Promoting prevention with economic arguments – The case of Finnish occupational health services

Background  

Both social and ethical arguments have been used to support preventive occupational health services (OHS). During the 1990s it became more common to support political argumentation for occupational health and safety by converting the consequences of ill health at work into monetary units. In addition, OHS has been promoted as a profitable investment for companies, and this aspect has been used by OHS providers in their marketing.     

Health insurance and imperfect competition in the health care market

We show that when health care providers have market power and engage in Cournot competition, a competitive upstream health insurance market results in over-insurance and over-priced health care. Even though consumers and firms anticipate the price interactions between these two markets - the price set in one market affects the demand expressed in the other - Pareto improvements are possible. The results suggest a beneficial role for Government intervention, either in the insurance or the health care market.     

Purchasing health care services from providers with unknown altruism

Cost-sharing rules for paying physicians have been advanced as a way of generating incentives for the provision of quality care, while recognizing their potential negative effects on production efficiency. However, the optimal sharing rate typically depends on the degree to which the physician acts in the interest of the patient, what we identify as the physician's altruism. Since the degree of altruism is likely to vary across physicians, and to be private information, the standard rules for setting the cost-sharing rate are unlikely to be optimal. This paper derives conditions for the optimal non-linear cost-sharing mechanism in the presence of asymmetric information about altruism, and shows how it can sometimes be implemented through a menu of linear cost-sharing schemes. The model can be used to rationalize the design of the fund-holder system for general practictioners that operated in the 1990s in the United Kingdom.     

The impact of the introduction of market incentives on occupational health services and occupational health professionals: experiences from The Netherlands

OBJECTIVES: This paper describes the reform of the regulations on safety and health in the Netherlands towards a more competitive market and its impact on occupational health services (OHSs) and the health professionals over the period 1994-2005. Aims are to identify the crucial factors that bring about the intended effects (such as lower disability rates) and to evaluate the outcomes from the perspective of the occupational health professional. The paper contributes to the discussion of how the professionals could define and contain their professional identity and credibility in competitive circumstances. METHODS: Open interviews were completed with 12 key persons and secondary analyses were made on documents and various monitors. RESULTS: The reform changed the OHS safety market fundamentally. OHSs were transformed from medium sized regional units into business organizations mostly operating on a national level. Private insurance companies became key players. Only after the development of an effective social infrastructure, however, intended effects (lower absenteeism and disability) occurred. Occupational health professionals were initially opposed but by redefining their professional domain and identity, they finally succeeded in gaining negotiating power in order to preserve and develop expertise and professional integrity. CONCLUSIONS: The effectiveness of the introduction of market incentives depends strongly on their social embeddedness. Health professionals should adapt their strategy to the conditions of the competitive market, in order to preserve a credible and professional identity.     

Integrating occupational health services and occupational prevention services

BACKGROUND: Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients. METHODS: MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included. RESULTS: Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention. CONCLUSIONS: Research is needed to improve and promote clinical occupational health preventive services.     

Brand name changes help health care providers win market recognition

As the healthcare industry continues to recognize the strategic implications of branding, more providers will undertake an identity change to better position themselves in competitive markets. The paper examines specific healthcare branding decisions, the reasons prompting brand name decisions and the marketing implications for a change in brand name.     

Public health services in Shenzhen: a case study

As one of the fastest growing cities in Pearl River Delta of southern China, Shenzhen accommodates a higher percentage and increasing number of internal migrants, mainly coming from the inland areas. The public health issues that challenge its local government include the special population structure, high incidence of infectious diseases, high prevalence of mental problems, rising chronic disease burdens, and maternal and children's health issues, although progress has been made in the past years. The health authority of?Shenzhen has realized that provision of high quality equitable public health services to its residents, including migrants is of high priority, and should be supported by innovations in the health insurance system and establishment of community-based primary care networks. Making changes within the national-level health reform framework and learning from international experiences are necessary and important.     

Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis

Background

Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities.

Methods

A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher’s perspectives by means of document review and participatory observation.

Results

Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process.

Conclusions

Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.     

Estimating market boundaries for health care facilities and services.

Competition in the health care industry is intensifying. The changing environment is making it necessary for executives to integrate quantitative market identification methods into their strategic planning systems. The authors propose one such method that explicitly recognizes the relative strength of competition in the marketplace and offer two examples of its implementation.     

The emergence of employer-led health care purchasing organizations: a new market for providers

A new form of purchaser--the employer-led, community-based health care purchasing organization--is appearing in the health care marketplace. This article uses the author's experience with coalitions to describe the basic anatomy of private health care purchasing organizations, and suggests several strategies for marketing to this new buyer. The article also presents a market share/presence formula developed to test coalition viability.     

Accountable care organizations: the case for flexible partnerships between health plans and providers

Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories.