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PubMed1998

Understanding managed care organizations' liability exposure.

Managed care organizations can minimize their liability exposures by staying informed about industry changes and by implementing a comprehensive risk management program. Typically, managed care organizations face three general exposure areas: directors and officers liability (e.g., exposures associated with nonclinical aspects of an organization); errors and omissions (e.g., exposures involving the day-to-day operations of managing the health care received by an organization's members); and financial loss, or provider excess (e.g., exposures that occur when certain catastrophic events expose the organization to financial peril).

Credentialing↗
PubMed1997

Supply usage data base helps set best practices.

As hospitals move more quickly toward managed care, the impact of industry changes is taking its toll. Networks and systems are rapidly being formed throughout the industry. One advantage of network formation is group purchasing and system-wide contract development. Bundling large volume contracts can produce lower prices for the individual hospitals. Now the challenge for individual hospitals is "where do we go from here?" In many cases, the "system" performs the contract function and the price of most product lines has already been reduced. This article looks at how Alta Bates Hospital in Berkley, CA, continues its efforts to reduce costs as an individual hospital within a larger system, using supply data base information.

Benchmarking↗
PubMed1998

Dialogue. Carve-out or HMO: which will serve public sector beneficiaries better?

We are pleased to have three distinguished and thoughtful participants take part in this issue's Dialogue section. As the healthcare industry changes dramatically, new ideas and different approaches are being aired and debated. The three panelists in this discussion attempt to meet head on some of the problems that presently beset managed care and give us their expertise about the pros and cons of privatization, integrated systems, carve-outs, and carve-ins. They provide examples of steps that are being taken right now and suggest alternative means to achieving a more responsive and equitable system. Dr. Patterson provides an overview of the history of this question. Dr. Stelovich argues for systems that integrate mental health and medical services in a managed care setting and suggests that they provide the mental health patient with better healthcare delivery. Deborah Happ makes the case for the carve-out approach in which behavioral health and physical health services are separated and put under the direction of managed behavioral healthcare organizations (MBHOs). She cites Tennessee's TennCare Partners Program as an example of a successful endeavor and carve-out alternative.

Delivery of Health Care, Integrated↗
PubMed1998

Survey finds states widen reach of Medicaid risk programs.

Data File: What will industry trends mean for Medicaid providers? A new study details industry changes in Medicaid risk and concludes that providers will see new, more medically complicated and higher costing populations. Here are the details and some interesting statistics--from types of covered populations to marketing practices.

Capitation Fee↗
PubMedDate not supplied

FDA's new vending code: a review.

The concept of developing and promoting the nationwide adoption of uniform sanitation regulations for food and beverage vending was agreed upon by the U.S. Public Health Service and industry leaders more than 20 years ago. Two revisions of the original Vending Code which was published in 1957 have kept pace with industry changes, the most recent now available in booklet form. Trends in food and beverage vending prompted code revisions resulting in the 1978 Vending Code which has major changes and effects on existing state and local regulations.

Food Dispensers, Automatic↗
PubMed1987

Integrated system brings hospital data together.

Healthcare industry changes during the 1980s--increased competition and alterations in the Medicare payment methodology--place new and more complex demands on a hospital's information systems, which often fall short of meeting those demands. These systems were designed for financial reporting, billing, or providing clinical data, and few of them are capable of linking with other unrelated systems. Today's hospital manager needs timely and simultaneous access to data from a variety of sources within the hospital. All the elements to accomplish this are collected somewhere in the hospital, but finding them and bringing them together is difficult. The key to the efficient management and use of data bases is in understanding the fundamental concept of relational data bases, which is the capability of linking or joining separate data files through a common data element in each file. In this way, data files may be integrated into a "related" data base. Any number of separate files, or tables, may exist within a "relational" data base as long as a series of threads links them. A strategic management information data base includes the information necessary to analyze, understand, and manage the hospital's markets, products, resources, and profitability. The major components of this information system are the case mix and cost accounting, budgeting, and modeling systems. The case mix and cost accounting factors involve managing concrete pieces of data, whereas the budgeting and modeling factors manipulate data to create a scenario. The strategic management information data base is the foundation of a hospital's decision support system, which is rapidly moving into the category of a necessary tool of the hospital manager's trade.

