Health Care Delivery & Financing最新文献

{"title":"Management of Health Services in Ireland: Identifying the Determinants of Process Effectiveness in Health Related Services","authors":"Justin F. Keogan","doi":"10.2139/ssrn.944538","DOIUrl":"https://doi.org/10.2139/ssrn.944538","url":null,"abstract":"The term effectiveness presents a conceptual challenge to both academics and practitioners (Hirsch & Levin 1999). This is no less so in health care provision. Health care provision is a complex issue due to political, organisational, medical, technological, and multi-disciplinary approaches to solving health cases. Additionally, health care in Ireland is a multi-agent provided service, delivered through a variety of modes including market exchanges, networks and hierarchies. These complexities have resulted in multifaceted systems of service delivery and management that give rise to difficulties involved in the management of the health system particularly in terms of coordination which is linked to the construct of process effectiveness that is developed. These difficulties relate to the lack of understanding of process effectiveness within the present system and its determinants. At present we don't know a lot about process effectiveness or what determinants process effectiveness in the Irish health care system. Those responsible for the design of health services are faced with a dearth of information on what determines process effectiveness (Barrington 2003; Department of Health and Children 2001; Koeck 1998; Millar & McKevitt 2000; Page 2003). Health research in Ireland has not focused on service evaluation, which would provide a greater understanding of process effectiveness, and, while there is some annual statistical data available on the use of existing resources, there has been little evaluation of the effectiveness of service programmes (Barrington 2003; Deloitte and Touche 2001; Department of Health and Children 2001; Downey-Ennis & Harrington 2002; Government of Ireland 2003; Hensey 1988; Leahy & Wiley 1998; Millar & McKevitt 2000; O'Sullivan & Butler 2002; Prospectus & Watson Wyatt 2003; Wiley 2000). The lack of evaluation and/or measurement of effectiveness poses a serious challenge to the management of health service delivery. As McKevitt and Keogan (1997:20-21) identify without measurement there can be no clear view on progress towards strategic objectives and there is no meaningful basis for managerial action. This study addresses the concept of effectiveness as it applies to health care service provision and develops a construct of process effectiveness. A model is developed that will assist in the operationalisation of the effectiveness construct that can assist those responsible for health care service delivery to increase its effectiveness. The framework seeks to address the gap in our understanding of what determines process effectiveness at the level of service delivery by applying management and organisational approaches to Irish health care services.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128280456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget Impact Analysis of Expanding Access to Renal Replacement Therapy for End-Stage Renal Disease Patients under Universal Coverage in Thailand","authors":"V. Kasemsup, P. Prakongsai, V. Tangcharoensathien","doi":"10.2139/ssrn.1070762","DOIUrl":"https://doi.org/10.2139/ssrn.1070762","url":null,"abstract":"OBJECTIVES: To estimate the amount of government health budget required for the extension of universal access to renal replacement therapy (RRT) for beneficiaries of the universal health care coverage (UC) scheme in Thailand. Ability to bear the increasing budget of the government and appropriate measures to cope with anticipated costs of including RRT in the benefit package were also investigated. METHODS: Literature review on demand for RRT at both domestic and international levels, and the estimate of costs for haemodialysis and continuous peritoneal dialysis in Thailand. From the government perspective, several scenarios of budget requirements according to the estimated costs for RRT and possible rationing criteria were calculated. RESULTS: The government would spend approximately more than five billion Baht during the first year of implementation, if there is neither strategy to reduce the costs for RRT nor appropriate selection criteria for end-stage renal disease patients. The budget for universal access to RRT would increase to 74,355 million Baht in the sixteenth year of implementation if the government played passive roles in controlling costs of the program. The budget required would reduce to 58% of the estimate if the government introduced the rationing criteria for patients aged less than 60 years. CONCLUSIONS: The policy on the extension of access to RRT should be considered carefully by the government because of its financial impact on the government health budget. Appropriate interventions including effective measures to control costs of RRT, strategies to reduce the incidence of end-stage renal disease, and the rationing criteria for access to RRT are needed if the decision to implement the policy is made.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114607752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Miracle in Massachusetts: Why Governor Romney's Health Care Reform Won't Work","authors":"M. Tanner","doi":"10.2139/SSRN.975696","DOIUrl":"https://doi.org/10.2139/SSRN.975696","url":null,"abstract":"Massachusetts has enacted a far-reaching state health insurance reform package, featuring an unprecedented mandate that every resident obtain health insurance coverage. The package has received considerable praise from across the nation, but a number of its features should raise concern. Among those features: the individual mandate opens the door to widespread regulation of the health care industry and political interference in personal health care decisions; the act's subsidies are poorly targeted; the Massachusetts Health Care Connector, which restructures the individual and small business insurance markets, has the potential to severely limit consumer choice; and the act imposes new burdens on business and creates a host of new government bureaucracies to manage the health care system.