PSN: Health Care Delivery (Topic)最新文献

{"title":"Competition in the Healthcare Sector in Singapore - An Explorative Case Study","authors":"Andrea Gideon","doi":"10.2139/ssrn.2853888","DOIUrl":"https://doi.org/10.2139/ssrn.2853888","url":null,"abstract":"Market mechanisms have increasingly been introduced into the public service regimes of many countries over recent decades. This was meant to foster competition and choice which in turn was thought to increase quality while decreasing prices. Such progressive liberalisation led to public services increasingly falling within the ambit of competition laws which in turn partly required further liberalisation in some competition law regimes. However, there are certain tensions between providing such services in a competitive market and, at the same time, allowing them to retain their public interest character including such elements as universal provision, trust based relationships or equality of access. The ASEAN countries, in which competition law is still a relatively new area of law, might face such tensions with increasing application of competition law to these areas. Yet, the application of competition law to public services in ASEAN countries has thus far received virtually no attention.The explorative case study ‘Competition in the healthcare sector in Singapore’ aims to make a first step in filling this gap in the research by exploring the healthcare sector in Singapore from a competition law perspective. It will leave to one side questions on medical research, pharma firms’ interaction with the market and primary care. Instead it focuses its analysis on hospital care; more specifically on in-patient care (i.e. mainly secondary care). The research will explore in how far the notion of undertaking is applicable to hospital in-patient services in Singapore. Since the notion of undertaking in Singaporean competition law has received hardly any attention so far this is of relevance beyond the case study. It will then proceed to analyse in how far there might be potential issues with competition law application (s 34, 47 and 54 of the Competition Act) and if there would be recommendations beyond the legal analysis.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129263822","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":"Comparison of Organizational Climate in the Regional Unit of the National Institute of Public Health Before and after Reorganization","authors":"G. Jordan, Gozdana Miglič, Miha Marič","doi":"10.17573/IPAR.2016.4.04","DOIUrl":"https://doi.org/10.17573/IPAR.2016.4.04","url":null,"abstract":"Organizations have been focused on organizational climate (OC) as one of the influencing factors, which has an impact on organizational outcomes, attaining organizational goals and employee satisfaction. Our research focuses on the regional unit of the National Institute of Public Health in Slovenia and the comparison of the OC before (2013) and after reorganization (2015). We used a modified SiOK (Slovenian Organizational climate) questionnaire to shed light on employees’ perception of OC. OC and reorganization are closely connected on account of the relationship between management and employees; if OC is positive, we can expect less complicated process of reorganization as it can be if it is negative. The research revealed misfired attempt of OC improvement in all dimensions, though we expected ameliorated results in the three worst assessed OC dimensions before reorganization. Further, in the paper several recommendations are suggested to managers facing reorganization.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131757512","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":"Certificate of Need in the Post-Affordable Care Act Era","authors":"E. W. Parento","doi":"10.2139/ssrn.2845687","DOIUrl":"https://doi.org/10.2139/ssrn.2845687","url":null,"abstract":"Certificate of need (CON) programs were conceived approximately fifty years ago as supply constraint mechanisms for health care services, in an environment that is essentially unrecognizable today. Every aspect of the health care landscape has changed dramatically, particularly in the years since the enactment of the Affordable Care Act. The historical rationales in support of CON programs have been vigorously questioned by scholars across disciplines, roundly criticized by the federal government, and largely disproven by research. Yet the status quo persists, with 36 states retaining CON laws, due in large part to a combination of entrenched interests and political inertia that prevents either repeal or significant modification. Still, proponents of a more efficient health care model need not lose hope. Kentucky was widely recognized as among the most successful states in its implementation of the Affordable Care Act. As part of its implementation efforts, the Commonwealth reformed its CON program to reward health care providers who embrace rather than resist the changes occasioned by health care reform. While the eventual impact of Kentucky’s CON modernization cannot yet be known, these reforms may offer insights for additional states as they consider whether and how to reform their own CON programs. Indeed, rather than being an historic relic that must be tolerated in the absence of political will for change, it may be possible for a modernized CON program to serve as an additional regulatory tool for states seeking to nudge their health care providers into fuller engagement in the post-Affordable Care Act health care landscape.