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At least 19 recordsLinked to original sources
PubMedDate not supplied

Cost-effectiveness of public sector substance abuse treatment: comparison of a managed care approach to a traditional public sector system.

Costs and cost-effectiveness of public sector substance abuse treatment in 2 California counties with similar substance abuse treatment system histories are compared; one county (MidState) has adopted managed care principles. As hypothesized, MidState's costs for the index treatment episode were significantly lower than SouthState's, although unexpectedly because of lower outpatient utilization. Treatment benefits in the 7 Addiction Severity Index functional areas were examined through cost-effectiveness analyses. MidState can claim greater cost-effectiveness for its treatment dollars for significant improvement in alcohol and medical functioning (compared to unsuccessful clients and those reporting no problems). When comparing both improved clients and those maintaining no problems to unsuccessful clients, MidState is more cost-effective for improving alcohol, medical, legal, and family/social functioning; and 3 outcomes important to community stakeholders and taxpayers (legal, medical, and psychiatric functioning) are more cost-effective than alcohol, drug, and employment improvement.

Adult↗
PubMed2000

Professional opportunities for toxicologists: the requirements of the public sector for education/teaching.

The public sector provides rewarding career opportunities for professional toxicologists. Public sector toxicologists evaluate diverse data on chemicals, assess the risks for exposed populations and assist in the articulation of policies for management of those risks. The latter aspects require extensive experience in the regulatory field, awareness of national/international policies and developments, and ability to communicate risk to politicians and the general public. Education of toxicologists for the public sector must reflect the broad general and specialist knowledge required.

Accreditation↗
PubMed2002

Health sector reform and public sector health worker motivation: a conceptual framework.

Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms may have differential impacts on various cadres of health workers.

Attitude of Health Personnel↗
PubMed1990

Utilisation of 350 billion SEK in the Swedish public sector.

Sweden has the largest public sector in the western world. It has been estimated that in 1990 public expenditure will amount to 62% of the GNP compared with 43% in the OECD countries. Sweden has chosen to allow the public sector, on national, regional and local levels, to administer, produce and distribute welfare services such as education, child care, the care of the elderly, medical services and social insurances. Today it is generally agreed that the public sector cannot continue to grow. It has been estimated that total expenditure in the public sector in 1990 will amount to 800 billion SEK. Of this amount, transfers, mainly social insurances, account for 400 billion SEK, investments for 40 billion SEK and consumption for 350 billion SEK.

Financing, Government↗
PubMed1993

Demographic diversity and the size of the public sector.

"We investigate the possibility that diversity in income, religion, and ethnicity affects the size of a country's public sector. Public provision of goods may be inefficient in the presence of diverse preferences about public sector spending, and voters may be unwilling to finance transfer payments to people whom they perceive as different from themselves. We find that ethnic diversity discourages transfer payments by central governments, and that income diversity discourages other public expenditure." (SUMMARY IN FRE AND GER)

Culture↗
PubMed1997

Accountability and the accounting regime in the public sector. Some messages from the NHS.

In the UK, the government is keen to introduce private sector procedures into the public sector. The latest stage of this process has been to suggest the adoption of accruals accounting by those parts of the public sector where it is not already operated. This approach to accounting was introduced into the NHS as part of the reforms which implemented a quasi-market to match the demands of purchasers of health care with its providers. Outlines the assumptions which underlie accruals accounting and considers whether the environment created for NHS Trusts is sufficiently like that of the private sector to justify its use. Shows that the initial ideas of the extent to which Trusts could mimic private sector organizations have not been fulfilled in practice, and concludes that it is not possible to justify the use of accruals accounting in the public sector simply on the grounds that as it is the technique used in the private sector it must be superior to the available alternatives.

Accounting↗
PubMed2002

A primer for advancing psychology in the public-sector.

Psychologists working in the public sector should, in addition to providing direct services, advocate for systems change. Although many consumers treated in the public sector face a constellation of severe life problems, working to improve the system of care is more difficult than providing treatment. Improving the quality of life of consumers of publicly funded mental health services requires that psychologists become advocates. Four prerequisites to systems change, plus coalition building, legislative advocacy, the work of state psychological associations, and forming alliances between psychologists and nonpsychological community organizations such as Rotary International, are described. In conclusion, 12 orienting ideas are listed for psychologists who want to advocate for social, institutional, and political change.

Awards and Prizes↗
PubMed1997

Public-sector immunization coverage in 11 states: the status of rural areas.