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131277183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Malpractice Standard-Setting: Developing Malpractice 'Safe Harbors' as a New Role for Qios?","authors":"J. Blumstein","doi":"10.2139/ssrn.899321","DOIUrl":"https://doi.org/10.2139/ssrn.899321","url":null,"abstract":"Recent tort and medical malpractice reform has largely been directed at damages for noneconomic loss, a remedy-centric approach. This article addresses the issue of cost not from a remedy-centric perspective but from the perspective of the impact of the liability-determination process and standards on levels of utilization and therefore cost - the defensive medicine perspective. Establishing medical liability relies on the professional customary practice standard and is premised on the assumption that science determines a standard of care that controls medical decision-making in individual circumstances. Evidence of unexplained practice variation (clinical uncertainty) calls this scientific premise into question in a large number of situations, making compliance with a standard of care difficult, even mythical, in many clinical circumstances. Because the medical profession sets the standard, consideration of cost-benefit issues in individual cases is not part of the liability-determination process in medical malpractice cases. Further, the professional standard of care is established after-the-fact (structural uncertainty) by expert testimony ostensibly based on scientifically validated customary practices. Such ex post standard-setting is understandable in a medical-practice world characterized by scientific evidence, but the evidence on clinical uncertainty undermines that claim. This creates structural uncertainty, which makes compliance with the after-the-fact \"standards of care\" difficult - pursuit of a moving target. The result of clinical and structural uncertainty is an incentive for risk-averse medical decisionmaking - doing more than might be medically optimal to avoid liability. Such defensive medicine is facilitated by the prevalence of third-party payment, which funds this type of risk-averse clinical decisionmaking and reduces the reliability that custom might otherwise reflect in balancing cost and benefit in a less subsidized market. This article proposes the use of ex ante standard-setting to reduce uncertainty faced by medical providers and to allow for the appropriate balancing of costs and benefits in formulating such protocols. Such standards should be symmetrical - the controlling legal standard that serves both as both a liability sword and shield. From a quality-assurance perspective, this sword-and-shield dimension creates a powerful incentive for compliance. To make ex ante standard-setting work, the standard must be the controlling standard. The federal QIO legislation allows QIOs to establish practice standards that become the standards of care. Such QIO-developed standards trump state-created standards by conferring immunity for conduct in compliance with the QIO standards. To be effective as a defense against defensive medicine, such QIO-developed standards must be modest in conception, narrow in design, and targeted in their implementation. They must be targeted at narrow and specific circumstances, providing specif","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134395958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Drives Health Care Expenditure? Baumol's Model of 'Unbalanced Growth' Revisited","authors":"Jochen Hartwig","doi":"10.2139/ssrn.910879","DOIUrl":"https://doi.org/10.2139/ssrn.910879","url":null,"abstract":"The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's (1967) model of 'unbalanced growth', showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128368909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costing Information in the UK NHS: The (Non-) Use of Cost Information in the UK NHS Trust Hospitals","authors":"D. Agrizzi","doi":"10.2139/ssrn.870424","DOIUrl":"https://doi.org/10.2139/ssrn.870424","url":null,"abstract":"This paper aims to examine empirically the development and usage of cost information in the UK National Health Services (NHS) in order to provide information on how it is currently used and how it might be used in the future. The issues of costing healthcare service have been discussed internationally, in the light of the Diagnostic Related Groups (DRGs). The findings suggest that, in the UK, despite the introduction of Health Resource Groups (HRGs), there is no indication that the Department of Health has any direct interest in pursuing the consideration of HRGs as a control device. Therefore the micro effect is a decoupling from cost control at the organisational level. The paper adds to our understanding of the nature of the interaction between the macro steering process and the micro effects. The analysis of the data follows Habermas' (1984) discussion process, which involves marshalling evidence, informed by a 'middle range' methodology (Laughlin, 1995, 2004) to develop a convincing argument concerning a particular situation.