Healthcare finance and economics

This article is a wide-ranging overview of the field of healthcare financing, health economics and the development of financial management. It vividly demonstrates that all healthcare systems have too many demands and too few resources, and that problems can manifest themselves in different forms depending on the precise funding structure of the health service concerned.     

Parent proxy-report of their children's health-related quality of life: an analysis of 13,878 parents' reliability and validity across age subgroups using the PedsQL™ 4.0 Generic Core Scales

Background  

Health-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. While pediatric patient self-report should be considered the standard for measuring perceived HRQOL, there are circumstances when children are too young, too cognitively impaired, too ill or fatigued to complete a HRQOL instrument, and reliable and valid parent proxy-report instruments are needed in such cases. Further, it is typically parents' perceptions of their children's HRQOL that influences healthcare utilization. Data from the PedsQL™ Database^SM were utilized to test the reliability and validity of parent proxy-report at the individual age subgroup level for ages 2–16 years as recommended by recent FDA guidelines.     

Guidance for a failing system. Catholic social teachings provide the needed principles

Catholic healthcare has traditionally relied on four major ethical principles--nonmaleficence, beneficence, autonomy, and justice--to address conflicts between various goods. However, all healthcare now finds itself facing great changes. "Principleism" is too limited to guide the Church's health ministry through the current crisis. But the Church possesses a body of social justice teachings that may provide healthcare with the necessary guidance. Eight inseparable but distinct themes are found in the social teachings: human dignity, human solidarity, the option for the poor, the common good, human rights, social justice, stewardship, and liberation. The eight themes are here applied to five critical healthcare issues: the patient-physician relationship, the right to choose, healthcare as a communal good, rationing and limits, and work and its implications. The Church's social teachings may provide us with a basis for a structural reexamination of healthcare--including Catholic healthcare. In that analysis, we may find that Catholic healthcare has developed practices and standards that are at odds with its own teachings. Such an analysis will be painful, but it must be done.     

1例因服用保健药品引起转氨酶升高的启示

本文报告1例因服用某品牌保健品而致ALT、AST严重超标的病例。停用保健品一个月后,两次复查检测,均恢复在正常范围。该病例提醒人们,使用保健品应持慎重态度。     

广州市城镇人口医药卫生服务可及性调查报告

采用分层随机抽样的方法对广州市常住人口医药卫生可及性进行了电话调查。目前,广州城镇人口大多数自付过医药费用,相当一部分城镇人口自付的医药费用比例过高,药品费用在城镇人口自付的医疗费用项目中居首位,城镇人口自付医药费用的主要原因是没有其他选择。城镇人口医疗保障覆盖面还不高,30%的城镇人口没有参加任何一种医疗保障项目。城镇人口在就医时倾向于选择大医院。完善基本医疗保障制度,引导患者就医行为,推进医药分家体制改革,转变基本医疗保障费用支付方式和加大公共卫生投入改革有助于提高广州市目前城镇人口医疗卫生服务可及性。     

States turn up the heat. As self-regulation sputters, state legislatures are leading charge for more accountability in governance of not-for-profit hospitals

Recent scandals have pushed some states to tackle transparency and governance issues at healthcare not-for-profits, which the federal government has been reluctant to touch. Rhode Island Lt. Gov. Charles Fogarty, left, supports a bill in his state that would establish a code of ethics for hospital boards. Fogarty sees leaders as getting too comfortable in their jobs and working without accountability.     

Healthcare in Japan: its professionals, institutions, and financing

Like the United States, Japan's healthcare system is a conglomerate of government, employer, and individual financing--but that's about as far as the similarity goes. Universal access to basic healthcare has been achieved in Japan through comprehensive employer/employee plans and government subsidies. However, the United States should not be too hasty in emulating Japan, for culture plays a definite role in healthcare on both sides of the Pacific.     

Vaccinations among medical and nursing students: Coverage and opportunities

Healthcare students are a specific subgroup of healthcare workers as they are often not identified by the occupational medicine systems in healthcare facilities, because of their shared time between hospital wards and universities. Nevertheless, they should comply with the same vaccination recommendations as employed healthcare workers because they are in close and repeated contact with patients. Occupational immunization recommendations may vary between countries, but always include vaccine-preventable diseases that might lead to nosocomial outbeaks and/or fatal outcomes for healthcare workers or patients. Studies conclude that vaccine coverage is too low in healthcare students, and that they are often not aware of their possibility to be vectors of infections to frail patients. Efforts should be made to educate medical and nursing students on vaccines, to convince them of the utility of immunization and to offer them an increased access to occupational vaccinations in hospitals and universities.     

