Managing healthcare services in the global marketplace

The world is getting "flatter"; people, information, technology, and ideas are increasingly crossing national borders. U.S. healthcare is not immune from the forces of globalization. Competition from medical tourism and the rapid growth in the number of undocumented aliens requiring care represent just two challenges healthcare organizations face. An international workforce requires leaders to confront the legal, financial, and ethical implications of using foreign-trained personnel. Cross-border institutional arrangements are emerging, drawing players motivated by social responsibility, globalization of competitors, growth opportunities, or an awareness of vulnerability to the forces of globalization. Forward-thinking healthcare leaders will begin to identify global strategies that address global pressures, explore the opportunities, and take practical steps to prepare for a flatter world.     

Canadians write a new Rx for healthcare. Canada's healthcare system is not a panacea, but it raises interesting issues for the United States

The Canadians have been impressive in delivering universal healthcare access and high-quality care. Operating under global budgets set by provincial governments, Canadian hospitals have prudently managed available resources to meet community needs. A weakness of this single-payer system, however, is its inability to effectively coordinate and integrate services delivered by hospitals, physicians, and other providers. As the U.S. health system faces stringent cost containment with President Bill Clinton's proposal, significant savings are expected of U.S. hospitals. New alliances constrained by global budgets might require healthcare services managers to operate under a disparate set of assumptions and incentives. Before making such a transition, we can learn from the experiences of our Canadian colleagues. The challenges for both nations in the remaining years of this century will be drawn primarily from the effective macromanagement controls of the Canadian system and the lessons being learned from the U.S. managed care networks. This will occur as each nation strives to provide a more effective, less costly, integrated delivery of healthcare services.     

The urban fiscal crisis in the United States, national health insurance, and municipal hospitals.

The fiscal stress which many U.S. cities are currently experiencing, the persistent problems of large-city local government hospitals, the recent decisions for selected public hospital closings in New York City and Philadelphia, and the prospective enactment of a program of national health insurance collectively raise questions about the viability of the nation's major municipal hospitals. While the majority of the nation's 40 largest cities are in a state of economic and demographic decline, the diversity which characterizes their fiscal conditions and their responses to fiscal stress suggests caution in generalizing from the highly publicized New York City experience in asserting the ability of cities to continue to maintain public hospital activities. Indeed, there is considerable evidence to indicate that the staying power of municipal hospitals is quite substantial even in circumstances of severe fiscal stress. Further, analysis of the effect of Medicaid implementation on municipal hospital utilization and of the impact of prospective national health insurance programs on the demand for and supply of medical services suggests that municipal hospitals will continue to be important providers of health care services for many years to come.     

Hurricane Katrina and the healthcare infrastructure: A focus on disaster preparedness, response, and resiliency

The aftermath of Hurricane Katrina provides a window of opportunity to address a frail and failing healthcare system. Katrina was the rare incident that disrupted the external systems supplying hospitals with key services and resources needed for the organizations to function; increased the number of patients, both present and expected, that required medical care; and affected directly the physical plants of the hospitals, challenging their functionality. Sorting through and gleaning useful lessons to increase the resilience of hospitals for this type of catastrophic incident will take time and will require system-wide public health planning and intervention. In this article, the authors focus on how hospitals prepared for, responded to, and coped with Katrina. They also provide a brief overview of the current situation and the healthcare crisis confronting hospitals and communities in the region affected by Katrina and discuss the impending need to develop disaster-resilient medical and healthcare systems. Planning, access to adequate resources, networking, effective communication and coordination, and training and education of doctors, nurses, technicians, and medical staff are essential in the development of a resilient healthcare infrastructure that will be able to provide the much needed services to populations affected by future disasters.     

International patients: a lucrative market for U.S. Hospitals

Ravaged by diminishing revenues and intense price competition, U.S. hospitals desperately need to find profitable areas of healthcare. International patients that travel to the United States for treatment offer such an opportunity. Marketing directors, administrators and medical staff of leading hospitals are recognizing the value of this market segment. They are making special efforts to attract foreign patients. They have developed tailored services for international patient and are forming alliances with civic and business organizations to support the needs of patients traveling from overseas.     

对营利性与非营利性医疗机构界定的探讨

营利性、非营利性医疗机构的产生与发展及其特征以及如何界定和管理。     

Urban U.S. hospitals and the mission to provide HIV-related services: changes and correlates

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare, the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.     