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126385621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Compliance, Co-Payment and Health Outcomes: Evidence from a Panel of Italian Patients","authors":"V. Atella, Franco Peracchi, D. Depalo, C. Rossetti","doi":"10.2139/ssrn.871395","DOIUrl":"https://doi.org/10.2139/ssrn.871395","url":null,"abstract":"This paper studies the relationship between medical compliance and health outcomes - hospitalization and mortality rates - using a large panel of patients residing in a local health authority in Italy. These data allow us to follow individual patients through all their accesses to public health care services until they either die or leave the local health authority. We adopt a disease specific approach, concentrating on hypertensive patients treated with ACE-inhibitors. Our results show that medical compliance has a clear effect on both hospitalization and mortality rates: health outcomes clearly improve when patients become more compliant to drug therapy. At the same time, we are able to infer valuable information on the role that drug co-payment can have on compliance, and as a consequence on health outcomes, by exploiting the presence of two natural experiments during the period of analysis. Our results show that drug co-payment has a strong effect on compliance, and that this effect is immediate.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127380406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Copayment Strategies in a Public Health Care System","authors":"L. Levaggi, Rosella Levaggi","doi":"10.2139/ssrn.734923","DOIUrl":"https://doi.org/10.2139/ssrn.734923","url":null,"abstract":"Health care usually represents a so called merit good, i.e. a good whose consumption should be promoted and given that in most cases it might be essential to restore health or to stop its decay, most countries have implemented a public health care system where care is supplied to anybody needing it for free and its cost is borne by all the community. inappropriate use of health care. To curb this expenditure waiting lists and copayments have been introduced in the public health care system. In this paper we study the optimal definition of the copayment schedule in two different environments, namely when there are no limits to the resources that can be raised using the tax system and when there are specific limits to public expenditure. The paper shows that if the tax system is optimal the copayment can be used as a risk sharing instruments; in the presence of ceilings on expenditure its revenue should be used to increase public provision, but it assumes the role of an instrument to improve income distribution.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125410161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance and Innovation in Health Care Markets","authors":"D. Lakdawalla, N. Sood","doi":"10.3386/W11602","DOIUrl":"https://doi.org/10.3386/W11602","url":null,"abstract":"Innovation policy often involves an uncomfortable trade-off between rewarding innovators sufficiently and providing the innovation at the lowest possible price. However, in health care markets with insurance for innovative goods, society may be able to ensure efficient rewards for inventors and the efficient dissemination of inventions. Health insurance resembles a two-part pricing contract in which a group of consumers pay an up-front fee ex ante in exchange for a fixed unit price ex post. This functions as if innovators themselves wrote efficient two-part pricing contracts, where they extracted sufficient profits from the ex ante payment, but still sold the good ex post at marginal cost. As a result, we show that complete, efficient, and competitive health insurance for innovative products - such as new drugs, medical devices, or patented procedures - can lead to perfectly efficient innovation and utilization, even when moral hazard exists. Conversely, incomplete insurance markets in this context lead to inefficiently low levels of innovation. Moreover, optimally designed public health insurance for innovative products can solve the innovation problem by charging ex ante premia equal to consumer surplus, and ex post co-payments at or below marginal cost. When these quantities are unknown, society can usually improve static and dynamic welfare by covering the uninsured with contracts that mimic observed private insurance contracts.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121877877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Prizes: Filling the Gaps in Pharmaceutical Innovations","authors":"Bryan P. Schwartz, Marhi Kim","doi":"10.2139/ssrn.920063","DOIUrl":"https://doi.org/10.2139/ssrn.920063","url":null,"abstract":"This paper identifies the importance of creating a strong innovation policy to support industrial growth and strengthen Canada's competitiveness in a globalized marketplace. This paper summarizes market failures in the pharmaceutical industry that inflate the cost of healthcare in Canada and hinder research and development for treatments of diseases that primarily affect welfare sectors. This paper proposes a system of cash prizes to reward researchers upon production of demonstrably effective and tested products (or processes) that will improve healthcare. The prize authority would pre-specify diseases for which treatments are a priority and offer to pay a cash prize in proportion to the relative social value (cost savings) of any innovation that offers a solution, without pre-specifying the technical requirements. This approach is particularly innovative as it encompasses any type of healthcare innovation, patentable or non-patentable - thereby tapping into the enormous potential of overlooked but highly valuable innovations. In the long run, such a system will help control the high cost of healthcare in Canada, assist the economies of developing countries and improve Canada's international standing as a leader in industrial innovation and foreign aid policy.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117264177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}