Quality and Cost in Healthcare

Debate over healthcare often focuses on two key issues: quality and cost. However, because of the unique characteristics of healthcare, this relationship is not as simple as it might seem. A recent Supreme Court of Canada judgement directly addressing aspects of quality of care, combined with related government policy, provides an impetus for a review of research on quality as it affects costs of care. Our premise is that quality problems may not be the result of financing constraints but rather quality issues are a significant contributor to funding pressures. Theoretical and empirical evidence is reviewed and the implications for decision makers are discussed. A managerial focus on cost minimisation strategies makes implementing priority setting processes challenging because it calls for behaviours that typically counter professional self-interest. We suggest that a focus on quality would ultimately provide an effective strategy to contain costs, not to mention having a positive impact on patient well-being.     

Measuring the Quality of Healthcare

Recently, enormous efforts to measure the quality of healthcare have been made to attain information on ways to improve the quality of healthcare. However, this area of research is still at an early stage of development and more research is required. This article outlines a framework by which the quality of healthcare can be analyzed on the basis of the three quality dimensions introduced by Donabedian. The article then goes on to test the validity of this (theoretical) framework within an empirical analysis.Because of increasing financial shortages within health systems, this article focuses on the treatment of myocardial infarction, which is one of the costliest and most prevalent diseases. This approach establishes a link between medical and economic problems. The variables for structure quality (i.e. number of cardiologists, number of catheterization facilities) were sourced and evaluated from the ‘Herzberichte der Jahrgänge’ (‘heart reports’) compiled by Bruckenberger for the period 1994–2004 for the 16 German federal states. Data from the Federation of Quality Assurance (BQS) were used for the evaluation of process quality (i.e. adequacy of indication for coronary angiography). Finally, administrative data from the German Federal Statistical office for 1994–2004 were used to determine the variables of outcome quality (i.e. standardized mortality rate due to myocardial infarction, potential years of life lost <70 years due to myocardial infarction).Three hypotheses were tested using panel data: (i) a better structure and/or process quality increases the probability of getting a better outcome quality for the clinical picture under observation; (ii) by employing additional input factors (such as additional catheterization facilities), the probability of getting a good outcome quality is increased; and (iii) in addition to structure quality and process quality, factors lying outside of the sphere of influence of the health system have an additional influence on outcome quality (marginal gains would decrease in this case). Three models were used to test these hypotheses using fixed effects estimation.The empirical analysis produced three results. First, the analysis confirms the predicted causality between the different dimensions of quality of care for the German federal states. Notably, the number of catheterization facilities has a highly significant positive influence on the outcome quality. Second, support is found for decreasing marginal gain of inputs. Third, a good structure and a good process quality alone cannot guarantee good outcome quality. However, the analysis also showed that, in addition to healthcare provided, there are other determinants that also affect the outcome quality of healthcare. Further empirical investigation regarding the influence of these factors on the outcome dimension could elaborate on our findings and deliver additional insights.     

Buying Healthcare Quality with Grants and Donations

We find that grants and contracts increase California healthcare clinics' average costs, but donations do not. We interpret these results as meaning that grants and contracts change the nature of the product while donations are used to increase output without changing the product. One possible scenario is that grants and contracts are targeted money used to enhance quality. A theoretical analysis shows that quality is enhanced more if grants and contracts are used to reward quality rather than as seed money to create quality. The empirical evidence, however, is that grantors are motivated by the second reason.     

Conceptualizing a Quality Plan for Healthcare

Today, health systems around the world are under pressure to create greater value for patients and society; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system's customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery.     

