cost Control↗
PubMedDate not supplied

Implementing public competition in Swedish county councils: a case study.

Earlier presentations of the theoretical framework for public competition (Saltman and von Otter, 1987) and of the comparative advantage of public competition as against a mixed market model (Saltman and von Otter, 1989a) suggest the importance of concrete arrangements to introduce a public competition approach at the operating level. This paper explores the administrative infra-structure required to implement public competition within the Swedish county-council-based health care system.

Budgets↗
PubMedDate not supplied

Analyzing the evidence on European health care reforms.

Health system reform, in Europe as elsewhere, has often been influenced as much by theory and conjecture as by fact and experience. In a study published in September 1997, the Regional Office for Europe of the World Health Organization (WHO) drew together the available evidence about the health care systems in the fifty-one countries of the European region. This paper focuses on western European countries. It reviews a variety of policy strategies and then explores implications from this European experience for the formulation of U.S. health care policy.

Cost Sharing↗
PubMedDate not supplied

Preventive medicine for hospital costs.

The reality of soaring health care costs has hospital administrators facing the prospect of mandatory state regulation or voluntary restraint on their financial expenditures. In either event, whether formulated and implemented through external rate setting or internal cost containment, managers should be preparing to adjust their hospitals' management control systems to the emerging requirements of tighter budgetary limitations. The authors discuss the implications such cost-containment programs have for hospital control systems, identify the five cost-influencing variables that must be monitored, and consider the critical importance of incorporating attending physicians into the management control effort.

Cost Control↗