Laying the groundwork for a smooth transition to TQM

The increasingly popular corporate philosophy of total quality management (TQM) can (and should) be applied to the healthcare industry--as structured and bureaucratic a system as can be found. Yet one does not begin by running, but by learning how to walk. So, too, with TQM. In this article, the author makes several suggestions that will enable healthcare managers to take those first few steps toward better quality service and patient care.     

The value of information technology in healthcare

Not only will healthcare investments in information technology (IT) continue, they are sure to increase. Just as other industries learned over time how to extract more value from IT investments, so too will the healthcare industry, and for the same reason: because they must. This article explores the types of business value IT has generated in other industries, what value it can generate in healthcare, and some of the barriers encountered in achieving that value. The article ends with management principles for IT investment.     

Metadata and meaningful use

The healthcare industry will find out soon if ONC intends to include metadata requirements in stage 2 of the meaningful use program. Many feel it is too soon. But given metadata's potential to support health information exchange, the expanded and standardized use of metadata tagging in healthcare is ultimately a matter of when, not if.     

Stand-by!: U.S.A.F. Medical Crash Team

The increasingly popular corporate philosophy of total quality management (TQM) can (and should) be applied to the healthcare industry—as structured and bureaucratic a system as can be found. Yet one does not begin by running, but by learning how to walk. So, too, with TQM. In this article, the author makes several suggestions that will enable healthcare managers to take those first few steps toward better quality service and patient care.     

Healthcare-financing reforms in transitional society: a Shanghai experience

Since the 1950s, China has had a very wide coverage of healthcare service at the local level. In urban areas, the employment-based healthcare-insurance schemes (Government Insurance Scheme and Labour Insurance Scheme) worked hand in hand with the full employment policy of the Government, which guaranteed basic care for almost every urban resident. However, since the economic reforms of the early 1980s, China's healthcare system has met great challenges. Some came from the reform of the labour system, and other challenges came from the introduction of market forces in the healthcare sector. The new policy of the Chinese Government on the Urban Employees' Basic Health Care Insurance is to introduce a cost-sharing plan in urban China. Like other major social policy changes, this new health policy also has a great impact on the lives of the Chinese people. Affordability has been the major concern among urban residents. Shanghai implemented the cost-sharing healthcare policy in the spring of 2001. It may be too early to assess the pros and cons of the new policy, but evidence shows that the employment-based health-insurance scheme excludes those at high risk and in most need. It is argued that the cost-sharing healthcare system will limit access by some people, especially those who are most vulnerable to the consequences of ill health and those in low-income groups, unless the deductibles vary according to income and unless low-income groups are exempt from paying premiums and deductibles.     

Career extensions: bringing academicians and practitioners in healthcare management together

A growing number of health administration faculty are realizing that they can learn a lot by periodically stepping out of academe and into practice settings. And healthcare executives who are opening their organizations to faculty fellows are realizing that they can learn a lot, too.     

The excesses of individualism. For meaningful healthcare reform, the United States needs a renewed sense of community

In the United States at the end of the twentieth century, the balance of values tilts too far toward the individual and away from the community. What is needed is a renewed sense of community that enhances the lives of individuals as it serves the common good. The first step toward creating a new balance is a critique of the present imbalance, which is shaped by excessive forms of individualism that affect every aspect of our healthcare delivery system. Technological individualism occurs when the value of technology is measured only by its service to the individual. The results are a technological imperative, unreasonable expectations on the part of the community, distorted judgement on the statistical likelihoods of individual outcomes, fragmentation of care, and a reliance on rescue medicine. A psychosocial individualism has misshapen our attitudes about ourselves and our communities, bringing with it a deepening sense of alienation. The results in U.S. healthcare include commercialization, exclusion of the poor, a litigious provider-patient relationship, declining respect for life, and a sense of community that excludes other generations and nations. Libertarian individualism has created political isolation and prevents the evolution of democratic decision making and real partnerships in healthcare. The results are an unpooling of insurance risk, an interpretation of freedom that is inimical to family and community ties, hostility to government, a view of healthcare as a commodity, and deprofessionalization of the medical professions. Healthcare reform must seek to change what medical technology does for us, repair the psychosocial harms healthcare individualism has produced, and promote citizen participation in the healthcare system in new and important ways.     

