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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.
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.
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.
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.
Predictions of the rise of a take-charge health care consumer have proved premature. Opinion polls and data paint a confusing portrait of a consumer who wants quality care at discount prices, but who doesn't know how the system works, what it costs or what his or her role is. When will this super consumer emerge, and will the industry change as a result?
The problems of the aged assume significance partly from the fact that numerically this segment of the population is expanding at a rapid rate, although in California their proportion of the total population is expected to decline. Further, our urban, industrial, changing society has created problems of abrupt social transition from productivity to retirement, often with an accompanying loss of role and status.Several studies have pointed out that the problems of adjustment to new social roles for the aged vary for different occupational groups. Other studies indicate that activity per se is an important element in whether a person considers himself well, despite existing physical ailments. In addition, numerous research studies of personal and social adjustments of the aged suggest that living arrangements play an important function in the social and psychological well-being of elderly persons.
A strategic plan is your organizational touchstone Given the rapid rate of change in health care, your practice's capacity to succeed is based on its ability to adapt quickly; this, in turn, relies on the level of detail in the operational plan. A well-devised and detailed plan will enable your practice to navigate the waters of industry change. An operational plan begins with the practice's vision, values and mission.
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.
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.
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.
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.
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.
"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."
"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.
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The author examines internal migration and its relation to economic conditions in Poland during the period since World War II. The "basic facets of internal migration in Poland, as they prevailed over the last decades, will be summarized in Section 2 and [compared] with the most recent mobility trends. Section 3 will focus on migration flows within and among 49 regions over the 1975-1983 period while taking account of changing industrial employment levels in individual regions. Alternative interpretations of observed migration patterns will be sought in Section 4. Preliminary conclusions and some further questions will be listed in Section 5."