医疗质量粗放型评价管理模式

现行医疗质量评价管理模式多采有用综合目标管理办法，它源于多目标、全方位、全过程管理思路。存在指标繁琐、重点模糊、操作复杂的弊端。笔者通过研究，提出了以床日门诊指数、床位利用指数、CD型率，人均医疗费、病员满意度五项指标为主要内容的粗放型医疗质量评价管理模式，提供了操作方法，并讨论了该模式对于提高医疗质量评价准确性、加大医疗质量管理力度，减轻管理人员工作强度等方面产生的作用。     

Healthcare Quality in an International Setting

This report discusses the process used by the Healthcare Quality Certification Board to internationalize Tits certification program. With some modifications this methodology can be utilized to define the role of any healthcare professional and to legitimize, create or restructure a certification program that assesses competency in a particular healthcare field. This process and the importance of quality management are related to today's cataclysmic healthcare environment which challenges efforts to confront cost and access.     

Assessing Cultural Perspectives on Healthcare Quality

This study explores cultural differences in perceptions of quality of care and examines whether existing surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS^?) questionnaires, adequately capture conceptions of healthcare quality among members of racial/ethnic minority groups. Eight focus groups with African Americans, Asian Indians, Latinos, and whites were organized into two 45-minute segments. In one segment, participants rated the quality of care depicted in a video; in the other they discussed the concept of “healthcare quality.” We found that members of racial/ethnic minority groups are more likely than whites to identify cultural competency and providing a holistic approach to care as important to healthcare quality. Neither of these concepts is currently included in the core CAHPS^? questionnaire. The CAHPS^? and other quality surveys may not accurately capture concepts of healthcare quality that members of racial/ethnic minority groups deem most important.     

Reproductive and Sexual Healthcare Needs Among Adults with Disabilities as Perceived by Social Workers

People with disabilities often experience unique gynecological and reproductive healthcare needs, which may be exacerbated by their experience of sexual victimization. Previous research on adolescents with disabilities found that social workers held beneficial roles in supporting their clients to make empowered decisions concerning sexual healthcare, pregnancy, and parenting. This study aimed to assess the reproductive and sexual health needs of adults with various disabilities from the perspectives of their social workers. Eleven social workers working primarily with adults with various disabilities were interviewed using a phenomenological study design to offer their perspectives of the sexual and reproductive health needs of their clients. Interviews were transcribed and analyzed; themes and subthemes were identified. According to social workers, (1) adults with disabilities experienced distinctive reproductive healthcare interactions and challenges, including specific needs that were uniquely related to risks for sexual victimization and (2) social workers performed several roles in supporting sexual and reproductive healthcare of these clients, including education and brokering. Social workers demonstrated the need to support clients within a biopsychosocial framework since their biological, psychological, and social needs intersected to either restrain or empower their reproductive health. Social workers played key roles in supporting their clients in reproductive and sexual health decision-making, yet appeared to struggle to address ethical dilemmas, especially those related to ensuring their clients’ well-being and self-determination. Secondly, the results of this study made a connection between challenges in adults with disabilities’ receipt of health wellness exams and histories of sexual victimization.     

Nativity and Cardiovascular Disease Screening Practices

Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson Model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults living in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine check up in the past 2 years. Multivariate analyses were used to control for sociodemographic factors, while accounting for complex sampling design. Compared to those born in Mexico, US-born Mexican Americans had significantly greater odds of obtaining blood pressure (OR=5.61), and cholesterol screenings (OR=1.60) and having a routine checkup (OR=2.69) in the past 2 years. Health professionals with an agenda to increase screenings for CVD risk factors among Mexican Americans living in northern cities should understand the impact of nativity on screening practices.     

军队保健医生能力素质指标体系

通过文献回顾法,编制专家函询问卷.采用德尔菲法,确定军队保健医生能力素质指标体系,运用层次分析法计算各指标权重.构建军队保健医生能力素质指标体系,为军队保健医生的选拔、培养、评价提供数据化客观标准.     

阻碍医疗服务质量改善的内生性障碍

医疗行业的内生性障碍决定了改善服务质量的困难．使医疗服务质量的提升水平低于其他行业。通过描述内生性障碍的表现,分析约束条件下的改进措施,制订能够激发组织主动性的政策是取得有价值效果的前提。