Compensation in the year 2000: pay for performance?

Notes the attempts by many companies today to identify innovative compensation strategies that are directly linked to improving organizational performance. Observes that there are many approaches to incentive compensation such as cash bonuses, stock purchase and profit sharing. Examines the individual and group incentive concepts that reward performance based on predetermined organizational goals and metrics, several behavioural theories that can be associated with reward and compensation, and convergent and divergent views and conclusions from the business community.     

‘HIV is an enemy of childbearers’: the construction of local epidemiology in rural Malawi

In the sub-Saharan African AIDS epidemic there is no shortage of formal messages about HIV distributed through health clinics, NGOs and the media. These messages, however, do not always address the issues that are of most importance for people living in the epidemic and learning how to navigate it safely. In rural Malawi, one message that has been absent concerns the implications of HIV for childbearing. Using data from in-depth interviews, this paper argues that rural Malawians socially constructed their own belief system and came to believe strongly that pregnancy and childbirth would negatively impact the disease progression of HIV-positive women. Through the recursive processes of selective observation, interpretation of formal public health messages and discussion within social networks, rural Malawians concluded that HIV and childbearing did not go together. In an uncertain world, social constructive processes such as these that are fluid and responsive to local circumstances are particularly important for making sense of the seemingly senseless and for developing tools to navigate unsettled times.     

On the unraveling of ‘revitalization of local health traditions’ in India: an ethnographic inquiry

Background

India has recently renewed emphasis on non-allopathic systems of medicine as a means to address the health needs of its populace. Earlier in 2002, its national health policy had sought to ‘revitalize’ community-based health knowledge and practices – jointly christened ‘local health traditions’. Yet policy texts remain silent on the actual means by which ‘revitalization of local health traditions’ should take place. Our research sought to understand the policy lessons of and for revitalization of local health traditions in the three Southern Indian states through an ethnographic inquiry in 2014–2016.

Methods

Our inquiry included a narrative synthesis of policy texts tracing the history of governance processes and mechanisms pertaining to traditional medicine, including local health traditions, linking this to the activities of non-governmental organizations (NGOs) and networks involved in “revitalization”. Through in-depth interviews, observations and case studies, we sought to understand the life worlds of local health tradition practitioners and what revitalization meant to them. Our method revealed that beyond a purely academic inquiry, we needed an (inter)action that would give greater voice to these perspectives and views leading to hosting an interactive dialogue among practitioners, NGO representatives, academics, and government officials.

Results

Our ethnographic inquiry unraveled the problematic of a litotic approach to local health traditions as those which are non- institutionalized, non-certified, non-documented; assuming the state to be the only source of power and legitimacy. Revitalization discussions were restricted (and often misled) by such an approach. Local health practitioners and others directed us to interesting possibilities of revitalization either through participatory modes of documentation of traditional health knowledge, strengthening existing collective forums for formal social recognition, and building pedagogical institutions that promote experiential learning.

Conclusion

Were we not enabled by ethnography as a method that changes its shape apace with emerging findings, we would have not been able to comprehensively answer our questions. This is critical because not only was this already a marginalized area of inquiry, but with any other method we risked reinforcing inequities by imposing epistemological and other hierarchies on our participants– whom we would argue were partners - in arriving at our conclusions.

     

A certain ratio? The policy implications of minimum staffing ratios in nursing

The debate about how best to determine nurse staffing levels continues. The conventional wisdom is that determining staffing levels is something best left to local management, taking account of local workload and resources. This 'bottom up' philosophy has now been challenged by the use of a different approach--the use of 'top down'standardized, and mandatory, nurse:patient or nurse:bed ratios. This paper examines the characteristics and early results of the use of staffing ratios in the two health systems where nurse staffing ratios are now mandatory--the states of Victoria (Australia) and California (USA). It then discusses the policy implications of using ratios. The paper identifies the main weaknesses of the use of nurse:patient ratios as being their relative inflexibility and their potential inefficiency, if they are wrongly calibrated. Their strength is their simplicity and their transparency. Their impact will be most pronounced when ratios are mandatory and where they offer a mechanism to improve and then to maintain staffing levels at some pre-determined level. The biggest challenges in their use are calibration (what is 'safe'? or 'minimum'?) and achieving the support of all stake-holders. The paper concludes that nurse:patient ratios are a blunt instrument for achieving employer compliance, where reliance on alternative, voluntary (and often more sophisticated) methods of determining nurse staffing have not been effective.     