Computer Systems↗
PubMed2000

New leaders drive managed care. Sensitivity with a bulletproof attitude required.

It's been a time of rapid-fire change in the managed-care industry--change that has included high-profile turnover in the executive suites at many of the large publicly held HMOs. Stepping into the top jobs has been a new generation of leaders with skills and qualities unheard of in boardrooms just a decade ago. But those skills will be tested as the industry continues to evolve.

Administrative Personnel↗
PubMed1996

The changing environment for technological innovation in health care.

A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already having considerable effects on investment patterns and the development, adoption, and use of new technologies. Until recently, new technologies that offered the prospect for health benefit, however, marginal or unproven, were paid for with little or no regard to cost. Technical wizardry alone no longer carries the day in health care. Today's health care market increasingly demands what other markets do--measurable improvements in benefits at acceptable costs--and innovators have begun to respond accordingly. Even so, certain key venues for health care innovation are at risk.

Biomedical Technology↗
PubMed2001

Bedside glucose testing. Applications in the home and hospital.

Point-of-care testing is an increasingly popular means of delivering diagnostic testing closer to the site of patient care. Although point-of-care glucose testing devices have been around for over a decade, concerns about the quality of the results still plague the industry. Changes in federal and state laws that treat point-of-care testing as an extension of the core laboratory promise to improve the quality of testing. The most challenging aspect of quality testing is selection of the appropriate method (core laboratory versus point-of-care test) for the optimal patient outcome.

Blood Glucose↗
PubMed1994

[Not Available].

This thesis describes the beginnings of the first clinic for children's psychiatry in Zurich which was at the same time the first one in Switzerland. A historical part shows how (mostly) doctors influenced by the ideas of the Enlightenment started developing specialized theories about mentally handicapped children. At the beginning of the 19th century these theories led to the new professions known as therapeutic pedagogy (Heilpädagogik), child and developmental psychology, pediatry as well as to the psychiatry that demanded the treatment of children to be different from the one of adults. Due to socially motivated thinking, the development of the welfare system was highly influenced by the industrialization. Changing the national law (Schweizer Zivilgesetzbuch) in 1907 was one consequence, more public welfare another. This very complex evolution led to a widely held discussion about the need of specialized institutions to observe and treat children psychiatrically. People engaged in the field of psychiatry as well as welfare supported these ideas. In 1921 such an institution was founded as an outstation of the psychiatric clinic of the university of Zurich ("Burghölzli"), the "Kinderhaus Stephansburg", a house for 25 children up to the age of 14. A teacher was emploied being responsible for the special education during the children's hospitalization.

Child Psychiatry↗
PubMed1994

Hospital-physician relations: the recruitment perspective.

One of the biggest problems in the health care industry today is the supply and demand of physicians. As health care organizations scramble to recruit physicians for vital positions, they find themselves in a highly competitive and exhausting battle. As the health care industry changes, so do the needs and desires of physicians, especially young physicians. The heart and soul of a good recruitment program must include understanding who physicians are and what motivates them, selecting the right candidate, and most importantly, retaining them once you have gone to the time, expense, and heartache of recruiting them. Understanding how integrated systems can deal with these factors in the most effective and efficient way is key to surviving and thriving in an era of health care reform.

Economics, Medical↗
PubMed1993

Home health care: occupational health issues.

1. Although much work has been done to identify occupational risks to health care workers in institutions, little has been done to describe such risks in the growing home care industry. Changes in the nature of home care suggest the risks may be equivalent, with additional risks from the variable environment of the home. 2. Directors of home care agencies in Northern California were surveyed with respect to the nature of home care, workers, characteristics of occupational programs, and common illnesses and injuries. Musculoskeletal injuries were the most common occupational injuries reported. 3. Despite legislation and accreditation standards, occupational programs in home care agencies are incomplete. Further work is needed to determine the relationship between the presence of occupational health programs and home health care outcomes.

California↗
PubMed1995

[The beginning of psychology as a profession in Argentinian universities].

