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PubMed1994

Serious mental illness and capitation financing.

Traditional organization and financing of mental health care has not adequately served the needs of persons with serious mental illness. Capitation financing is being tested in several localities, but little experimental data has been yielded to date, and it is mixed. The results from the Rochester experiment were positive but limited, and some other pilots also reported positive experiences with capitation. Others have ended prematurely or confronted obstacles. Experimental findings are also anticipated from the Philadelphia and California pilots, and others are just beginning. Existing financing mechanisms, cost-shifting efforts, and professional cultures represent powerful obstacles to successfully implementing capitation financing for care of persons with long-term mental illnesses, and potential incentives to underserve enrollees require adequate accountability structures. In spite of obstacles, the goodness of fit between the needs of persons with serious mental illness and capitation flexibility warrant further exploration of this financing modality.

Capitation Fee↗
PubMed1995

Power and new economic relationships.

We are going through a transformation of our health services from a community and patient focus fueled by fee-for-service and cost-plus reimbursement. This transformation, called managed care, is shifting power away from professionals and communities into both new and old organizations financed by Wall Street. Even traditional community organizations are driven by Wall Street-dictated financial ratios that represent scoreboards to determine who gets capital for growth and development. Times are changing, organizations are changing, and still more change is ahead.

Cost-Benefit Analysis↗
PubMed1981

Development of a preventive dental care programme for children and adolescents in the county of Jönköping 1973-1979.

Dental research the last two decades has created a basis for understanding the etiology, prevention and treatment of dental diseases. As a consequence, particular interest has been focused on the effect of prophylactic measures, efficiently organized and carried out, for various groups of individuals. However, it has proved difficult to organize systematic integrated preventive dental care for large parts of the population. The present paper describes in detail the development of integrated preventive dental care for children and adolescents in the County of Jönköping. Sweden, from 1973 to 1979. Based on the circumstances that existed before 1973 as regards e.g. personnel and the nature and content of the prophylactic measures, a description is made of the aims, methods, target groups, organization, financing and evaluation of a preventive dental care organization gradually developed for the age groups 0-16 years in the whole county (308,000 inhabitants; 4,000 individuals in each age-group). Important practical information as to the performance of the organization is given as well as examples of both basic preventive dental care programmes and supplementary programmes intended for individuals exhibiting a high prevalence of caries and gingivitis. As an effect of the programme instituted of remarkable improvement in dental health among children and adolescents has been achieved.

Adolescent↗
PubMedDate not supplied

Entrepreneurial nursing: the right course at the right time.

As more nurses start businesses of their own, there is a need for a course to help them learn to plan, organize, finance, and operate these businesses. The author describes the course's organization, its outcomes, and reactions of the first students to participate in the course.

Commerce↗
PubMedDate not supplied

Management theory and applications.

Management is critical as an organization pursues its mission. There are many theories of management, but all agree that an effective organizational structure can facilitate the operation of a company. The author describes the typical functional areas found in most organizations (finance, operations, marketing, information systems, legal, and human resources); examines how the organization of tasks and people are inter-linked; and shows that administrators who have a working knowledge of management theory tend to be effective in the performance of their jobs.

Guidelines as Topic↗
PubMedDate not supplied

Kenneth W. Kizer on a national quality strategy. Interview by Lori Blades and Patricia A. Cholewka.

Kenneth W. Kizer, MD MPH, is president and chief executive officer (CEO) of the National Forum for Health Care Quality Measurement and Reporting (National Quality Forum [NQF]), a not-for-profit membership organization created to develop and implement a national strategy for measuring and reporting healthcare quality. Dr. Kizer previously served as Under Secretary for Health in the U.S. Department of Veterans Affairs (VA) and is widely credited as being the chief architect of and driving force behind the greatest transformation of VA healthcare since its creation in 1946. NQF is a public-private partnership designed to involve all segments of the nation's healthcare system. The organization was proposed as part of the findings of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). Since the release of those findings, leaders from consumer, purchaser, provider, health plan, and health services research organizations, as well as from government, have met to define the mission, structure, and financing of NQF, and staff support has been provided by the United Hospital Fund of New York. NQF is primarily a membership dues- and grant-financed organization and has received significant public and private funding from foundation and corporate grants, including a $2.5-million founding grant from the Robert-Wood Johnson Foundation and a $1-million founding grant from the California Healthcare Foundation. NQF also received initial financial support from The Commonwealth Fund and United Hospital Fund.

Hospitals, Veterans↗
PubMed1995

Health system reforms in industrialized democracies: an emerging paradigm.