医院改革的新机遇和新课题：职工医疗制度改革对医院的影响

结合我国职工医疗制度改革试点的实践,从医院的补偿、医院的发展和医院的经营目标三个方面论述了职工医疗制度改革对医院的影响。指出医院适应职工医疗保障制度改革是适应社会主义市场经济的具体化,医院要增强竞争意识,强化成本核算,提高服务质量,研究医疗需求态势,避免盲目发展。医院应取的经营目标是在确保基本医疗服务的前提下,正确引导合理健康的医疗消费,满足不同层次的医疗需求。     

The Jackson National Health Program

In this position paper we outline the major problems that exist in the U.S. health care system and present a proposal for addressing them. This paper contains the major health proposal put forward by the Jesse Jackson 1988 Campaign, calling for the establishment in the United States of a universal and comprehensive National Health Program (NHP) that will be federally funded and administered and be equitably financed. We also discuss how the NHP will affect patients, unions, corporations and employers, practitioners and other health workers, hospitals, and the insurance industry. Specific proposals are made for the transition from the current system to the proposed NHP, with a discussion of the major differences between national health proposals put forward by the two major Democratic contenders for the U.S. Presidency. This position paper also includes a brief appendix sketching some of the major differences between the U.S. and the Canadian medical care systems.     

Well-being revisited: improving the health of a population

Changes in society and the healthcare system are challenging healthcare executives to do more than provide medical services. Leaders now take broader responsibility for the health and well-being of the people and communities they serve. Health--the "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (World Health Organization 1944)--is determined by four forces: environment, heredity, lifestyle, and medical care services. Health-care managers who want to improve the health of their served populations must improve these forces. Strategic and operational lessons can be learned from the pioneering work done by several hospitals, health plans, and healthcare systems to improve their local environment, heredity, lifestyles, and medical care services. Managers who wish to improve health in their communities should strongly embrace and commit to "health" rather than mere "medical services" in their mission, vision, and values. They should collaborate with many other organizations and people--such as schools, churches, police, and businesses--to build partnerships that extend beyond the healthcare sector into the total community. Healthcare organizations should provide some resources and funds to improve the health of their served populations, and they should view this commitment as an investment (especially if there are capitated lives) rather than as an expense. They should also obtain public and private grant funds and leverage the resources of their collaborative partners to improve their local environment, heredity, lifestyles, and medical care services. Finally, leaders can advocate and support public policy that would improve the four forces that shape health.     

Globalization,global health,and access to healthcare

It is now commonly realized that the globalization of the world economy is shaping the patterns of global health, and that associated morbidity and mortality is affecting countries' ability to achieve economic growth. The globalization of public health has important implications for access to essential healthcare. The rise of inequalities among and within countries negatively affects access to healthcare. Poor people use healthcare services less frequently when sick than do the rich. The negative impact of globalization on access to healthcare is particularly well demonstrated in countries of transitional economies. No longer protected by a centralized health sector that provided free universal access to services for everyone, large segments of the populations in the transition period found themselves denied even the most basic medical services. Only countries where regulatory institutions are strong, domestic markets are competitive and social safety nets are in place, have a good chance to enjoy the health benefits of globalization.     

The future of health care in the United States

The U.S. government is involved in health care in various ways that include (1) providing services to veterans, (2) paying for care received by Medicare and Medicaid beneficiaries, (3) assuring quality through regulatory activity, (4) financing the discovery of medical breakthroughs, and (5) training members of the health workforce and assuring that the nation has an adequate supply of them. With the aging of the population, the role of the government in these endeavors will increase. This essay considers ways in which the health care of tomorrow will be affected by the intermingling of factors such as demography, epidemiology, economics, technology, globalization, and individual health behavior.     

Introducing the health coach at a primary care practice: impact on quality and cost (Part 1)

The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.     

The Role of Business Impact Analysis and Testing in Disaster Recovery Planning by Health Maintenance Organizations

The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.     

