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1.
OBJECTIVES: To help develop a means, based on the views of purchasers and providers of health care, of incorporating national research on clinical effectiveness into local professional advisory mechanisms in order to inform health care purchasing and contracting. METHODS: Three geographically based multidisciplinary workshops attended by National Health Service (NHS) staff drawn from the principal purchaser and provider groups in one English region were organized around the discussion of three health care purchasing case studies: coronary artery disease, diabetes and management of clinical depression in general practice. The proceedings were transcribed and analyzed using content analysis methods. RESULTS: 95 people took part. There were major differences between the purchasers' and health care providers' views on the right balance between local and national information and advisory sources for purchasing. In general, providers wanted the provision of advice to purchasers to be local, in which their opinion was sought, either individually or collectively, acted on and the results fed back to them. In contrast, health authority purchasers considered that local professionals were only one source of professional advice, albeit an important one, to be utilized in coming to decisions. General practitioner fundholders as purchasers, however, preferred to rely on their own experiences and contacts with local providers in making purchasing decisions. CONCLUSIONS: Professional specialist advisory groups are necessary to inform the purchasing of health care, but should extend beyond advising on the placement of individual contracts. Involving health care providers in all short-term contracting is unlikely to be cost-effective given the time commitment required. The emphasis at purchaser/provider meetings should be on education: providing an opportunity for purchasers and providers to develop closer relationships to discuss political imperatives and financial constraints; increasing communication and understanding of providers' and purchasers' roles; and providing an environment for professionals and purchasers to share their views on purchasing. As currently presented, elements of the national policies in the NHS advocating the use of both national evidence on clinical effectiveness and local professional advice are contradictory and should be clarified. 相似文献
2.
Examines the links between workforce demand and two health care related markets, the first being the internal market between purchasers and providers of health care, and the second the market for education expressed between colleges of education as providers and NHS Trusts as purchasers of the courses. Workforce demand has to take account of the numbers of people on courses, but also specialist skills required to enable NHS Trusts to deliver changing health care needs of the future. 相似文献
3.
J R Butler 《Child: care, health and development》1997,23(4):327-337
Postal surveys were conducted in 1993 among all, or samples of, six groups of providers and managers of pre-school child health surveillance (CHS) in England and Wales. Content analyses were also carried out of strategic policy statements for CHS produced by 54 district health authorities in England and Wales. The surveys aimed to document the views and experiences of CHS providers and managers about the impact of recent changes affecting the structure and operation of CHS, including the publication of Health for All Children , the 1990 Contract for General Practitioners (GPs), the implementation of the National Health Service and Community Care Act 1990 , and the changing roles of community doctors and health visitors. Five positive findings from the surveys are discussed: the impact of the first edition of Health for All Children ; improvements in the development and use of child health information systems; the beneficial effects of the growing involvement of GPs in CHS; the developing understanding of, and commitment to, the principle of clinical audit in CHS; and the growing collaboration between providers in the NHS internal market. A separate paper reports the negative findings from the study. 相似文献
4.
Øvretveit J 《International journal of health care quality assurance incorporating Leadership in health services》2003,16(2-3):116-127
Much has been written about quality in patient care and clinical support services, but very little about the quality of purchasing. This paper gives an overview of quality issues in purchasing, and offers guidelines and practical steps for purchasers to improve service quality--both their own and their providers'. It defines quality in purchasing and considers how purchasers can influence markets and work with providers to improve health services quality. The paper gives practical guidance for improving quality, which recognises the limited resources and skills which purchasers have for the task. It addresses some issues raised by purchaser/managers: How does a purchasing organisation measure and improve quality? Is there a better way of specifying and monitoring quality than the "shopping-list of standards" approach--what should be asked of providers? How can information about clinical quality, outcome and costs, be obtained in a form in which reliable comparisons can be made? Is quality accreditation or registration a good predictor of future quality? 相似文献
5.
