Human resource staffing and service functions of community health services organizations in China

PURPOSE We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future.     

Economic expansion is a major determinant of physician supply and utilization

OBJECTIVE: To assess the relationship between levels of economic development and the supply and utilization of physicians. DATA SOURCES: Data were obtained from the American Medical Association, American Osteopathic Assocation, Organization for Economic Cooperation and Development (OECD), Bureau of Health Professions, Bureau of Labor Statistics, Bureau of Economic Analysis, Census Bureau, Health Care Financing Administration, and historical sources. STUDY DESIGN: Economic development, expressed as real per capita gross domestic product (GDP) or personal income, was correlated with per capita health care labor and physician supply within countries and states over periods of time spanning 25-70 years and across countries, states, and metropolitan statistical areas (MSAs) at multiple points in time over periods of up to 30 years. Longitudinal data were analyzed in four complementary ways: (1) simple univariate regressions; (2) regressions in which temporal trends were partialled out; (3) time series comparing percentage differences across segments of time; and (4) a bivariate Granger causality test. Cross-sectional data were assessed at multiple time points by means of univariate regression analyses. PRINCIPAL FINDINGS: Under each analytic scenario, physician supply correlated with differences in GDP or personal income. Longitudinal correlations were associated with temporal lags of approximately 5 years for health employment and 10 years for changes in physician supply. The magnitude of changes in per capita physician supply in the United States was equivalent to differences of approximately 0.75 percent for each 1.0 percent difference in GDP. The greatest effects of economic expansion were on the medical specialties, whereas the surgical and hospital-based specialties were affected to a lesser degree, and levels of economic expansion had little influence on family/general practice. CONCLUSIONS: Economic expansion has a strong, lagged relationship with changes in physician supply. This suggests that economic projections could serve as a gauge for projecting the future utilization of physician services.     

The changing role of health‐oriented international organizations and nongovernmental organizations

Apart from governments, there are many other actors active in the health policy arena, including a wide array of international organizations (IOs), public‐private partnerships and non‐governmental organizations (NGOs) that state as their main mission to improve the health of (low‐income) populations of low‐income countries. Despite the steady rise in numbers and prominence of NGOs, however, there is lack of empirical knowledge about their functioning in the international policy arena, and most studies focus on the larger organizations. This has also caused a somewhat narrow focus of theoretical studies. Some scholars applied the ‘principal‐agent’ theory to study the origins of IOs, for example, other focus on changing power relations. Most of those studies implicitly assume that IOs, public‐private partnerships and large NGOs act as unified and rational actors, ignoring internal fragmentation and external pressure to change directions. We assert that the classic analytical instruments for understanding the shaping and outcome of public policy: ideas, interests and institutions apply well to the study of IOs. As we will show, changing ideas about the proper role of state and non‐state actors, changing positions and activities of major stakeholders in the (international) health policy arena, and shifts in political institutions that channel the voice of diverging interests resulted in (and reflected) the changing positions of the health‐oriented organizations‐and also affect their future outlook. Copyright © 2015 John Wiley & Sons, Ltd.     

Preferred provider organizations and physician fees

Preferred provider organizations (PPOs) represent a form of managed care in which providers agree to accept discounted fees in exchange for the expectation that their patient volume will increase or at least be maintained. Managed care plans that rely on discounted fee-for-service (FFS) payments have increased from about 10 plans in 1981 to over 700 plans in 1994. In this study, we document levels of discounts achieved by two large national insurers and discuss how the size of the discount varies by type of service and how the discounted rates relate to Medicare fees. Our results show that, despite achieving large discounts (approximately 10 20 percent) relative to their indemnity plans, the two nationwide PPOs studied here pay at rates substantially above Medicare levels.     

四川省医疗卫生行业组织职能履行现状分析

目的 分析四川省医疗卫生领域行业组织的职能履行现状及存在的问题并提出建议。方法 通过问卷调查和定性访谈收集资料，用Excel对问卷结果进行统计描述；对访谈结果进行文字整理及定性分析。结果 受调查行业组织中目前履行最多的职能是组织行业培训、开展咨询服务和促进交流合作；在组织自律方面在实际发挥最好的是科普宣传与公益活动、维护行业公信力与信誉和加强行业人才培养培训。进一步分析，发现行业组织存在行业组织现有职能未充分履行；部分“硬”职能缺失，组织自律能力较弱；行业组织职能发挥缺少授权，法律与行政授权不足的问题。结论 以行业自律为切入点，明确自身职能；构建医疗卫生行业自律体系；试点探索下放职能，适度予以法律和行政授权。     

