On the "efficiency" of managed care plans.

The claim that managed care plans are more efficient than fee-for-service plans has been made so often that it has reached the status of folklore, but the evidence is inconclusive. The claim is usually based on one or both of the following errors: (1) lower medical care costs mean lower total costs (medical plus administrative costs) and (2) lower HMO premiums mean HMOs are more efficient than fee-for-service plans. The first assertion ignores evidence indicating that managed care has driven up administrative costs for both insurers and providers. The second ignores evidence that managed care plans have numerous methods of shifting costs that are unavailable or less available to fee-for-service plans. The lull in health care inflation during the mid-1990s is often cited as evidence that managed care is efficient. But the lull may have been caused not by the spread of managed care but by the near-simultaneous occurrence of four events: a downturn in the insurance underwriting cycle, the 1990-1991 recession, endorsement of managed competition by numerous politicians, and the merger fever triggered by those endorsements.     

Quant efficiency of the detection as a quality parameter of the visualization equipment

The critical parameter of notion "quant efficiency of detection" is defined in the paper. Different methods of specifying the detection quant efficiency (DQE) are under discussion. Thus, techniques of DQE determination for a whole unit and means of DQE finding at terminal space frequency are addressed. The notion of DQE at zero frequency is in the focus of attention. Finally, difficulties occurring in determining the above parameter as well as its disadvantages (as a parameter characterizing the quality of X-ray irradiation visualizing systems) are also discussed.     

Minimizing losses and maximizing efficiency in the detection of acute severe malnutrition

OBJECTIVE: One of the many challenges faced by epidemiologists is to adequately plan and optimize subject selection procedures in terms of effectiveness and efficiency. In the context of a case-control study involving severe acute malnutrition, a two-step subject selection procedure is used. The aim of the article is to establish an appropriate cut-off point for the screening phase and to achieve a common ground for standards, efficiency in detecting severe malnutrition and the two-step procedure. METHODS: The study includes 154 children under the age of 2 from two different hospitals. To determine the ideal cut-off point of weight-for-age (WFA), the following estimators are of interest: the proportion of false negatives (PFN), false positives (PFP) and the percentage of total gain by time (ptg). Weight-for-height (WFH) (cut-off point at -2 SDs) is used as reference for establishing severe acute malnutrition. RESULTS: The magnitude of false negatives declines steadily until the 3rd WFA percentile (P3) and reaches zero close to P9. At this point, the PFP is around 0.4. The ptg decreases sharply up to P4, declining smoothly towards P10 thereafter (54.5%). CONCLUSIONS: The WFA P10 can be recommended for the screening phase. At this cut-off point, there is still efficiency whereas losses of true cases of severe acute malnutrition are minimized.     

Health care reform and the paradox of efficiency: "writing in" culture.

Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations.     

Predicting instrument detection efficiency when scanning point and small area radiation sources

Accurate quantification of radionuclides detected during a scanning survey relies on an appropriately determined scan efficiency calibration factor (SECF). Traditionally, instrument efficiency is determined with a stationary instrument and a fixed source geometry. However, as is often the case, the instrument is used in a scanning mode where the source to instrument geometry is dynamic during the observation interval. Procedures were developed to determine the SECF for a point source ("hot particle") and a 10 x 10 cm source passing under the centerline of a 12.7 x 7.62 cm NaI(Tl) detector. The procedures were first tested to determine the SECF from a series of static point source measurements using Monte Carlo N-Particle code. These point static efficiency values were then used to predict the SECF for scan speeds ranging from 10 cm s(-1) to 80 cm s(-1) with a simulated instrument set to collect integrated counts for 1 s. The Monte Carlo N-Particle code was then used to directly determine the SECF by simulating a scan of a point source and 10 x 10 cm area source for scan speeds ranging from 10 cm s(-1) to 80 cm s(-1). Comparison with Monte Carlo N-Particle scan simulation showed the accuracy of the SECF prediction procedures to be within +/-5% for both point and area sources. Experimental results further showed the procedures developed to predict the actual SECF for a point and 10 x 10 cm source to be accurate to within +/-10%. Besides the obvious application to determine an SECF for a given scan speed, this method can be used to determine the maximum detector or source velocity for a desired minimum detectable activity. These procedures are effective and can likely be extended to determine an instrument specific SECF for a range of source sizes, scan speeds, and instrument observation intervals.     

实行“双补一控”机制确保公立医院效率和公益性

“双补一控”机制是在现行财政补助基础上．按分级财政补偿与分级卫生管理控费的原则,对公立医院“按服务量适度补基本工资”、“按医疗收益补绩效工资”及“按比例和有关政策进行适度控费”,以遏制不合理的医疗费用增长,强化政府的职责和投入,确保公立医院的公益性。     

222Rn detection efficiency and sensitivity coefficient of the LR 115-II nuclear track detector.

Radon activity concentrations in air were measured by the Kodak-Pathé LR 115-II nuclear track detector. Using the calibrated sensitivity coefficient of the detector (k = 0.0285 Bq-1 m3 tr cm-2 d-1 = 0.33 cm), the critical detection angle was calculated. In the alpha-particle energy region of 1-3.7 MeV, the detector efficiency for 241Am was near 32% but the 222Rn detector efficiency was 23%. The permeability constant of the detector paper filter was measured in a standard radon atmosphere and a value of 9.08 x 10(-6) cm2 s-1 was obtained.     

