Medical care review最新文献

{"title":"An integrative overview of the quality dimension: marketing implications for the consumer-oriented health care organization.","authors":"S J O'Connor, M R Bowers","doi":"10.1177/107755879004700204","DOIUrl":"https://doi.org/10.1177/107755879004700204","url":null,"abstract":"Stephen J. O’Connor, Ph.D. is an Assistant Professor in the Center for Health Services Education and Research, St. Louis University. Michael R. Bowers, Ph.D. is an Assistant Professor in the Department of Marketing, University of Alabama at Birmingham. A major problem with the quality concept is that it is so broad and multifaceted that the issue becomes obfuscated and confused. Quite often when quality is mentioned in a health care context, it is assumed that the ensuing discussion will focus on the appropriateness and effectiveness of certain technical procedures applied by medical professionals that result in a certain outcome level of health status for a patient. The problem is further compounded since, for a number of reasons, consumers of health services have not played a strong role in determining what constitutes quality. These reasons have served to ad-","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 2","pages":"193-219"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978153","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":"Clinical ethics and HIV-related illnesses: issues in treatment and health services research.","authors":"B Lo","doi":"10.1177/107755879004700103","DOIUrl":"https://doi.org/10.1177/107755879004700103","url":null,"abstract":"Bernard Lo, M.D. is Associate Professor in the Divisions of General Internal Medicine and Medical Ethics, and is affiliated with the Center for AIDS Prevention Studies, and the Robert Wood Johnson Clinical Scholars Program, University of California at San Francisco. This work is supported in part by Center Grant MH42459 from the National Institutes of Mental Health and Drug Abuse, by Grant HS 05791 from the National Center for Health Services Research, and by The Robert Wood Johnson Foundation. The acquired immune deficiency syndrome (AIDS) epidemic has forced physicians and public officials to grapple with longstanding clinical and policy dilemmas (Mangione and Lo 1989; Walters 1988). The epidemic has dramatized perennial problems such as access to medical care, the cost of care, and the allocation of resources. While these dilemmas also occur with other diseases, the sudden harsh reality of the human immunodeficiency virus (HIV) epidemic has added even more urgency to the need for solutions. On other issues, AIDS has required a reevaluation of existing policies; for example, in decisions","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 1","pages":"15-32"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978634","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":"Physician payment reform: an idea whose time has come.","authors":"P R Lee, L B LeRoy, P B Ginsberg, G T Hammons","doi":"10.1177/107755879004700202","DOIUrl":"https://doi.org/10.1177/107755879004700202","url":null,"abstract":"Philip R. Lee, M.D. is Professor of Social Medicine at the Institute for Health Policy Studies, University of California, San Francisco, and Chairman, Physician Payment Review Commission; Lauren B. LeRoy, Ph.D. is Deputy Director, Paul B. Ginsburg, Ph.D. is Executive Director, and Glenn T. Hammons, M.D. is Deputy Director, all of the Physician Payment Review Commission. The Physician Payment Review Commission was created in 1986 to advise Congress on reform of methods used to pay physicians for services to Medicare beneficiaries. In 1988, Congress added to the commission’s charge the consideration of policies to slow the growth in spending for these services. The commission began operation in November 1986, and in its first annual report to Congress, submitted the following March, it called for a fee schedule for Medicare. In April 1989, the commission forwarded a set of proposals to Congress that sought both to rationalize the pattern of payment to physicians and to slow the increases in program costs so that they are affordable to beneficiaries and taxpayers. To realign payments, the commission proposed a Medicare Fee Schedule based primarily on","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 2","pages":"137-63"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978151","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":"Rural health care: the future of the hospital.","authors":"D A Ermann","doi":"10.1177/107755879004700104","DOIUrl":"https://doi.org/10.1177/107755879004700104","url":null,"abstract":"medical care are all characteristics of the rural health care system. The rural hospital has been particularly hard hit in the early 1980s, and since, due to a decreasing demand for inpatient services and increased costcontainment efforts on the part of health care payers. The rural hospital has been a traditional symbol of a community’s identity and pride, as well as a major component of the local economy. The rural hospital is often a major employer in the area. It has been estimated that a typical hospital in a rural Pennsylvania community with","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 1","pages":"33-73"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978635","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 differential effects of a change in reimbursement on public and private university hospitals.","authors":"W M Lerner","doi":"10.1177/107755879004700406","DOIUrl":"https://doi.org/10.1177/107755879004700406","url":null,"abstract":"<p><p>The primary purpose of the government's prospective payment system was to decrease the rate of federal spending for Medicare patients by paying fixed prices for services and by transferring the financial risk for the care provided to the hospital. While PPS certainly has affected all hospitals, this article has attempted to identify some of the expected and unexpected consequences of the change in reimbursement on publicly and privately owned university hospitals. Of importance is the discussion that has analyzed the specific effects of PPS on the components of the UHs' missions. The implementation of PPS may exaggerate the effects of the payment change on both types of UHs. The provision of broadly based primary and specialty care services may be in question as institutions find themselves potentially unable to deliver these services on a price-competitive yet profitable basis. The costs associated