Comparing costs of a senior wellness care redesign in group and independent physician practices of an accountable care organization

Primary care redesign for older adult patients is currently ongoing in countries with aging populations. One of the main challenges of this type of transformations is how to estimate implementation costs in different types of health care delivery organizations. This study compares start‐up and incremental expenses of implementing a primary care redesign across 2 organization types: integrated group (n = 31) practices and independent practice association (IPA) sites (n = 213). Administrators involved with implementing the redesign completed a cost capture template to quantifying expenses. The potential impact of measurement error, recollection bias, and implementation models across sites and geographic regions was examined in sensitivity analyses. Marginal start‐up and incremental expenses were higher for Group sites ($122‐$328) compared to IPA sites ($31‐$227). Group and IPA sites, however, implemented the redesign with different intensities. According to our analyses, if IPA sites implemented the redesign with the same intensity as Group sites, marginal costs would have been $5 to $13 higher for IPA sites than for Group sites. This study shows how a flexible approach to estimate the cost of a wellness care redesign is needed when the intensity of the transformation differs across 2 different types of health care organizations.     

The myth of the lone physician: toward a collaborative alternative

Cultural values and beliefs about the primary care physician bolster the myth of the lone physician: a competent professional who is esteemed by colleagues and patients for his or her willingness to sacrifice self, accept complete responsibility for care, maintain continuity and accessibility, and assume the role of lone decision maker in clinical care. Yet the reality of current primary care models is often fragmented, impersonal care for patients and isolation and burnout for many primary care physicians. An alternative to the mythological lone physician would require a paradigm shift that places the primary care physician within the context of a highly functioning health care team. This new mythology better fulfills the collaborative, interprofessional, patient-centered needs of new models of care, and might help to ensure that the work of primary care physicians remains compassionate, gratifying, and meaningful.     

国外健康素养型医疗机构建设与评价及对我国的启示

介绍了美国医学研究所(Institute of Medicine,IOM)发布《健康素养型医疗机构的10个特征(Ten Attributes of Health Literate Health Care Organizations,HLHO 10个特征)》文件的背景及健康素养型医疗机构(health literate health care organization,HLHO)概念,并以Donabedian的理论为指导综述了HLHO的特征和建设措施及HLHO评价的研究进展。提出了我国医疗机构可借鉴《HLHO 10个特征》文件与国外HLHO评价现状,从人员培训、文化、制度、物理和信息环境建设,要求员工应用健康素养策略,促进服务对象参与健康材料的开发及医务人员健康教育工作的考核等措施入手,践行《健康中国行动(2019—2030年)》提出的“医务人员在诊疗过程中主动提供健康指导”和“建立医务人员开展健康教育绩效考核机制”两项指标。     

Physician patient questionnaire to assess physician patient agreement at the consultation

OBJECTIVE: The primary aim of this study was to validate an instrument of physician-patient agreement in the consultation. A secondary aim was to assess this agreement. METHOD: The setting was a county in the southwest of Sweden with a cross-sectional survey of primary care patients and physicians using separate coded questionnaires. Forty-six physicians and 316 patients aged 16 or more with a new complaint lasting 1 week or more. Thirteen items were evaluated and index of proportional agreement for the dichotomized answers agree (P(pos)) and disagree (P(neg)) was calculated. RESULTS: In 10 of the 13 items, a high level of agreement between physician and patient was seen. Discussion. Index of proportional agreement was useful in finding statements in a questionnaire on agreement for both physicians and patients that could be used for educational purposes and as a check-up for the GP in daily practice.     

The performance of material management in health care organizations

This paper studies the hospital supply chain. The analysis of the operational and financial data of hospital administrative structures has permitted the discovery of the characteristics of work carried out by the employees and the different strategies used by the managers. Firstly, hospital supply chains must be classified into two groups influenced by medical factors (short-term and long-term hospitals). Secondly, two different management approaches can be observed when the supply chain operations are analysed. The first approach assigns a larger budget priority to inventory control, packages reception and internal distribution. Thus, the purchasing services have relatively fewer resources. In the second approach, contract negotiation and product ordering processes are enforced by the deployment of, relatively, more personnel. In both cases, the central store service performs merchandise reception and distribution according to the strategies determined by the purchasing service.     

