Effective health care最新文献

{"title":"Programme budgeting: an aid to planning and priority setting in health care.","authors":"G Mooney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Programme budgeting can assist in overcoming some of the current problems besetting health care planning and management. In particular, health services suffer from lack of (i) explicit objectives; (ii) comprehensive overviews; (iii) knowledge of production functions; (iv) incentives for efficiency; and (v) inappropriate budgeting structures. Programme budgeting while not in itself capable of overcoming all these problems can create an information framework which first highlights but secondly fosters amelioration of these problems. In essence programme budgeting links outputs and inputs by health care programme. This facilitates monitoring, planning, control and the fostering of evaluation. Two examples of the use of programme budgets are presented.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"65-8"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138953","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":"A child is born, or a tale of moral hazard.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 3","pages":"131-2"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138959","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":"Budgeting in health care systems.","authors":"A Maynard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economise in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"41-9"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21139137","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":"Proposals for a prevention policy: an analysis of the French report.","authors":"L L Abenhaim,&nbsp;W Dab","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present here and criticize the \"Proposals for a Prevention Policy\" drawn up by a multidisciplinary commission in France during 1982. The Report provides original elements at three conceptual levels: (i) a socio-economic model of causality of disease with a temporal, a probabilistic and a polyfactorial dimension; (ii) a social point of view brought to the concepts of health, prevention and health promotion; (iii) general principles for preventive intervention at a population level, including a breaking with the \"victim-blaming\" ideology. In this Report, work is always at the very center of the analysis developed by the commission. Practically, proposals are concerning work and environment on the one hand and structures and functional of public health services on the other hand. They may appear somewhat unrealistic or not clearly detailed. But one should understand that the commission essentially proposes an attitude of active involvement on the part of social actors rather than a list of concrete proposals. Undoubtedly, this French Report poses and discusses questions which are of interest even outside of the French context.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21141696","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 the quality of data in a computerised patient master index: implication for costs and patient care.","authors":"R B Jones,&nbsp;R A Nutt,&nbsp;A J Hedley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study was designed to test the accuracy and completeness of nominal identifying data recorded on a hospital patient master index (PMI) and to estimate the cost-effectiveness of using patient questionnaires for improving quality of data. The study showed that the design of any PMI should include a method of obtaining and storing the last date at which a patient's details were confirmed as correct, a prompt system for identifying missing data and a routine report on completeness and inconsistencies within the data. Both accuracy and completeness of patient identification can be improved by the use of patient questionnaires. The cost of their use is more than matched by the savings obtained from complete accurate data. The use of computer produced questionnaires also reduces the need for peak time activity on busy computer systems.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 3","pages":"97-103"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21182384","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":"Reducing inequalities in health: political and organisational implications for the British National Health Service.","authors":"D J Hunter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Tackling health inequalities with any hope of success requires an understanding and appreciation of a number of issues concerning the nature and operation of services. Focussing on the British experience, the paper considers notions of need and demand insofar as these have a bearing on health inequalities. Need and demand are not finite, absolute states but are relative notions which are affected by users' attitudes and knowledge and by providers' preferences and interests. Drawing upon recent work, the paper argues that the existence of the National Health Service (NHS) has not fundamentally altered the nature of health inequalities in Britain. Those living in the North of the country generally enjoy poorer health than those living in the South. Inequalities between socio-economic groups are also much in evidence. The paper considers possible policy implications and comes out in favour of process change rather than major structural change of the kind witnessed in recent years in Britain where the NHS has undergone two major upheavals within a decade. This disruption has had the effect of diverting attention away from important policy issues at all levels of service planning and provision.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 4","pages":"191-7"},"PeriodicalIF":0.0,"publicationDate":"1983-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136051","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":"Equity in health care: confronting the confusion.","authors":"G H Mooney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite general agreement that equity is part of the objective of the UK National Health Service (as indeed it is in other health services), there is little consensus on what is meant by equity in health care. This paper suggests seven possible definitions of equity not with the intention of trying to decide which is in any sense best but rather simply to try to reduce some of the confusion surrounding the concept of equity. These definitions include equality of expenditure per capita; equality of inputs per capita; equality of input for equal need; equality of access for equal need; equality of utilisation for equal need; equality of marginal met need; and equality of health. The paper then takes a closer look at some of the issues surrounding these definitions. The difference between equity by access and by utilisation lies in separating supply and demand (or need) issues. Thus equality of access is about equal opportunity: the question of whether or not the opportunity is exercised is not relevant to equity defined in terms of access. Utilisation is a function of both supply and demand. If access, a supply side phenomenon, is equalised, unless demand is the same, utilisation will not be equalised.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 4","pages":"179-85"},"PeriodicalIF":0.0,"publicationDate":"1983-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21180373","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":"Cancer registries: their interest and practical problems.","authors":"S Schraub,&nbsp;J Faivre,&nbsp;M Gignoux,&nbsp;F Menegoz,&nbsp;J Robillard,&nbsp;P Schaffer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cancer registries record all new cases of cancer within the population they survey. Thus they provide accurate regional measurements of cancer morbidity and mortality and their geographical distribution. This form of epidemiology allows the study of regional variations and alterations with the passage of time. It also allows the study of environmental factors that might cause cancer. The work of the French regional cancer registries is described to illustrate these points. The problems of running a cancer registry are also set out and suggestions are made for future organization. The statistics gathered by such registries indicate possible methods for the early detection and treatment of some cancers and provide evidence of the long-term effects of all kinds of therapy. The socio-economic aspects of cancer can also be measured by the registry, thus providing valuable data for use in the planning of health care in any community.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 4","pages":"205-14"},"PeriodicalIF":0.0,"publicationDate":"1983-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136053","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":"Hospital information systems.","authors":"A R Bakker,&nbsp;J L Mol","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The intention of this paper is to give an overall view of. (a) The part a computer-based hospital information system (HIS) might play in a hospital. (b) The consequences of this part as to requirements for the contents (components, structure) of a hospital information system. This intention takes shape as follows: (1) Characteristics of data and their use in a hospital are considered including sensitivity, poor standardisation, high availability and long term storage required, incompleteness. (2) An outline is given of which part a HIS might play in this context and how a HIS can achieve this. Quantitative as well as qualitative improvements are described to be realised by checking the input, fast accessibility, improved standardisation, improved exchange of data, improvement of coordination of activities in the hospital. The concept of integration is shortly described. The logical structure of most HISs is introduced: a central databank with a huge storage capacity, accessible for authorised users by means of various application-packages (software) and a large number of terminals (hardware). (3) As an example of an operational HIS, the Leiden University Hospital HIS is described. The following subjects are covered: technical form (hardware, availability for the users), organisation, the applications, the use of the system, costs and benefits.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 4","pages":"215-23"},"PeriodicalIF":0.0,"publicationDate":"1983-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21180374","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":"Controlled assessment of diagnostic techniques: methodological problems.","authors":"A Alperovitch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The increasing requests for diagnostic tests is one of the many causes of rising costs in health care systems. Many health care professionals think today that this increase could be reduced if diagnostic tests were accurately assessed, as are drugs. If there are similarities between a controlled treatment trial and a diagnostic method trial, there are also many differences relating to the sample size, the choice of criteria for final judgment, the study design and the clinician's behaviour when faced with the problem. These differences make it difficult to organise controlled trials of diagnostic techniques. A different approach using simulation methods and a decision tree appears more appropriate in the evaluation of diagnostic techniques.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 4","pages":"187-90"},"PeriodicalIF":0.0,"publicationDate":"1983-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21184547","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}