Do local inhabitants want to participate in community injury prevention?: a focus on the significance of local identities for community participation

During the 1980s the community became the object of new interest and enthusiasm among many health promotion practitioners and researchers, and the principle of community participation was put on the research agenda. However, recent evaluations of major community health promotion programs have questioned the value of community interventions. This paper argues that the community level need not be of less importance in future health promotion initiatives. It is discussed whether the cultural dimension and the significance of local identities, neglected in most community health promotion programs, should receive more attention when local inhabitants are invited to participate in health promotion or disease prevention activities. Results from a study of injury prevention projects in small Norwegian municipalities indicate that the inhabitants' identification with local spatial subarenas might play an important role when they decide to become involved in injury prevention. Contemporary sociological approaches to the community, focusing on developments of local identities in processes of globalization, have formed a theoretical frame of reference in this study.     

Do divergences between stated and actual willingness to pay signify the existence of bias in contingent valuation surveys?

This study's objective is to determine the factors that cause divergences over time (differences) between stated willingness to pay (WTP) and actual WTP (purchase behaviour), and consider whether any divergence signifies the presence of bias in contingent valuation studies. Stated WTP for insecticide-treated bed-nets (ITNs) was elicited from a random sample of respondents using three question formats in Nigeria. The question formats were the bidding game (BG), binary with follow-up (BWFU) and a novel structured haggling (SH) technique. The sales of the nets and a second survey were conducted 1 month after the first survey. In the second survey, factors that might explain the divergences were built into the questionnaire and these together with socio-economic variables were examined for causes of divergences in WTP. Data were analysed using non-parametric tests, testing of means and cross-tabulations. There were divergences in WTP in all three question formats: 69.4% in the BG, 78.7% in the BWFU and 48.8% in the SH. The higher the stated WTP, the more likely the divergence between stated and actual WTP. The attitude of the community leaders to the ITNs in the BG (p<0.05), the time respondents had to think about their WTP (p<0.05) and the external information they received about the ITNs in the BWFU (p<0.05) all led to divergences in WTP. We conclude that there are genuine causes of divergences between stated and actual WTP across the three question formats, and that the lesser the criterion validity score, the more the level of divergence in WTP. Studies that compare stated and actual WTP should explicitly determine the causes of divergences in order to assess the role of bias in the divergences.     

Commentary: The benefits of collaboration in research: who will pay?

Collaboration between MCOs and researchers holds promise for benefiting consumers by working on quality-of-care-related research. There are at least three areas of collaboration that might benefit both researchers and MCOs: (1) the developing and validating of management and fiscal indicators, (2) developing and validating clinical indicators and (3) studying access to treatment for vulnerable populations. These three areas offer benefits to the MCO and unusual research opportunities for investigators. Barriers for both MCOs and researchers must be overcome before this work can be carried out, not the least of which is who will pay for the work to be done.     

Cost structure of osteopathic hospitals and their local counterparts in the USA: are they any different?

Due to the emphasis on preventive care and less invasive solutions to medical problems, osteopathic hospitals may deliver cost efficient and cost effective care. This study examines the cost structure of osteopathic hospitals and compares their performance to a local control group selected from allopathic hospitals. Osteopathic hospitals are identified in the 1999 American Hospital Association (AHA) data and matched to local allopathic hospitals with respect to location, bed size, system, for-profit and teaching status. Cost functions are estimated for both groups of hospitals, and significant differences in input, output and costs are highlighted. Results show that osteopathic hospitals are more costly and less productive in comparison to their counterparts. Inefficient production of outpatient services and high cost of medical education are two reasons for the poor performance. The study has important policy implications on two fronts: first, osteopathic hospitals are more costly to operate than their counterparts, and subsequently this requires further analysis of the osteopathic treatments and techniques. In an environment where health care revenues are shrinking and costs are rising, this is probably much needed information for osteopathic hospitals. Secondly, there is an emerging concern among osteopathic medical schools and osteopathic physicians due to the declining number of osteopathic hospitals, which translates to a smaller number of residency positions for osteopathic medical school graduates. Analyzing cost, input and output variables reveal some of the contributing factors to the decline of osteopathic hospitals and help preserve this rich tradition.     

Do mandates requiring insurers to pay for emergency care influence the use of the emergency department?

Many states have "prudent layperson" mandates that require health plans to reimburse hospitals for emergency department (ED) care delivered to patients who believe that they have symptoms warranting emergency treatment. Increased, and possibly unnecessary, ED use has often been attributed to these policies. We use data from thirty-five states to study relationships between passage of prudent layperson policies in the late 1990s and ED use among the privately insured. None of the analyses show evidence that the mandates are associated with increased use. We conclude that prudent layperson mandates are not associated with increases in ED visits among privately insured patients.