流动人口基本公共卫生服务利用及影响因素分析

目的：了解流动人口基本公共卫生服务利用情况及影响因素,为推进基本公共卫生服务均等化提供对策和建议.方法：利用2013年全国流动人口动态监测调查数据及2013年流动人口卫生计生基本公共服务专项调查数据,对流动人口基本公共卫生服务利用及影响因素进行分析.结果：流动人口基本公共卫生服务利用总体水平较低,最近一年内接受过体检的比例为33.02％,只有23.84％的流动人口在当地建立了居民健康档案,5.15％的流动人口了解有关职业病防治的法律法规,55.00％的流动人口没有接受过职业安全与健康防护培训.0～6岁儿童免疫接种和健康管理工作开展情况较好,但存在一定比例的重复建卡和重复管理情况.“不知道”和“没有时间”是其未接受各项基本公共卫生服务的主要原因;多因素分析显示,影响流动人口基本公共卫生服务利用的因素主要有：性别、年龄、教育程度、每天工作时间、流动范围及流入时间.结论：流动人口对基本公共卫生服务利用不足,健康意识薄弱和服务可及性差是影响该群体卫生服务利用的主要原因.应该提高该人群对基本公共卫生服务的认识,并探索适宜的服务机制,促进其对基本公共卫生服务的利用.     

Implementation of a patient‐friendly medication schedule to improve patient safety within a healthcare system

Preventable adverse drug events have a direct impact on the well‐being of patients. The creation and implementation of a patient‐friendly daily medication schedule improved the way care is delivered at Memorial Healthcare System. The staff collaborated with patients and families and empowered them with the knowledge and tools needed to make their healthcare safer. Patient and family participation, a critical component of patient‐ and family‐centered care, is a vital part of making healthcare safer. This tool enhances communication with patients and family members and enables patients to better understand the medications they receive while hospitalized. An additional welcomed byproduct is the prevention of potential medication errors.     

Rural healthcare needs and solutions

Many rural communities are finding it necessary to create innovative ways to make healthcare more accessible to their residents. Successful rural healthcare delivery systems require the resources of an institution willing to serve the rural healthcare market, a community wanting to improve its healthcare, and dedicated practitioners. Physicians must be willing to see Medicaid and charity care patients. If physicians in the community are too busy or unwilling to accept indigent patients, the community may need more physicians. When the community recruits additional physicians, leaders must clarify that all physicians have a responsibility to serve indigent patients. As a result, a community-wide healthcare planning process is essential. Because residents might not always be aware that they should receive certain routine healthcare services or how to access those services, the community must establish strategies to reduce this knowledge gap. Urban healthcare centers can help by bringing health screening services to the rural community and by providing health education programs. Providers can close another part of the knowledge gap by helping patients fill out the insurance forms required to receive payment and by helping them find and apply for indigent patient coverage. To help solve the physician shortage problem in rural areas, communities can work with urban healthcare providers to purchase or start new practices in rural areas and then supplement the practices with additional primary care physicians or other healthcare practitioners.     

区域协同医疗系统及协同机制

依据赫尔曼.哈肯的协同学原理,建立了基于协同学原理的区域协同医疗系统的模型,确定了模型关键序参量是协同价值,分析了区域协同医疗系统的自组织运动及协同机制,并以某区域协同医疗系统为例对区域协同医疗系统的构建和协同效应进行探讨,可为构建区域协同医疗系统、提升医院信息化管理水平提供参考。     

The birth of InterQual: evidence-based decision support criteria that helped change healthcare

PURPOSE/OBJECTIVES: InterQual evidence-based clinical decision support criteria are used by thousands of organizations in healthcare. What industry trends led to their creation, and what accounts for their longevity and widespread acceptance? PRIMARY PRACTICE SETTINGS(S): Hospitals, health systems, and managed care organizations. FINDINGS/CONCLUSIONS: Although the healthcare puzzle sometimes seems too complicated for anyone to solve, passionate people with good ideas have been able to effect substantive and relatively rapid change throughout healthcare history.