Despite the wide variety of health care systems in industrialized democracies, a universal paradigm for financing, organization, and macromanagement has been emerging through reforms of the past decade. The policies within this paradigm attempt to promote equity, social efficiency, and consumer satisfaction by combining the advantages of public finance principles--universal access and control of spending--with the advantages of competitive market principles--consumer satisfaction and internal efficiency. This paradigm is characterized by three systemic functions: (1) financing of care, based on public finance principles, not necessarily carried out by government; (2) organization and management of publicly funded care consumption by either competing nongovernmental entities or noncompeting public administrations; and (3) provision of care based on competitive market principles. The institutional arrangement of these functions lends itself to the creation of two internal markets for consumer choice and, of the three, the second function is a key component of the emerging paradigm.

Australia↗
PubMedDate not supplied

Who should call the plays?

The seamless health care organization is a term increasingly used to describe efforts to deliberately bring into alignment heretofore diverse interests in financing, organization, delivery and utilization of health services, writes Mary Alice Krill, Ph.D., FACMGA. Her article describes one such system.

Cardiac Care Facilities↗
PubMed2004

Teaching about the changing U.S. health care system: an innovative clerkship.

Changes in the U.S. health care system have necessitated modifying the scope and content of existing courses in the medical school curricula. In 1996, the Weill Medical College of Cornell University created a new, integrated public health curriculum to reflect the changes in the ways that medical care is organized, financed, and delivered. Teaching medical students to understand the constantly changing health care system is a primary objective of the new curriculum. As part of this curriculum, the medical college instituted a required public health clerkship that focused on the health care system, to be taken in either the third or fourth year. Students are prepared for the clerkship by taking courses in epidemiology, biostatistics, and evidence-based medicine in the first year and an introduction to the health system in the second year. The two-week clerkship, which may be unique in U.S. medical education, seeks to present an in-depth exposure to issues in health care financing and delivery by means of lectures, panel discussions with experts in the field, seminars, and field assignments to health care organizations and agencies.

Clinical Clerkship↗
PubMed2002

Characteristics of eye care practices with managed care contracts.

OBJECTIVES: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. STUDY DESIGN: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. RESULTS: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. CONCLUSIONS: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care.

Capitation Fee↗
PubMedDate not supplied

Attracting qualified physicians to underserved areas. Part 2. Pay physicians more to practice in underserved areas.

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part I of this article, which appeared in the November/December issue of The Physician Executive, reviewed the efficacy of these approaches. The second part explores a more pragmatic option: to simply improve the working conditions and pay substantially more to physicians who practice in "less desirable" locations. Although this idea is consistent with economic principles, drawbacks must be considered, such as: (1) the American taxpayers' reluctance to finance a more costly health care delivery system for the poor; (2) the inherent conceptual difficulties of a capitated Medicaid HMO serving as the linchpin for organizing, financing, and delivering care for the underserved; and, (3) many providers being expected to react in a fairly litigious manner to such an approach.

Capitation Fee↗
PubMed1995

From managing access to managing care: the impact of primary care on health care delivery organizations.

Professional "revenge of the nerds" is currently taking place, as managed care evolves generalist physicians into new professional prominence. Primary care physicians are finding themselves at the center of health care market reform as health plans, insurers, and other financing organizations turn to them as the key to cost control. In short supply, they are prospering financially from the demand. As the source of patients, they are gaining in prestige from specialists and hospitals who once demeaned them. But these newfound roles are only the initial steps in the transformation of the primary care practitioner. The change that the generalists are experiencing is essentially managing access to care, not truly managing care itself. There are large and crucial differences between managing access to care and actually managing care. These differences are, in many ways, a higher calling for primary care practitioners as they refocus attention on patient outcomes, which will in itself result in a lower resource utilization above and beyond the crude controlling of access. What those differences are, what new roles they require, and what impact they will have on organizations that either house or contract with primary care physicians will be the focus of this article.

Health Services Accessibility↗
PubMed1986

Long-term care for the elderly: public dreams and private realities.

The health care policy and provider community is struggling to come to grips with the dual problems of the burgeoning "old-old" population that is putting an increasing strain on nursing home bed supplies, and the increasing difficulty of paying for long-term care through Medicaid budgets and out-of-pocket payments by the individuals and families affected. The Reagan administration's approach to the problem is away from public solutions and toward private ones. This paper reviews the trend toward privatization in long-term care for the elderly, raises some concerns about these trends, and concludes with some alternative suggestions.

Aged↗