Competitive Health Care System Research Articles

Izgradnja liderstva u sestrinskoj praksi

In the pursuit of a competent and competitive healthcare system, nurses and healthcare technicians, as key figures in the healthcare process and scientific discipline of nursing, should possess not only professional knowledge but also managerial abilities and skills. This includes the effective management of human and material resources within the healthcare system. Leadership in nursing practice can be understood as the influence of head nurses on the quality and effectiveness of all activities within their domain. By reviewing the literature on research concerning leadership in nursing and the factors influencing its development in nursing practice, which have not yet been definitively defined, we aim to provide an overview for the professional community in the fields of biomedicine and health, especially in healthcare where nurses operate at all levels. To achieve the goals necessary for developing leadership in nursing practice, the implementation of appropriate strategies, methods, and tools within the healthcare system is crucial for human resources, a key factor in improving healthcare delivery. The role of the head nurse, or nursing leader, is of paramount importance in enhancing the organization and quality of healthcare at all levels.

Влияние новых медицинских технологий на качество медицинской помощи в мегаполисах (на примере города Москвы)

Background. The effective development of healthcare and, in particular, clinical medicine, increasingly depends on the unique medical technologies and modern equipment used. Therefore, in order to form a competitive healthcare system in a megapolis, it is important to introduce a management mechanism that allows constant monitoring of emerging new technologies and a comprehensive assessment of their impact on changing the quality of medical care, assessing their contribution to public health, that is, creating a “technological funnel” for the healthcare system. Purpose. The purpose of this study is to identify the urgent problems in the analysis and comprehensive assessment of new medical technologies and determine the possible mechanisms for their introduction into clinical practice. Materials and methods. The methodology of this work is to study the literature and research of the most successful practices of introducing new medical technologies (on the example of the capital's healthcare), study the opinions of the population and healthcare professionals based on the analysis of social networks. Results. Based on the systematization of information obtained by the authors in the course of the study, authors identified the most important new medical technologies for the population and health care professionals, which, in their opinion, have changed the landscape of the capital's health care for the better. Authors determined significant criteria for improving the efficiency of the health care system through the search, comprehensive assessment and scaling of innovative practices in clinical medicine. Discussion. The creation of a "technological funnel" in the health care system of the capital makes it possible to conduct comparable research on the quality of medical care provided with many countries of the world. In addition, the constant search and comprehensive assessment of new medical technologies, potentially suitable for implementation in city clinics, can significantly influence the improvement of the quality of medical care provided to the population. Conclusion. Solving the problems associated with the optimization of search processes, comprehensive assessment, unification of the processes of introducing new medical technologies, can significantly improve the quality of medical care, as well as affect the contribution of health care to the health of citizens. At the same time, such studies require careful research and search for approaches that meet modern realities.

Healthcare Quality Management System in Pakistan

The competitive healthcare system and healthcare environment, modern hospitals with substantial investment, healthcare reforms, availability of specialized persons in hospital management, health services management, the success of quality management programs in developed nations and high interest of international health organizations like WHO has led the developing countries like Pakistan to pay due attention to quality in national healthcare system.  Since the time of independence healthcare system in Pakistan is striving for improvements. Despite of the physical infrastructure and availability of qualified workforce for service delivery there are gaps in strategic and operational planning which resulted in poor quality health services. The leaders in healthcare has little awareness that the quality management is an organized specialty to improve the quality of healthcare. It is need of the hour that healthcare leaders in Pakistan must integrate quality improvement activities in strategic and operational planning process of healthcare system. This the only way to maximize the benefits of healthcare system and restore the rapidly deteriorating public trust.

Collaboration in a competitive healthcare system: negotiation 101 for clinicians

PurposeThe purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when.Design/methodology/approachThis is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia.FindingsParticipants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed; suggestions for improving sustainability included provision of refresher training and mentoring.Research limitations/implicationsLimitations include self-reported data, and interview questions positively elicited examples of training translation.Practical implicationsThe training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical examples of how the skills were used in the workplace are provided.Originality/valueTo the authors’ knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior clinicians and management staff in a large healthcare organization.