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115732325","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":"Improving Student Nurses' Attitudes Towards the Elderly","authors":"Maria E. Mackey","doi":"10.2139/SSRN.2962083","DOIUrl":"https://doi.org/10.2139/SSRN.2962083","url":null,"abstract":"The elderly population is projected to nearly double by the year 2030. With the increased number of elderly needing healthcare and concerns of ageist attitudes towards the elderly, student nurses need to have a better understanding of this patient population and the implications of providing biased care. Research indicates that there are multiple variables that help form attitudes about the elderly, and the positive influence of education. Using Kogan’s (1961) Attitudes Towards Old People scale, this project surveyed attitudes of pre-licensure diploma level nursing students, both before and after the completion of a seven-week gerontology specific course, guided by Miller’s (1990) Functional Consequences Theory for Promoting Wellness in Older Adults. Using an independent-samples t-test, before gerontology ATOP total scores were compared to after gerontology ATOP total scores to determine if the gerontology specific education improved student nurses’ attitudes toward the elderly. The findings of this project demonstrated no significant difference in scores for before and after, suggesting that the intervention of gerontology specific education had no impact as a strategy to improve student attitudes. The lack of improvement may be a result of students already having positive attitudes. Another reason that the results may have failed to demonstrate an improvement in student attitudes after gerontology education, was the sample size which may have been too small to capture a change that may have occurred with a larger sample size.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132889634","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":"The Naylor Report and Health Policy: Canada Needs a New Model","authors":"Å. Blomqvist, C. Busby","doi":"10.2139/ssrn.2808504","DOIUrl":"https://doi.org/10.2139/ssrn.2808504","url":null,"abstract":"The federal government should recognize the limited success of past attempts to achieve healthcare reform with conditional transfers to the provinces and instead focus more on independent initiatives, according to a new C.D. Howe Institute report. In “The Naylor Report and Health Policy: Canada Needs a New Model,” authors Ake Blomqvist and Colin Busby suggest a variety of initiatives including the promotion of better information technology dissemination to providers and patients, and more systematic cost-effectiveness evaluations of new drugs and devices.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115136780","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":"Expanded HTA, Legitimacy and Independence; Comment on 'Expanded HTA: Enhancing Fairness and Legitimacy'","authors":"K. Syrett","doi":"10.15171/ijhpm.2016.75","DOIUrl":"https://doi.org/10.15171/ijhpm.2016.75","url":null,"abstract":"This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evidence, but also to that of legitimacy. However, as expansion of HTA also renders it more visibly political in character, it is plausible that its legitimacy may be undermined, rather than enhanced by, independence from the policy process.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130560209","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":"The Value Proposition of Prevention: The Impacts of Pure North S’Energy Foundation’s Preventive Care Program on Acute Care Utilization in Alberta","authors":"J. Emery","doi":"10.11575/SPPP.V9I0.42583","DOIUrl":"https://doi.org/10.11575/SPPP.V9I0.42583","url":null,"abstract":"This analysis of Pure North S’Energy Foundation’s preventive health services shows that the acute health care cost savings of being pro-active, rather than reactive, and averting chronic disease, are significant, immediate and worth pursuing further. Chronic disease, such as cardiovascular maladies, diabetes, cancer and other long-term illnesses, represents the leading cause of disability and death in Canada. An estimated 25 per cent of expenditures in the public health system go towards treating these frequently avoidable diseases. This health-care cost curve, which sees more money expended on fighting the increase of chronic disease, can be bent, so to speak, through prevention services that offer long-term benefits to people’s health. Preventing disease is not just good for individuals, but for the health system in general, as prevention frees up acute care beds for more timely access by those who need them. The concern for health care decision makers struggling to find dollars to meet current health care needs is that investment in prevention is risky compared spending on medical treatment. It is often expressed that the health cost savings of prevention are too far off in the future and there is a lack of convincing evidence that preventive services and interventions will achieve the health gains expected. Pure North offers participants in its eight-year-old program access to a variety of healthcare practitioners, including doctors, naturopaths, nurses, nurse practitioners and dentists. Participants receive lifestyle counselling and dietary supplements aimed at combating vitamin D insufficiency, obesity, insulin resistance and other problems that can lead to chronic disease. Our study found that participants who stay with the program for two years demonstrate significant reductions in their number of visits to emergency rooms and hospitals. Indeed, after just one year in the program, the number of hospital visits was down 27 per cent and the number of visits for ambulatory care reduced by 14 per cent over a control group matched for age, sex and postal code, who did not participate in the Pure North program. In the second year after joining the program, hospital admissions dropped by 32 per