Two characteristics of professional psychology in Argentine are interesting for historians. On the one hand, the omission of the large past of scientific psychology that began at the end of last century. On the other, the omission of the most recently beginning of professional psychology on '50. In this paper, we point out some political features of the process of psychology's professionalization around those latter years. The main subject of this paper, are the studies of psychology at Tucuman and Cuyo universities, on '40 and '50. In those years, the social and industrial changes in the country, leads to new problems of adaptation to job and to environment. Those subjects and the old problems of psychological aspects in school, pave the way for the new needs of psychological profession in all the country.

Argentina↗
PubMed1996

Re-emergence of malaria in India.

Malaria was nearly eradicated from India in the early 1960s but the disease has re-emerged as a major public health problem. Early set backs in malaria eradication coincided with DDT shortages. Later in the 1960s and 1970s malaria resurgence was the result of technical, financial and operational problems. In the late 1960s malaria cases in urban areas started to multiply, and upsurge of malaria was widespread. As a result in 1976, 6.45 million cases were recorded by the National Malaria Eradication Programme (NMEP), highest since resurgence. The implementation of urban malaria scheme (UMS) in 1971-72 and the modified plan of operation (MPO) in 1977 improved the malaria situation for 5-6 yr. Malaria cases were reduced to about 2 million. The impact was mainly on vivax malaria. Easy availability of drugs under the MPO prevented deaths due to malaria and reduced morbidity, a peculiar feature of malaria during the resurgence. The Plasmodium falciparum containment programme (PfCP) launched in 1977 to contain the spread of falciparum malaria reduced falciparum malaria in the areas where the containment programme was operated but its general spread could not be contained. P. falciparum showed a steady upward trend during the 1970s and thereafter. Rising trend of malaria was facilitated by developments in various sectors to improve the national economy under successive 5 year plans. Malaria at one time a rural disease, diversified under the pressure of developments into various ecotypes. These ecotypes have been identified as forest malaria, urban malaria, rural malaria, industrial malaria, border malaria and migration malaria; the latter cutting across boundaries of various epidemiological types. Further, malaria in the 1990s has returned with new features not witnessed during the pre-eradication days. These are the vector resistance to insecticide(s); pronounced exophilic vector behaviour; extensive vector breeding grounds created principally by the water resource development projects, urbanization and industrialization; change in parasite formula in favour of P. falciparum; resistance in P. falciparum to chloroquine and other anti-malarial drugs; and human resistance to chemical control of vectors. Malaria control has become a complex enterprise, and its management requires decentralization and approaches based on local transmission involving multi-sectoral action and community participation.

Disease Outbreaks↗
PubMed1997

Community systems management: preparing nurse managers for today and tomorrow.

Industry changes not only demand flexibility among health care workers but also require transformation of education programs that prepare leaders and managers for practice in evolving venues of delivery. Schools of nursing are responding by listening to the market and designing curricula to meet the new demand. This article describes one cutting-edge graduate program that prepares nurses for new leadership roles in health care.

Community Health Nursing↗
PubMed1991

Interregional gross migration and structural changes in local industries.

"In this paper the impacts of structural changes in local industries on interregional gross migration in Japan for 1974-85 are empirically examined. Structural changes in local industries, which are represented by a simple index of local employment growth dispersion across sectors, induce interregional migration, as well as intraregional migration. The estimation results with pooled data support this hypothesis. The impacts of structural changes in local industries are different across gross migration flows (rural-urban, urban-rural, urban-urban, and rural-rural migration), as are the impacts of other determinants of migration such as earnings differentials, aggregate employment growth, national unemployment, distance, and age structure."

Asia↗
PubMed1984

Shifting balances in U.S. metropolitan and nonmetropolitan area growth.

"This paper assesses some of the recent attempts to explain the perceived growth reversal between metropolitan and nonmetropolitan areas in the United States during the 1970s. The paper argues that the reversal in population trends was not a one-time, radical shift in settlement trends, but rather the result of more continuous underlying industrial trends. Indeed, since 1979, population growth has again become faster in metropolitan than nonmetropolitan areas." The paper includes three sections. Regional and area population and industrial earnings growth patterns are first summarized for the 1960s, 1970s, and 1980s. Theories of polarization and polar reversal are then evaluated and found to be inadequate. Finally, a reconstruction of the neoclassical model is proposed.

Americas↗