Latvian health care competitiveness in relation to its infrastructure and available resources

Resources are one of the essential indicators for the functioning of the health care system. Better health care provision is an essential prerequisite for the export of services. Traditionally a competitive health care system is linked to a number of factors (price, quality, reliability, products and services) largely determined by the new technologies, innovations and implementation the new methods. The authors of this article analyzed and collected data from the European Commission Eurostat and OECD data. Current situation in health care in Latvia is characterized by populations’ restricted access to health care services, high out-of-pocket payments and poor health outcomes of the population. More than 10% of Latvian population can’t afford medical care. The ratio of public funding for healthcare in Latvia is among the lowest in EU countries. Latvia spends 5.3% (USD PPP 1217) of GDP on health, lower than the OCED country average of 8.9% (USD PPP 3453). Latvia is facing a dramatic gap between the availability of hospital beds and long term care beds and the lowest prevalence of general medical practitioners among all Baltic States 321.6 per 100 000. These mentioned factors may hinder the development of health care in Latvia and reduce the ability to participate in international health service market.

The level of consumer information about health insurance in Nanjing, China

The Chinese government is considering a (regulated) competitive healthcare system. Sufficient consumer information is a crucial pre-condition to benefit from such a change. We conducted a survey on the level of consumer information regarding health insurance among the insured population in Nanjing, China in 2009. The results from descriptive analysis and binary logistic regression demonstrate that the current level of consumer information about health insurance is low. The level of consumer information is positively correlated with the subscribers' motivation to obtain the information and its availability. The level of searching for health insurance information is also low; moreover, even upon searching, the chance of finding relevant information is less than 25%. We conclude that the level of consumer information is currently insufficient in China. If the Chinese government is determined to adopt market mechanisms in the healthcare sector, it should take the lead in making valid and reliable information publicly available and easily accessible.

Transforming the Safety Net: Responses to Medicaid Managed Care in, Rural and Urban New Mexico

In this article we examine the impact of Medicaid managed care on safety net organizations in New Mexico and their ability to maintain their traditional mission of charity care. We address two particular areas of concern that have arisen in the literature on Medicaid managed care. First, analysts have debated under what circumstances safety net organizations are better positioned to survive under market competition without abandoning their social orientation. Second, analysts have suggested that populations in rural areas may be more disadvantaged under Medicaid managed care due to its intensification of already‐existent barriers to access. By comparing the differential ability of safety net organizations in rural and urban New Mexico to buffer their patients from potentially harmful effects of Medicaid managed care, we identify factors that place these safety nets particularly at risk. We find that a rural location, lack of affiliation with a larger organization, and lack of recourse to charitable funding are "risk factors" determining who sinks—and who floats—in this new competitive health care system, [privatization of health care, Medicaid safety net organizations, managed care, resistance, ruralurban]

Public health nursing directors' perceptions regarding interagency collaboration with community mental health agencies.

Involvement in collaborative interagency relationships is crucial to the future of public health nursing and public health agencies. The purpose of this study was to describe public health nursing directors' perceptions regarding relationships between public health agencies and mental health agencies in their communities. A secondary analysis was conducted of textual responses to open-ended questions and unsolicited comments from 71 (55%) the of respondents to a larger survey of nursing directors of all public health agencies in Ohio. Data were analyzed inductively using content analysis for emergent themes and patterns, which were organized and classified deductively according to a community interagency collaboration framework. Public health nursing directors described environmental, situational, task, and interagency factors that impact collaboration between their agencies and local community mental health agencies. These descriptions provide a context for understanding impediments to collaboration between these two types of agencies, and have implications for designing interventions to enhance public health nursing directors' skills at marketing both their profession and their agencies. Collaborative relationships between public health and mental health agencies could improve care for community-dwelling persons with severe mental disabilities and enhance the future of public health nursing in a changing, competitive health care system.