Mapping physician networks with self-reported and administrative data

Objective. To assess whether connections between physicians based on shared patients in administrative data correspond with professional relationships between physicians. Data Sources/Study Setting. Survey of physicians affiliated with a large academic and community physicians' organization and 2006 Medicare data from a 100 percent sample of patients in the Boston Hospital referral region. Study Design/Data Collection. We administered a web‐based survey to 616 physicians (response rate: 63 percent) about referral and advice relationships with physician colleagues. Relationships measured by this questionnaire were compared with relationships assessed by patient sharing, measured using 2006 Medicare data. Each physician was presented with an individualized roster of physicians' names with whom they did and did not share patients based on the Medicare data. Principal Findings. The probability of two physicians having a recognized professional relationship increased with the number of Medicare patients shared, with up to 82 percent of relationships recognized with nine shared patients, overall representing a diagnostic test with an area under the receiver‐operating characteristic curve of 0.73 (95 percent CI: 0.70–0.75). Primary care physicians were more likely to recognize relationships than medical or surgical specialists (p<.001). Conclusions. Patient sharing identified using administrative data is an informative “diagnostic test” for predicting the existence of relationships between physicians. This finding validates a method that can be used for future research to map networks of physicians.     

Purchasers look at physician hospital organizations

Business leaders are finally seizing the opportunity to shape the future of this country's health care delivery system. One such system could be new, community-based alliances known as physician hospital organizations.     

Patients' preferences for technical versus interpersonal quality when selecting a primary care physician

OBJECTIVE: To assess patients' use of and preferences for information about technical and interpersonal quality when using simulated, computerized health care report cards to select a primary care provider (PCP). DATA SOURCES/STUDY SETTING: Primary data collected from 304 adult consumers living in Los Angeles County in January and February 2003. STUDY DESIGN/DATA COLLECTION: We constructed computerized report cards for seven pairs of hypothetical individual PCPs (two internal validity check pairs included). Participants selected the physician that they preferred. A questionnaire collected demographic information and assessed participant attitudes towards different sources of report card information. The relationship between patient characteristics and number of times the participant selected the physician who excelled in technical quality are estimated using an ordered logit model. PRINCIPAL FINDINGS: Ninety percent of the sample selected the dominant physician for both validity checks, indicating a level of attention to task comparable with prior studies. When presented with pairs of physicians who varied in technical and interpersonal quality, two-thirds of the sample (95 percent CI: 62, 72 percent) chose the physician who was higher in technical quality at least three out of five times (one-sample binomial test of proportion). Age, gender, and ethnicity were not significant predictors of choosing the physician who was higher in technical quality. CONCLUSIONS: These participants showed a strong preference for physicians of high technical quality when forced to make tradeoffs, but a substantial proportion of the sample preferred physicians of high interpersonal quality. Individual physician report cards should contain ample information in both domains to be most useful to patients.     

The use of evidence by health care user organizations

Objectives To explore the use of research evidence by consumer and patient organizations and the extent to which their goals and activities are consistent with evidence-based health care and patient-centred care.
Design A mailed survey, telephone and face-to-face interviews of leaders of organizations representing health care users.
Setting Norway.
Participants Sixty-nine of 109 questionnaires that were mailed were included in our analysis and approximately 20 interviews were conducted with representatives of general consumer and patient advocacy groups and interest groups that focus on particular diseases or disabilities.
Measurements Information was collected on the goals of the organizations, the nature of their everyday work, the extent to which research information is required in this work and how research information is accessed and appraised.
Results An important focus of many user groups is peer support. They tend to emphasize experience-based knowledge. A total of 82% of the respondents said that they often or sometimes had use for research results in their work. Research-based information is most often obtained indirectly through physicians or researchers.
Conclusions Norwegian health care user organizations do not appear to promote evidence-based health care. To the extent that they help to disseminate scientific information, they appear to do so uncritically, relying on few sources and traditional authorities.     

How health care organizations are using data on patients' race and ethnicity to improve quality of care

Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi‐structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self‐reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they deliver, common standards will be needed for organizations’ data measurement, analysis, and use to guide systematic analysis and robust investment in potential solutions to reduce and eliminate disparities.     

Reducing health inequalities trough digital options in mental health: A physician’s perspective

This article explores the physicians’ perspective regarding the potential of computerized cognitive behavioral therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator.