Reforming the health care system: implications for health care marketers

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.     

Assessment of the sterilization of medical devices--an important challenge to health care in Poland

The aim of the study was the evaluation of sterilization of medical devices in Polish hospitals. The system that we use to establish which sterilization procedures should be employed to reduce the risk of hospital infections associated with medical devices. Based on inquiries, the conditions for the sterilization of medical devices in 21 Warsaw hospitals were assessed. The following issues were taken into consideration: preparation of medical supplies for sterilization, methods of sterilization and the monitoring system. In order to evaluate hygienic conditions due to sterilization points system was applied. 10% of the hospitals had Central Sterilization Service Department with 3 zones where automatic washing and disinfection, sorting, packaging, sterilization and storage of medical devices had been performed. The other 20% had CSSD without zones. In more than 65% there were common services for sterilization only. Instruments were delivered already prepared for sterilization. In remaining hospitals all steps, including sterilization were performed in words. According preparation of medical devices for sterilization it was established that mainly chemical disinfection just after use and than manual cleaning was used; the automatic cleaning in washer-disinfectors is used mainly in CSSD. Steam was the preferred method of sterilization, but also low temperature methods were used for heat sensitive devices. The monitoring of sterilization processes was satisfactory. There were first trials of the validation of the sterilization processes. There is still a need for improvement in the sterilization of medical devices, especially including: the organisation of CSSD in all Polish hospitals; replacement of manual cleaning processes by automatic cleaning; organisation of advanced training courses for the heads and staff of the CSSD.     

加强监测 迎接流行性感冒新挑战

流行性感冒 (流感 )是由流感病毒引起的急性传染病 ,以其病原的易变性和疾病的传播速度快而著称。流感的影响主要表现在流行期间急性病人的高发病率 ,就诊人数增加 ,住院率甚至死亡率增加 ,对老年人、儿童和有潜在健康问题的人有合并并发症甚至致命的危险。据史料记载 ,早在 1173～ 1875年之间全球共发生流感大小流行 2 99次。 2 0世纪发生 4次世界性大流行 ,最严重的是 1918～ 1919年Ａ1(Ｈ1Ｎ1)亚型的大流行 ,为人类现代史上最大的瘟疫 ,累计发病达 7亿多人 ,造成 2 0 0 0多万人的死亡 ,超过第一次世界大战的战亡总人数。之后每发生一次型…     

The Generation-Y workforce in health care: the new challenge for leadership

The new generation of workforce entering health care today is the new challenge for leadership. This young workforce, known as the "Generation-Y," is demanding a different organizational culture to meet its needs. These new spoilers, once the babies of the baby boomers, will once again test the creativity and patience of their parents, who are now the leaders in health care. The baby boomer leaders of today face a delicate balance to meet the new demands of the Generation-Y workforce, along with the patients' demands. At stake in this balance is the viability of health care as we know it today. If the leadership of health care fails to grab hold of this new generation of employees, the ability to provide safe and quality health care and the survivability of the organization will be compromised. This article identifies the problem and provides guidelines to journey through this new wave of spoilers.     

对中国医院院长在当前卫生改革中所关注问题的分析

目的：研究中国医院院长在当前卫生改革中所关注的问题。方法：在2001年8月，通过问卷的形式对75名中国医院院长进行了调查，并对调查结果进行了分类和排序。结果：主要的问题依次是人事制度、职业培训、医院管理、奖金计算和工资以及提高医院的收入。结论：中国医院院长们愿意接受卫生改革的挑战，他们没有向国家索取经济补贴来维持现状，而是要求给予改革卫生体制所必需的权力，为中国医疗卫生事业创造更美好的未来。     

Urban health care in transition: challenges facing Los Angeles County.

The authors examine the Medicaid Section 1115 Demonstration Project currently underway in Los Angeles County. The waiver was designed as part of a response to a financial crisis the Los Angeles County Department of Health Services (LACDHS) faced in 1995. It provides financial relief to give the county time to restructure its system for serving the medically indigent population. Los Angeles County's goal is to reduce its traditional emphasis on emergency room and hospital care by building an integrated system of community-based primary, specialty, and public health care. This case study describes activities completed through the spring of 1997, approximately 1 year after the waiver was approved.     

A challenge for primary health care: mental health care implementation

The objective of this study was to evaluate mental health care provided within a primary health care setting. The study was conducted in a Primary Health Care Center (PHC) in the city of Sao Paulo, Brazil. A comparative study was made between pediatricians' diagnosis of mental health problems and those identified by the Child Behavior Checklist (CBCL) in children (5-11 years) from August to October 2000. Eleven pediatricians were interviewed for more in-depth analysis. The study analyzed 411 patient charts and held 206 interviews with the children's parents. Analysis of the resulting data shows that the pediatricians provided a diagnosis of mental health problems in 17.5% of the children examined. When compared with probable mental health problems identified by the CBCL, only 25.3% of the children were diagnosed by the physician as having mental health problems. Interviews with pediatricians identified difficulties in the definition and conceptualization of mental health problems, lack of organization in the referral system, and insufficient technical support.     

Managed care and the public health challenge of TB.

Managed care is fast becoming the dominant form of medical care delivery and financing in the United States, yet its effects on public health practice remain largely unknown. Tuberculosis (TB) is a classic example of a disease with both public health and medical care implications, and as such it provides an opportunity for examining the impact on public health of the shift towards managed care in the medical marketplace. The authors approach the role of managed care in TB control by first considering the need for interorganizational coordination at the community level. The authors identify four basic models of how managed care organizations may fit into TB control efforts in local communities, using observations from 12 local public health jurisdictions to illustrate these models. These TB control models provide insight into the general mechanisms through which managed care organizations may affect other areas of public health practice.