Escalating price competition in health care has pushed providers and purchasers to scramble for outcome measures to use as indicators of minimum acceptable quality. This article suggests that health care managers assist purchasers in developing quality measures that include patient perceptions in addition to technical competence and also build a general philosophy that values quality. 相似文献
6.
Shifting services from secondary to primary care: stakeholders' views of the barriers. 总被引:2,自引:0,他引:2
OBJECTIVES: To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. METHODS: Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrasting initiatives to shift services. RESULTS: Stakeholders perceived similar barriers in the two initiatives: disinvesting from existing providers; lack of information on activity and costs; uncertainty over the quality of the proposed alternative service; concern about an increasing workload in primary care; diversity of views within primary care; difficulties in communication between the many agencies involved; and lack of leadership by purchasers. CONCLUSIONS: Service shifts which involve disinvestment from existing providers and collaboration between agencies with different views and interests will inevitably face a range of barriers. Attempts to shift services by disinvesting from secondary care are likely to encounter the greatest difficulties. Attempts to shift without concomitant disinvestment may also be slow because of the difficulties of multi-agency collaboration. Frustration will be reduced if those involved have a realistic understanding of the difficulties rather than being surprised and overwhelmed by them. 相似文献
7.
The confirmation of NHS responsibilities for continuing health care has important implications for primary and community health services. In early 1996, during the period of consultation on draft local policies and eligibility criteria, exploratory interviews were carried out with general practitioners (GPs), community nursing managers, primary care development officers and social services purchasers in three health authority areas. The interviews indicated that few GPs had responded to local consultation and were only slowly becoming aware of the implications for the provision and purchasing of primary and community health services. Moreover, local continuing care policies had apparently not addressed two issues which GPs and community nursing staff indicated were currently highly problematic: their responsibilities in relation to independent sector residential and nursing home patients; and the consequences for primary health and community nursing services of hospital discharge decisions. The need for purchasers and commissioners of health services, whether health authorities or GPs, to begin collecting information on patients' potential needs for continuing care services was widely recognised as an urgent priority. 相似文献
8.
Ong BN 《Health policy (Amsterdam, Netherlands)》1993,23(1-2):83-95
The diffusion of minimally invasive therapy (MIT) must be understood against the background of sweeping changes in the organisation and funding of the National Health Service (NHS) in the UK. The separation of purchasers from providers of health care makes national policy, in theory, less important, as local developments are supposed to drive the process of needs assessment and resource allocation. Within this climate new technologies increasingly have to prove their cost-effectiveness. Yet the country case study illustrates that such studies lack established methodologies and wide application. One of the key barriers to diffusion lies within the profession itself, where resistance to paradigmatic change is the strongest force against innovation. The partnership between innovative clinicians and forward-looking managers is important if diffusion of new procedures is to be secured. The discussion of the 10 examples will highlight some of these important issues. 相似文献
9.
Bull A 《Journal of management in medicine》1994,8(2):5-8
Quality should be a central issue in the commissioning and provision of health care. This requires a systematic approach to defining and monitoring quality. Such an approach should address: quality characteristics such as efficiency, accessibility, effectiveness (which may conflict with each other); the several levels at which quality may be specified, from general (across all health care) to specific (particular conditions or patient groups); and the methods of quality monitoring which include documented policies, clinical audit, inspection visits/patient surveys, and routine information returns. Shows how a matrix for quality surveillance can be devised which provides a framework for purchasers and providers to work together in developing quality in health care. 相似文献
10.
In 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS "internal market" is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals. 相似文献
11.
We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract. 相似文献
12.