with educational, research, and community service programs can no longer be subsidized by excess patient care revenues as payers streamline payments to reflect only the costs of clinical care. Thus, university hospitals may be forced to reexamine their missions and change their operating plans to reflect the current fiscal environment. If taken to an extreme, it is likely that the local society may be negatively affected by these actions. Clinical and community services that increase access, assure continuity of care, or provide needed but costly (public) health services may be eliminated or reduced in scope in an effort to contain costs. Even those services that are cost beneficial from a societal perspective may be eliminated without some form of subsidy or direct payment as institutions are forced to reallocate their limited funds from these types of public health services to support nonprofitable, but critical clinical or academic programs. The potential impact on access, continuity of care, and morbidity and mortality will not be known for many years. Although it is not known how these changes will eventually affect university hospitals, two outcomes seem clear. University hospitals with different governance and management structures may not change their missions and means for achieving institutional goals as much as might have been expected. The interdependence of the university hospitals' goals and the role they play in their local communities may force them to begin to explore new ways to achieve their missions. Public-private sector cooperation is suggested as one approach to use in response to the demands of payers and patients while the institution remains true to its historical mission.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 4","pages":"503-23"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20985943","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 effect of utilization review on hospital use and expenditures: a review of the literature and an update on recent findings.","authors":"T M Wickizer","doi":"10.1177/107755879004700303","DOIUrl":"https://doi.org/10.1177/107755879004700303","url":null,"abstract":"Thomas M. Wickizer, Ph.D. is Assistant Professor in the Department of Health Services at the University of Washington, Seattle. The nature of the traditional relationships among providers, payers, and patients in the United States is changing as a result of cost containment pressures. Not long ago, privately insured patients could seek medical care under the guidance of their physician and remain largely unconcerned about the cost implications of the care they received. Decisions about the type of medical care provided and the treatment setting were made by patient and physician with few, if any, external constraints.","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 3","pages":"327-63"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20985963","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":"Innovation in medical care organizations: a synthetic review.","authors":"W R Scott","doi":"10.1177/107755879004700203","DOIUrl":"https://doi.org/10.1177/107755879004700203","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 2","pages":"165-92"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978152","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":"Capital expenditure decisions and the role of the not-for-profit hospital: an application of a social goods model.","authors":"J R Wheeler,&nbsp;J P Clement","doi":"10.1177/107755879004700404","DOIUrl":"https://doi.org/10.1177/107755879004700404","url":null,"abstract":"In recent years, there has been considerable controversy over whether not-for-profit (NFP) and for-profit (FP) hospitals really differ from each other in meaningful ways. Specifically, the ongoing debate has concerned whether NFP hospitals pursue objectives that differ from the objectives of FP hospitals and, if so, whether these different objectives get translated into different sorts of behaviors. Although it is difficult to derive empirical support for hypothesized objective functions of NFP hospitals (Pauly 1987a), some research studies have suggested important substantive differences in the behavior of NFP and FP hospitals. These findings include production of more costly and higher priced care in FP hospitals","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 4","pages":"467-86"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20985942","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":"Improved stakeholder management: the key revitalizing the HMO movement?","authors":"S Topping,&nbsp;M D Fottler","doi":"10.1177/107755879004700304","DOIUrl":"https://doi.org/10.1177/107755879004700304","url":null,"abstract":"<p><p>In summary, our purpose has been to propose and to demonstrate that the survival of HMOs (in whatever form) depends on the proper identification and management of key stakeholder strategies. It is believed that identification and assessment of key stakeholders holds much promise for improving both HMO management and the future performance of HMOs.</p>","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 3","pages":"365-93"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20979097","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":"American hospitals in the British health care market.","authors":"J Higgins","doi":"10.1177/107755879004700106","DOIUrl":"https://doi.org/10.1177/107755879004700106","url":null,"abstract":"regarded-as the most socialized system of health care in Europe and North America. It was financed largely out of general taxation, it was free at the point of use, and the private market was all but eliminated when hospitals were brought into public ownership and doctors became state employees. However, in the last decade the nature of health care provision has changed significantly, and it has done so partly because of the movement into Britain of American hospital corporations and American ideas. The aim of this article is to examine the recent growth of private health care in Britain, to discuss the influence of American providers on these developments, and to consider the possible changes to the public/private mix in health care that may result from the publication of the 1989 Government White Paper, Working for Patients.","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 1","pages":"105-30"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20978632","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}