Is there a PSO in your future?

A decision to form a provider-sponsored organization and go after the lucrative Medicare market depends on several variables. Chief among them are risk-management and marketing capabilities, strength of the provider network, the potential market and the competition, and availability of appropriate information systems and controls.     

Is there a future for the not-for-profit hospital?

The issue of the future of the not-for-profit hospital is not one of not for profit versus investor owned, but of economic viability. A shift toward business practices in the not-for-profit hospital is occurring and may help explain why few studies have been able to show distinctive differences between not-for-profit and investor-owned hospitals. Although the system is set up to give not for profits special privileges for promoting a societal common good, a gradual erosion of those privileges has blurred the distinction between the two types of entities. With a process I call "competitive advantage incrementalism," investor-owned hospitals chip away at the privileges afforded their tax-exempt competitors. At the same time, the not-for-profit hospitals increasingly adopt the successful practices of the business world, and are guided by board members and executives who hold to a big-business view of healthcare. What is the future for the not-for-profit hospital? They must continue to exist, although they can expect increasing operating burdens to continue as not for profits. They and investor-owned facilities become progressively more similar in operations and structure. The not-for-profit institutions must prove that they produce a community benefit to justify not-for-profit status. That is a heavier burden than merely producing a high rate of return for investors.     

Is there a future for retiree health benefits?

Faced with a shrinking active work force, and a growing retiree population, employers are rethinking who pays for what. Adding urgency to the issue are new regulations, expected to take effect in 1992, that will require company financial statements to reflect health benefits obligations to current and future retirees.     

Is there a time trend in medical practice variations?

The aim of this study was to review the research evidence for a decreasing time trend in medical practice variation and to contribute to our theoretical understanding of trends in medical practice variations. We searched PubMed for articles reporting on time trends in medical practice variations. Eleven relevant articles were identified. The studies we found tend to show a downward trend in practice variation. Six of the eleven studies show a decrease in practice variation, three studies report more or less stable variation, and only two show increasing variation. The number of studies is, however, small and the aspects of medical practice that were studied in these articles are diverse. A trend in medical practice variation can probably best be explained by institutional changes within and outside health care, which on the one hand directly lead to decreased practice variation and on the other hand make the working environment of physicians more uniform.     

Is there a future for a Staphylococcus aureus vaccine?

Multiple attempts to develop a vaccine to prevent Staphylococcus aureus infections have failed. To date, all have been based upon the development of opsonic antibodies. New information suggests that cell mediated immunity may be critical for protection against S. aureus infections. The arm of the immune system that provides the protection contains the Th17/IL-17 axis. Th17 cells release IL-17, which are important for mobilization and activation of neutrophils. Naturally, antibodies aid the neutrophils in the uptake and killing of staphylococci, but immune globulin does not seem to be sufficient to afford protection. New approaches that focus on Th17/IL-17 may allow for the development of a successful S. aureus vaccine.     

Is there a geography of alternative medical treatment in The Netherlands?

An increasing number of people are using alternative medical care. The literature suggests that there are important between place variations, however. This paper tries to assess the extent of these variations and mechanisms behind them for the utilization of homeopathy, paranormal healing and manual therapy. Are these variations a matter of level of supply, degree of urbanization, GP characteristics or simply a matter of composition of populations? Data are derived from the Dutch National Surgery of General Practice and analyzed using multilevel logistic regression models. Between place variation in utilization of homeopathy is mainly a matter of composition of populations with respect to health locus of control and religion. With respect to paranormal healing, it is exclusively a matter of religion. With respect to manual therapy, place variations are a matter of individual, GP, as well as area characteristics, but a relatively large amount remains unexplained.