This report uses county-level immunization data generated by state public health agencies to explore the rural-urban variation in the delivery of childhood immunizations in the public sector. Public health department-documented immunization coverage rates for 1995 were obtained from 882 counties in 11 states east of the Mississippi River. To assess the possible association between public health department immunization coverage rates and county rurality, descriptive statistics were calculated. A multiple regression model then was estimated. In all states except West Virginia, nonmetropolitan counties averaged higher completion rates than metropolitan counties. Consistent with the descriptive statistics, in the regression analysis nonmetropolitan counties had average immunization rates 2.47 percentage points higher than metropolitan counties, even when controlling for county socioeconomic characteristics. For the 11 states in the analysis, rural children immunized in the public sector had higher completion rates compared with urban children. These data reflect the dependence of rural families on the public health system and the potential for successful health care delivery through public clinics. As new health care systems are brought into rural areas, the success of this existing avenue for care must not be overlooked.

Adolescent↗
PubMed2003

Public sector health insurance trusts.

Public sector associations have successfully developed and run employee health insurance pools for almost 30 years, providing members with savings and flexibility not available from commercial health insurance carriers. This article looks at the models, technical tools and governance philosophy that have contributed to their success in a very challenging business environment.

Actuarial Analysis↗
PubMed2002

Childhood vaccine purchase costs in the public sector: past trends, future expectations.

OBJECTIVES: We examined recent public-sector trends in childhood vaccine costs and estimated future costs. METHODS: We used public-sector price data to calculate vaccine purchase cost per child for children aged 0 to 6 years from 1975 to 2001. We fit a linear regression model to historical data and then used it to project costs per child from 2002 to 2020, adjusted to 2001 US dollars. RESULTS: Controlling for inflation, the cost of vaccine purchase per child climbed from $10 in 1975 to $385 in 2001. The cost of vaccine purchase in the year 2020 following recommendation of 7 additional vaccines is estimated to be $1225 per child (95% confidence interval = $891, $1559). CONCLUSIONS: The cost per child for recommended vaccines at public-sector prices may triple over the next 2 decades. These projections have implications for vaccine financing at federal and state levels.

Child↗
PubMed1998

Rationalization as a key stressor for public sector employees: an organizational case study.

Public sector organizations throughout Europe have been subject to cuts in Government spending, allied to demands for enhanced efficiency and effectiveness. Consequently, many have embarked upon radical programmes of change which potentially have an adverse effect upon the psychological well-being of employees. This study aimed to assess linkages between organization change and the psychological well-being of employees within the Swedish social insurance organization Försäkringskassan. A case study approach was adopted for the investigation which was carried out within the Halland region between February and June 1995. A questionnaire which included the Cultural Audit and the General Well Being Questionnaire was distributed to the organization's 456 employees in Halland. Questionnaire were returned by 246 employees (54.6%), reflecting the employment structure of the organization. The findings revealed that many issues associated with the process of rationalization and change were of concern to employees. Statistical analyses revealed that these were linked to their relatively high levels of 'anxiety' and their symptoms of being 'worn out'. This study indicates that the process of organization change is stressful for employees within Försäkringskassan. As public sector organizations throughout Europe are subject to similar pressure and are being forced to embark upon change programmes, it is suggested that they take cognizance of the findings of this investigation when making decisions regarding the planning and implementation of organization change.

Adolescent↗
PubMed2000

Comparing quality of mental health care for public-sector and privately insured populations.

OBJECTIVE: This study examined the methodological difficulties of comparing quality of care in large health care systems. It demonstrated methods for measuring quality of mental health care and, using these measures, compared patients from Department of Veterans Affairs (VA) hospitals with privately insured patients. METHODS: Individuals receiving VA inpatient mental health care during the first six months of each fiscal year from 1993 to 1997 were identified from discharge abstracts. A similar cohort of privately insured individuals was identified using MEDSTAT's MarketScan database from 1993 to 1995. Individuals in both cohorts were tracked for six months after discharge. Length of stay, readmission rates, and access to outpatient services were calculated. RESULTS: The private sector outperformed VA on most quality measures, although differences were modest and can likely be explained by the greater severity of illness and social disadvantages of VA patients. Readmission rates increased considerably over time in the private sector, whereas they declined for VA patients. Quality measures varied by diagnosis, with VA performing better than the private sector in treating patients diagnosed with substance abuse and mental disorders not elsewhere classified but worse in treating patients diagnosed with depression. CONCLUSIONS: Although the private sector modestly outperformed VA on most quality measures, VA treats a more troubled population, and it improved markedly over time compared with the private sector. As health systems strive to reduce costs of care, methods for comparing and evaluating the quality of care become increasingly important. However, methodological challenges remain substantial.

Adult↗