Medical care review最新文献_第10页

The effect of competitive environments on university hospital-medical faculty/staff relationships. 竞争环境对大学医院-医学教职员工关系的影响。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600403

W M Lerner

{"title":"The effect of competitive environments on university hospital-medical faculty/staff relationships.","authors":"W M Lerner","doi":"10.1177/107755878904600403","DOIUrl":"https://doi.org/10.1177/107755878904600403","url":null,"abstract":"The change in reimbursement and turbulence in the external environment are elements of uncertainty to all hospitals, including university hospitals. The organizational character of the university hospital presents it with substantial challenges as it strives to continue to meet its traditional role in society. Changes in policy may indeed be enacted with specific outcomes in mind--but they may result in totally unexpected longer-term effects on the institutions affected. This article--an attempt to develop a model and a set of propositions through which such changes can be analyzed as they affect the university hospital and its relationship to its medical faculty/staff--focuses primarily on the effects of such changes on the delivery of clinical services. While individuals viewing the same problem from different perspectives could reach other conclusions regarding academic activities and community services, the approach may be useful as an analytic tool for these areas of concern as well. For the sake of simplicity and because patient care is important both clinically and financially to the university hospital, it was chosen as the critical variable on which to focus the analysis. The analysis was predicated on the interaction of two perspectives from the general area of exchange theory. While each can contribute to an understanding of the dynamics of organizational change, their complementary nature allows one to analyze organizational environments from a more inclusive perspective. It is suggested that changes in policy that result in changes in organizational performance should utilize frameworks that integrate perspectives--focusing on commonalities, identifying differences and, in essence, triangulating on the management of critical relationships--to ensure successful implementation of the policy change. In this way, the analytic framework developed in this article should be useful as a close reflection of organizational reality. Prospective payment, price competition, alternative sources of care, and the oversupply of physicians threaten to change the balance of influence among the university hospital's influential actors. Depending on the decisions made, any of the four goals of the university hospital (patient care, education, research, and community service) may have to be modified or eliminated. The university hospital's historical role as the last resort for the severely ill, developer of new basic and clinical knowledge, and provider of indigent care may be in jeopardy. While the long-term effects of PPS and competition for patients cannot be predicted, speculation can be offered regarding the possibility of changes in the traditional physician-patient and faculty/staff-university hospital relationships as both institutional and external regulators and purchasers of care exert increased control over UH physicians. Such changes may lead to an under-supply of physician educators and physician scientists as a result of a change in ","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"46 4","pages":"387-409"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755878904600403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21169603","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}

引用次数: 1

Governing boards and profound organizational change in hospitals. 管理委员会和医院深刻的组织变革。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600204

M L Fennell, J A Alexander

{"title":"Governing boards and profound organizational change in hospitals.","authors":"M L Fennell, J A Alexander","doi":"10.1177/107755878904600204","DOIUrl":"https://doi.org/10.1177/107755878904600204","url":null,"abstract":"Over the past decade the importance of governing boards as policy-making setting and oversight units within organizations has increased dramatically. Although this is true for both corporate- and private-sector organizations (Bacon and Brown 1977; Gelman 1988), it is particularly relevant to the health sector. Hospital governing boards, long considered inconsequential in hospital management, have recently become subject to closer scrutiny. The role of governing boards in decisions affecting hospital strategy and hospital performance is once again a topic of some interest in boardrooms and hospital trade journals. Impressive evidence of the renewed interest in governance is provided by the funding of an instructional consortium by the S.K. Kellogg Foundation to help strengthen trusteeship and governing board decision making, and to improve education for health services managers in the area of governance. Members of the consortium include the Hospital Research and Educational Trust, the American Hospital Association, the American College of Healthcare Executives, and the Association for University Programs in Health Administration. Among the activities being undertaken by this consortium is the development of a self-assessment tool/methodology for boards, a bibliography and reference guide on effective governance for practicing trustees, research workshops for faculty in health administration programs, and a teaching guide on governance and trustee leadership. Despite this interest, the question with which we began this article persists. Do governing boards make a difference? In the course of our review of previous work on governance we found that, more often than not, that question has been transformed into: how do boards influence hospital performance? And very often that question has been further narrowed into: which board structure leads to better hospital performance? We have argued for a respecification of the initial question. Rather than pursuing a definition of the maximally performing governing board, we should perhaps shift our focus back to a fuller understanding of board structure and function, and its influence on hospital change. The model developed here combines four essential, and very basic, questions: 1. What are the basic dimensions that underlie structural variation in different types of governing boards? 2. How do these board types influence structural change in hospitals? 3. How is the effect of board influence on change itself likely to change over time as a function of the hospital's general pattern of growth, decline, stability, or instability?(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"46 2","pages":"157-87"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755878904600204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21172371","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}

引用次数: 25

Long-term care services for the chronically mentally ill: reimbursement system structure, effects, and alternatives. 慢性精神疾病的长期照护服务:补偿制度结构、效果及替代方案。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600103

K L Grazier

引用次数: 0

Social policy, technology, and the rationing of health care. 社会政策，技术和医疗配给。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600202

D Mechanic

引用次数: 3

Access to health insurance in the United States. 在美国获得医疗保险。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600402

E R Brown

引用次数: 21

Strategic behavior of hospitals: a framework for analysis. 医院战略行为:一个分析框架。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600305

B Bigelow, J Mahon

引用次数: 28

Perspectives on a continuum of care for persons with HIV illnesses. 对艾滋病毒感染者持续护理的看法。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600404

A E Benjamin

{"title":"Perspectives on a continuum of care for persons with HIV illnesses.","authors":"A E Benjamin","doi":"10.1177/107755878904600404","DOIUrl":"https://doi.org/10.1177/107755878904600404","url":null,"abstract":"A. E. Benjamin, Ph.D. is Adjunct Associate Professor and Associate Director, Institute for Health and Aging, University of California, San Francisco. Since the first cases of acquired immune deficiency syndrome (AIDS) were reported in the United States in 1981, the attention of both federal policymakers and the general public has been directed foremost at issues involving biomedical research, epidemiology, education, and testing. Not surprisingly, understanding the transmission of this catastrophic disease and seeking ways to contain it have tended to dominate serious public discussion of AIDS. As the numbers of persons with diagnoses of AIDS and human immunodeficiency virus (HIV)-related illnesses other than AIDS have grown, however, policymakers have necessarily had to devote more attention to a range of service delivery issues related to the provision of appropriate and costeffective care to those affected by the virus. Research on service delivery issues has been concerned more with the costs of AIDS care than with patterns of service, but this is changing in two related ways. First, those doing (or reviewing) cost studies have shifted attention from costs alone to service utilization and its relation-","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"46 4","pages":"411-37"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755878904600404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21171898","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}

引用次数: 31

A framework for the definition and measurement of underutilization. 定义和衡量利用不足的框架。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600303

J D Restuccia, S M Payne, L V Tracey

引用次数: 8

Are Medicaid patients more expensive? A review and analysis. 接受医疗补助的病人是否更贵?回顾和分析。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600302

G A Melnick, J M Mann

引用次数: 4

Leadership: implications of the literature for health services administration research. 领导力:文献对卫生服务管理研究的启示。

Medical care review Pub Date : 1989-01-01 DOI: 10.1177/107755878904600104

R S Kurz, C C Haddock

引用次数: 3