cent for participants aged 55 and over. If these effects could be achieved in the population of Albertans aged 55 to 75, the hospital bed nights freed up per year would be equivalent to adding the acute care bed capacity of the Foothills Medical Centre in Calgary. These figures translate into significant cost differences. The average cost of hospitals, ambulatory care and visits to general practitioners in the year prior to joining Pure North’s program came to $1,320 per individual. Cost reductions in annual health-care utilization among participants ranged from $294 (22 per cent) per person who joined the program to $600 (45 per cent) per person who stayed in the program for at least a year. Two years into the program, a participant could expect to avoid","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129673975","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":"Information and Efficiency in Vietnamese Patients' Choice of Health-Care Provider: A Short Report","authors":"Q. Vuong","doi":"10.2139/ssrn.2710667","DOIUrl":"https://doi.org/10.2139/ssrn.2710667","url":null,"abstract":"This paper communicates results from a statistical investigation into questions of relationships between sources of health-care information, data sufficiency, and final outcomes of Vietnamese patients' choice of health-care provider. The study employs a data set of 1459 observations collected from a survey in Hanoi in the fourth quarter of 2015. Significant relationships among these factors are identified following categorical data modeling employing the baselinecategory logit (BCL) method. Among the significant results reported, sources ofinformation, cost, and amount of time for seeking information are found to have significant influences on data sufficiency. The quality of information and health professionals’ credibility are critical factors in helping patients choose a healthcare provider In addition, empirical probabilities for different conditions patients face are provided together with insights and policy implications. Final suggestionsemphasize an upgrade of the knowledge base and an increase in public access to information with Internet-based innovations such as smartphone apps and data storage with the participation of healthcare providers and the Ministry of Health's ICT units. The underutilized 115 Emergency Service could also be transformed to function as a call center that helps coordinate and channel requests forinformation across a broad network of health-care professionals for better public use.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126853754","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":"Evaluating the Impact of Social Security Benefits on Health Outcomes Among the Elderly","authors":"Padmaja Ayyagari","doi":"10.2139/ssrn.2669699","DOIUrl":"https://doi.org/10.2139/ssrn.2669699","url":null,"abstract":"Given concerns about the depletion of the Social Security Trust Fund, policymakers are considering several proposals to improve the financial sustainability of the program, including some that would lower benefits over time. The extent to which reductions in Social Security benefits impact individual health and well-being is not well understood. Using data from a nationally representative survey of older adults, we examine the impact of changes in Social Security income on a broad range of elderly health outcomes, including cognitive function, depression, disability and self-rated health. Prior literature has documented a positive association between income and health. However, this association may reflect unmeasured confounders that are correlated with both income and health (e.g. childhood environment) or may reflect the impact of health on income. To address these concerns and to identify the causal impact of income on health, we employ an instrumental variables strategy based on changes in Social Security income due to amendments to the Social Security Act in the 1970s. We discuss the implications of our findings for aging populations and for public policy.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131212689","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":"Designing Regional Health Systems in India: A Case Study of Himachal Pradesh","authors":"Nachiket Mor","doi":"10.2139/SSRN.2649562","DOIUrl":"https://doi.org/10.2139/SSRN.2649562","url":null,"abstract":"Designing health systems is a complex challenge. It is made all the more complex in a large and diverse country like India because of the extent and magnitude of variations in it. An attempt is made in this note to carefully study the Indian State of Himachal Pradesh as a case study and to develop a health systems design for it by carefully analyzing its health status, stage of development, and its local geography. The note finds that the State has a number of choices in front of it and if it carefully makes them at this stage over a five to ten year period of time it can aspire to build a first-world health system with health outcomes comparable to the Nordic countries. And, since improved health systems, particularly UHC focussed health systems, are very labour intensive, they should also be seen by the State as being one of the engines of growth in addition to being a means to provide improved healthcare. And, even as the States seeks to reconfigure its health system over the longer-term, it can achieve reductions in unmanaged hypertension, diabetes, and hyperglycaemia very quickly by the use of simple first line drugs, leading to enormous gains in productivity in the short-term while contributing to a reduction in the burden of disease in the medium to long-term.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121370296","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}