Biomedical subjects

Raisa Deber

Publications and source records attributed to Raisa Deber.

7 recordsLinked to original sources

PubMed2006

'Stickiness' and 'inflow' as proxy measures of the relative attractiveness of various sub-sectors of nursing employment.

Workplaces vary in their ability to recruit and retain workers. We introduce two new concepts which can be used as proxy measures of the relative attractiveness of a particular setting, where setting can be defined narrowly (e.g., a particular organization) or broadly (e.g., a sub-sector). "Stickiness" is defined as the transition probability that an employee stays in a given setting; "inflow" as the proportion of new employees. Using a longitudinal dataset of all nurses registered with the College of Nurses of Ontario, Canada 1993-2003, employment site was used to define consistent sectors and sub-sectors. Each nurse was assigned to one sector/sub-sector per year. Stickiness and inflow values were calculated for each sub-sector, and the trends across time were analyzed. Results show that despite shrinkage in the hospital sub-sectors, hospitals remained highly sticky. The expanding sub-sectors, in general, appear relatively unattractive to nurses; they couple medium/low stickiness with high inflow. Considerable variability across sub-sectors was evident. Stickiness and inflow were found to be useful as proxy measures of the relative attractiveness of the various sub-sectors of nursing employment over time. The concepts may be used for other workforces for which linked longitudinal data are available.

Employment↗

PubMed2006

Discharge destination from acute care after traumatic brain injury.

OBJECTIVE: To identify the impact of private insurance coverage on discharge disposition after a traumatic brain injury (TBI) using injury in a motor vehicle accident (MVA) as a proxy for private insurance, controlling for age and severity of injury. METHOD: Cross-sectional study. PATIENTS: Patients with TBI discharged between 1993-1994 and 2000-2001 (n = 9,703). MAIN OUTCOME MEASURE: Discharge destination from acute care; controlled odds ratio (OR) and confidence interval (CI) for type of injury. RESULTS: Type of injury, age, and length of stay are significantly associated with discharge destination. However, the motor vehicle accident patients are 56% more likely to be discharged to home with support services than patients with similar injuries from falls. CONCLUSION: Even in a system with universal coverage, availability of private insurance type is a potential independent determinant of post-acute care services. More research is required to determine the effect this relationship has on the cost and outcomes of care for TBI patients.

Accidental Falls↗

PubMed2004

Taking our medicine: who should pay for what?

The proposal made by Morgan and Willison for a pharmacare system that combines first-dollar coverage for required care with a program that provides additional support for those with catastrophic costs may be as good starting point as any for this very pressing issue. However, subsequent tinkering will inevitably be required.

Canada↗

PubMed2004

"What's in, what's out": stakeholders' views about the boundaries of Medicare.

The Canada Health Act requires that provincial insurance plans provide universal coverage without co-payments for all "medically necessary" services delivered by hospitals and doctors, but allows care delivered by other providers in other locations to fall outside of the boundaries of Medicare. Discussion about the sustainability of medicare at both the national and provincial levels has called for the revisiting of these boundaries. The M-THAC (Medicare to Home and Community) Research Unit attempted to clarify the areas of consensus and controversy as to what key stakeholders thought should be "in" or "out" of Medicare. Using a non-experimental, cross-sectional design, a self-administered survey (in both English and French, constructed in consultation with our partners) was distributed between January and April 2002 to policy elites of key stakeholder groups. The results are based on 2,523 responses. Much of the current "debate" is mired in discussing issues where consensus already exists. We found strong support for in-hospital care. However, there is considerable resistance, across all groups, to full funding for similar services in private clinics or in the home, and almost no support for full funding for non-medical home-based services. The vision of many policy elites remains heavily linked to the current system of guaranteed public funding only for acute care in hospitals or by physicians. Successful reform will need to address, rather than assume, a broader view of healthcare.

Attitude of Health Personnel↗

PubMed2002

Medical Savings Accounts: will they reduce costs?

BACKGROUND: Medical Savings Accounts are an attempt to reduce health care costs by transferring responsibility for expenditures to patients, while providing them with state-supported base amounts to cover some of the costs. We wondered whether such a system would actually be effective, given the fact that medical care expenditures (and illness) are unequally distributed across the population. METHODS: We used the Manitoba Population Health Research Data Respository to assess costs incurred by individual residents of Manitoba for all physician visits and admissions to hospital between 1997 and 1999, and we calculated an average expenditure per person per year over the 3 years. RESULTS: During fiscal years 1997-1999, physician and hospital costs that could be attributed to individual Manitoba residents averaged $730 each year. Most users accounted for very little expenditure. About 40% of the entire population of Manitoba used less than $100 each, and 80% used less than $600. The highest-using 1% of the Manitoba population accounted for 26% of all spending on hospital and physician care, whereas the lowest-using 50% accounted for 4%. When examined by age category, the results were similar. Even in the highest age category, most of the population falls into the low-usage category. If the entitlement under a Medical Savings Account scheme was set at the current average cost of $730 per year, then total spending by government on health care for this healthy group would increase (by $505 million) rather than decrease. If the "catastrophic threshold," above which the insurer would pay costs, was set at $1,000 per year, then the sickest 20% of Manitoba residents would become personally responsible for just over $60 million of current health care costs. The net result is a 54% increase in spending on hospital and physician costs that can be allocated to individuals. INTERPRETATION: Medical Savings Accounts will not save money but will instead, under most formulations, lead to an increase in spending on the healthiest members of the population.

Cost Control↗

PubMed2002

Maz confusion? Reflections on a framework for reform.

While the recent Mazankowski Report offers many wise suggestions for how the health system might be strengthened and the health of the population improved, some of the other ideas it presents are not so meritorious. These are most notable in the recommendations related to finance, where the Premier's Advisory Council has relied more on rhetoric than on evidence.

Alberta↗

PubMedDate not supplied

The learning needs of nurses experiencing job change.

This study explored the perceived knowledge needs of nurses who experienced job change because of health care restructuring and whether different types of job change influenced learning needs. A questionnaire was distributed to nurses in two teaching hospitals. Results indicated that nurses perceived they needed new knowledge and upgraded clinical skills when experiencing job change. Their learning needs, however, differed with the type of job change experienced. Additionally, nurses felt their orientation only moderately prepared them for their new jobs. The findings suggest orientation programs need to be tailored to address the learning needs of nurses experiencing job change.

Analysis of Variance↗