关于企业医院社会化的思考

企业医院社会化是实现卫生全行业管理的客观要求，是企业改革与医疗保障制度改革的必然结果。企业医院社会化是服务的社会化、管理的行业化、筹资方式的多元化。企业医院在观念上要“以变应变”，以新思想、新观念、新的管理方法适应改革的需要；在经营理念上要“以不变应万变”，以优质、优价在市场竞争中取得成功。     

部分国家政府举办公立医院的经验与启示

世界各国不论经济发达与否,均举办一定数量的公立医院。公立医院的重要地位和作用是：弥补市场缺陷、体现政府保障居民健康权益的责任,并在控制医药费用、提高卫生服务公平可及性、有效利用资源等方面发挥重要作用。不同卫生保健体制国家的公立医院功能定位具有不同特点：国民卫生服务体系国家强调政府主导卫生筹资,公立医院为人群提供免费或廉价的基本卫生服务;社会健康保险体制国家以德国为例,公立医院除承担一般性功能外主要提供住院服务;商业健康保险体制国家以市场为主导,公立医院的作用在于调节市场失灵,在医疗服务体系中发挥基础性但非主体性作用,并履行一定的社会职责。各国政府通过探索公立医院改革,如实行“管办分离”,以明确政府举办公立医院的职责。国际经验对我国的启示是：政府应举办一定数量的公立医院,为其承担大部分筹资,完善监管政策,促使其落实社会职能和责任;公立医院要通过高效率运行,为群众提供高质量的服务,并要代表国家医疗服务体系的先进水平,起到示范作用;政府进行公立医院改革要以转变政府职能为前提,并保障公立医院的社会功能;公立医院的功能应适应国家医药卫生体制的制度环境。     

低成本建立应对人口健康突发事件的卫星医院的建议与可行性分析

随着全球社会经济与科技的飞速发展,以可预见性差、影响人口数量大、健康影响程度深并具有较大的政治经济影响为特点的各类人口健康突发事件的发生愈加频繁。在先后经历了SARS和COVID-19这类新发传染性疾病的冲击,面对新时期更加复杂的国内外环境和多重应对矛盾的挑战,本文结合新时期人口健康突发事件面临的国内外背景与自身特点,提出低成本建立应对人口健康突发事件卫星医院（基站）的建议,并就建立的具体原则、突发时期和常态化的使用,以及筹建的基本方案与流程进行分析与阐释,以期为我国公共卫生体系进一步完善提供智力支持。     

Health technology assessment in Belgium

The Belgian healthcare system has a Bismarck-type compulsory health insurance, covering almost the entire population, combined with private provision of care. Providers are public health services, independent pharmacists, independent ambulatory care professionals, and hospitals and geriatric care facilities. Healthcare responsibilities are shared between the national Ministries of Public Health and Social Affairs, and the Dutch-, French-, and German-speaking Community Ministries of Health. The national ministries are responsible for sickness and disability insurance, financing, determination of accreditation criteria for hospitals and heavy medical care units, and construction of new hospitals. The six sickness and disability insurance funds are responsible for reimbursing health service benefits and paying disability benefits. The system's strength is that care is highly accessible and responsive to patients. However, the healthcare system's size remained relatively uncontrolled until recently, there is an excess supply of certain types of care, and there is a large number of small hospitals. The national government created a legal framework to modernize the insurance system to control budgetary deficits. Measures for reducing healthcare expenditures include regulating healthcare supply, healthcare evaluation, medical practice organization, and hospital budgets. The need to control healthcare facilities and quality of care in hospitals led to formal procedures for opening hospitals, acquiring expensive medical equipment, and developing highly specialized services. Reforms in payment and regulation are being considered. Health technology assessment (HTA) has played little part in the reforms so far. Belgium has no formal national program for HTA. The future of HTA in Belgium depends on a changing perception by providers and policy makers that health care needs a stronger scientific base.     

The general agreement on trade in services: implications for health policymakers

The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organization, aims to regulate measures affecting international trade in services-including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. We explain the rationale behind the agreement and discuss its scope. We also address the major controversies surrounding the GATS and their implications for the U.S. health care system.     

农村通向全民健康覆盖的障碍及其原因分析——基于供需双方经济激励机制角度

以宁夏回族自治区为案例,本研究对五个样本县进行大规模家庭入户调查、乡镇卫生院和村卫生室机构调查,分析了西部农村通向全民健康覆盖之路的障碍,并从供需双方经济激励机制角度剖析其原因.分析认为西部农村面临基层门诊服务可及性不足,居民经济负担沉重;服务流向不合理,资源配置效率低下;基层供方服务技术效率和质量不佳等问题.造成这些障碍的原因包括：从需方角度来看,新农合保障“轻门诊重住院、轻基层重高层”的特点;从供方角度剖析,对村医经济激励效力低下,按项目付费提供不恰当的经济刺激,难以引导供方提高自身服务效率和质量,以及欠缺促进体系整合的激励.