Laurence Malcolm Pauline Barnett Jill Nuthall 《Australian and New Zealand journal of public health》1996,20(6):567-573
Abstract: In 1993, New Zealand implemented radical health sector reform, separating purchaser from provider and creating a competitive market. This paper reports on a 1994 survey of senior managers' perceptions of how well public health services were adapting to this more commercial environment. An initial questionnaire to chief executive officers of Crown health enterprises, the main providers of public health, as well as secondary treatment services, was followed by a telephone survey of managers of public health services. Chief executives expressed generally positive views about the importance of public health, especially health promotion, within their organisations. Public health managers indicated a wide range of negative and positive views about the new system. They were concerned especially about service fragmentation, diminished information-sharing and decreased collaboration, especially with Maori and general practice providers. Questions were raised about the compatibility of competition with the need for collaboration in public health. The major issue was the inefficient, costly, conflicting and fragmented purchasing arrangements for public health. Managers wanted unified systems and fewer purchasers. More positive views were expressed on an improved focus on outputs and clearer directions, and none wanted to return to the former era of an entirely separate system for public health services. The abolition of the Public Health Commission during 1995 should lead to increased integration of purchasing and policy making, but important questions remain about the place of public health services, especially in their links with primary care. 相似文献
13.
As health care providers assess the future of managed care, the satisfaction of individual purchasers becomes an important issue. Do they become disenchanted after heavier use of managed care plans--and if so, does that contrast with purchasers of indemnity plans? The authors explore such issues. 相似文献
14.
While health care providers recognize employers as key purchasers of health benefits, there is little understanding of how employers make these important buys. We propose a model of health benefits acquisition using an organizational buying perspective, and discuss findings from a study of employee benefits managers. Critical marketing implications are presented. 相似文献
15.
This article explores the importance of high quality communication between managers and staff for the effective management of change within the National Health Service (NHS). In particular, a methodology termed communication audit is outlined. Such audits enable managers to gather accurate information about communication practices within organizations and allows them to assess the nature, quantity and quality of internal communications. This, in turn, facilitates the identification and resolution of potential problems and helps to provide a clearly focused agenda for action and change. A case study is offered which illustrates how such an audit was applied to a Unit of Management within the NHS. The implications for managers throughout the organization are then considered. 相似文献
16.
High-technology treatments such as total parenteral nutrition or intravenous antibiotics may increasingly be provided to patients at home. In the past, these services have been funded by the NHS prescribing budget. The aim of the Department of Health's Executive letter EL(95)5, Purchasing High Tech Healthcare for Patients at Home was to ensure that contracts placed by health authority purchasers maintain effective patient services and obtain better value for money by encouraging competition between potential homecare providers. Examines contracting for high-tech health care for patients at home and suggests that efficiency could be improved when contracting with commercial home-care organizations by lead purchasing arrangements. In the long-term, contracting with NHS tertiary centres is most likely to ensure continuity of care and appropriate clinical monitoring of patients. 相似文献
17.
The increase in managerialism in the 1980s and the 1990 NHS reforms have had major implications for the regulation of providers. Purchasers of health care in the UK are now expected to specify three factors in their contracts: volume, cost and quality. This paper focuses on one of these: i.e. the quality standards purchasers now include within their health service contracts. The case study is of a general practitioner multifund and the analysis focuses on how quality standards are derived and adopted in outpatient contracts. The data were derived from in-depth face-to-face interviews with the key participants in the contracting process. The evidence shows that the standards were derived and adopted with very little participation from the providers. The impact of the quality standards on hospitals consultants' behaviour was negligible, there was very little monitoring of the standards by the multifund, and providers accepted standards which they knew they could not meet. It is concluded that this non-participatory method of developing the quality standards is likely to mean that their impact on service delivery will be limited. 相似文献
18.
Commissioners of health care require rapid, accurate and usable information on health technology effectiveness to help them to decide on the content of contracts. Despite major strides in the national initiatives in health technology assessment, such information is still in short supply at the local level. In 1991 the former Wessex region (now in the new South and West Region) established a mechanism which continues to provide carefully established recommendations on new technologies. Its features include: identification of locally important topics for evaluation by the purchasers and the providers; an evaluation team, working to a well-defined format in a service-led academic institute; an arbitration committee to deliver recommendations to purchasers on the basis of both the cost-utility of proposals and the quality of the evidence; and implicit obligations for purchasers to respond to strong recommendations. 相似文献
19.
Publicly disclosed information about the quality of health care: response of the US public 总被引:5,自引:0,他引:5
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Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care. 相似文献