Melanoma early detection with thorough skin self-examination: the "Check It Out" randomized trial

BACKGROUND: Monthly thorough skin self-examination (TSSE) is an important practice for early melanoma detection that is performed by a small minority of the population. DESIGN: A randomized trial was conducted to determine whether a multicomponent intervention can increase TSSE performance and to describe the effects on performance of skin surgeries compared with a similar control intervention focused on diet. SETTING/PARTICIPANTS: One thousand three hundred fifty-six patients attending a routine primary care visit in southeastern New England participated in this trial. INTERVENTIONS: Participants received instructional materials, including cues and aids, a video, and a brief counseling session and (at 3 weeks) a brief follow-up phone call (from a health educator) and tailored feedback letters. MEASURES: Performance of TSSE assessed by telephone interview and having a surgical procedure performed on the skin were confirmed by examining medical records. RESULTS: TSSE was performed by substantially more participants at 2, 6, and 12 months in the intervention group than in the control group (55% vs 35%, p<0.0001 at 12 months). We also noted that a substantially higher proportion in the intervention group had skin surgery in the first 6 months (8.0% vs 3.6%, p=0.0005), but there was no difference at 6 to 12 months (3.9% vs 3.3%, p=0.5). CONCLUSIONS: The TSSE intervention was effective in increasing performance of TSSE, in that it resulted in increased surgery on the skin, and that increase in skin procedures only persisted for 6 months. Intervention to increase TSSE may result in long-term benefit in early detection of melanoma while causing only a short-term excess of skin surgeries.     

Managing care, incentives, and information: an exploratory look inside the "black box" of hospital efficiency.

OBJECTIVE. We sought to estimate the impact of individual dimensions of hospitals' managed care strategies on the cost per hospital discharge. STUDY SETTING/DATA SOURCES. Thirty-seven member hospitals of seven health systems in the Pacific, Rocky Mountain, and Southwest regions of the United States were studied. STUDY DESIGN. Separate cross-sectional regression analyses of 21,135 inpatient discharges were performed in 1991 and 23,262 discharges in 1992. The multivariate model was estimated with hospital cost per discharge as the dependent variable. Model robustness was checked by comparing regression results at the individual discharge level with those at the level of the hospital/clinical condition pair. DATA COLLECTION/EXTRACTION METHODS. Information on hospitals' managed care strategies was provided by mail and phone survey of key informants in 1991 and 1992. Other hospital characteristics were collected from AHA Annual Survey data, and discharge data from hospital abstracting systems. PRINCIPAL FINDINGS. The pooled discharge analysis indicated three dimensions of hospital managed care strategy that consistently related to lower costs per hospital discharge: the proportion of hospital revenues derived from per case or capitation payment, the hospital's mechanisms for sharing information on resource consumption with clinicians, and the use of formalized, systematic care coordination mechanisms. CONCLUSIONS. Three strategies appear to hold promise for enhancing the efficiency of inpatient resource use: (1) "fixed price" hospital payment incentives, (2) hospital approaches to sharing resource use information with clinicians, and (3) the application of formal care management mechanisms for specific clinical conditions.     

泊松分布在消毒与灭菌效果监测法检出限中的应用

目的 用泊松分布的方法研究消毒技术规范中消毒与灭菌效果监测法的检出限,并用试验对其进行验证.方法 用大肠埃希菌ATCC 25922、金黄色葡萄球菌ATCC 29213两种标准菌作为试验菌,配制一系列浓度的菌悬液,模拟消毒与灭菌效果监测法的操作过程,从某浓度菌悬液中取1 ml倾注培养,连续100次,计数能检出细菌的试验次数,与公式计算的理论次数进行卡方检验比较,验证理论计算值与试验值是否存在差异有统计学意义.结果 计算值与试验值两种菌株差异均无统计学意义;当从某一菌悬液中取1 ml进注培养,要求细菌检出率在99.00％、95.00％、90.00％、60.00％、50.00％时,其菌悬液的浓度要求分别为4.61、3.00、2.30、0.92、0.69CFU/ml.结论 在消毒效果监测过程中,对于采样后得到的混合溶液只能进行部分接种时,其不同检出率下的检出限可以用泊松分布的公式P(0)=e-λ进行计算,对于灭菌要求的监测,当细菌量很少时,将出现漏检,建议对其方法进行改进.     

破解效率、质量与服务难 ——详解北京协和医院“绩效指挥棒”

日前,北京协和医院公布了2009年上半年综合绩效考核结果,各项业绩指标呈现良好态势;门诊量比去年同期增长10％,出院人数增长16．3％,手术量增长18％,平均住院日下降0．9天,病人满意度进一步提升,医疗投诉率持续走低。这组全线飘红的数据表明医院整体的工作效率与服务能力得到大幅提升,同时也有力地证明了北京协和医院在现有人力和空间资源的前提下,通过推行全面绩效考核,使医院管理上了一个台阶。     

我国10家三级儿童医院的技术与规模效率及变动研究

目的:评价我国三级儿童医院的技术效率和规模效率,了解效率变动情况,为三级儿童医院改善其效率和提升生产率提供参考。方法:系统收集10家三级儿童医院2011—2012年人员、设备、资产、医疗服务等投入—产出指标,运用DEA的C2R模型和BC2模型计算样本医院的年度技术效率和规模效率,再利用Malmquist指数分析样本医院跨期效率变动情况。结果:2011年3家医院为DEA有效,无效的7家医院中4家处于规模报酬递增阶段,3家处于规模报酬递减阶段;2012年6家医院为DEA有效,无效的4家医院处于规模报酬递减阶段。2011—2012年,6家医院的生产率有所改善,4家医院的生产率出现了下降。结论:样本医院整体运行效率较高,但有个别医院技术效率较低;2012年多数医院运行效率和生产率有所提高,其中生产率的提高主要源于效率的改善;规模是影响效率和生产率的重要因素,不可盲目扩大规模。