Market-oriented health care reforms: Trends and future options

In many (predominantly) publicly financed health care systems market-oriented health care reforms are being implemented or have been proposed. The purpose of these reforms is to make resource allocation in health care more efficient, more innovative and more responsive to consumers preferences while maintaining equity. At the same time, the advances in technology result in a divergence of consumers' preferences with respect to health care and urge society to (re)think about the meaning of the solidarity principle in health care. In this paper we indicate some international trends in health care reforms and explore some potential future options. From an international perspective we can observe a trend towards universal mandatory health insurance, contracts between third-party purchasers and the providers of care, competition among providers of care and a strengthening of primary care. These trends can be expected to continue. A more controversial issue is whether there should also be competition among the third-party purchasers and whether in the long run there will occur a convergence towards some “ideal” model. Although regulated competition in health care can be expected to yield more value for money, it might yield both more efficiency and higher total costs. It has been argued that equity can be maintained in a competitive health care system if we interpret equity as “equal access to cost-effective care within a reasonable period of time”. Because the effectiveness of care has to be considered in relation to the medical indication and the condition of the patient, the responsibility for cost-effective care rests primarily with the providers of care. Guidelines and protocols should be developed by the profession and sustained by financial incentives embedded in contracts. It has been argued that the third-party purchasers could start to concentrate on the contracts with the primary care physicians. Contracts with other providers could then be a natural complement to these contracts. Coordinated-care contracts between the third-party purchasers and the consumer of care could provide the consumer with monetary incentives to go to efficient providers. A consumer choice of insurance contract could give the consumer an opportunity to make important choices in health care. However, each society has to make its own choices about what care should be available to everybody independent of an individual's purchasing power.

A MARKETING TOOL

. . . the spread of extracorporeal membrane oxygenation (ECMO) is not entirely in the hands of the physicians. For example, the May 1990 issue of America West Airlines Magazine contained an ad by the Board of City Development of a Southwest city with the headline: ‘Our ability to save struggling newborns with an ECMO Unit makes [our city] one of the healthiest medical communities in the nation.’ Use of ECMO as a marketing tool in a highly competitive health-care system makes its proper diffusion a much more complex problem.

Patient Selection in a Competitive Health Care System

Prologue: During the 1980s, as alternative medical care delivery systems have proliferated and nonprofit and commercial health insurance carriers have competed to remain viable enterprises, the insurance market has splintered into an array of new choices. As this more competitive environment has evolved, one increasingly important development in the health policy realm is how insurers select patients. Patients deemed high medical risks obviously cost considerably more than patients with fewer maladies. Within this context, it has become clear that as health insurers grow ever less willing to cross-subsidize hospital expenditures that are not otherwise covered—that is, indigent care and graduate medical education expenses—patient selection becomes a paramount concern of provider and payer alike. In this article, Harold Luft and Robert Miller examine the multitude of issues that arise around the subject of patient selection. Luft holds a doctorate in economics from Harvard University and also took a postdoc...

Clinical teaching associate model: implementation in a community hospital setting.

Collaboration between nursing education and practice has increased in importance as nursing must consolidate its efforts in a more competitive health care system. The demands of maintaining creative academic productivity among nursing faculty coupled with the need of nursing service departments to receive remuneration for providing clinical experiences for baccalaureate nursing students requires a reevaluation of the traditional relationship between schools of nursing and institutional nursing settings. This paper describes an innovative approach to collaboration, the clinical teaching associate model for baccalaureate nursing education at the University of Colorado School of Nursing. Preliminary evaluation of this model provides evidence that mutual benefits accrue when nursing educators and clinicians collaborate in nursing endeavors.

The key role of health insurance in a cost-effective health care system Towards regulated competition in the Dutch medical market

The previous two sessions of this Symposium have dealt with incentives for cost-effective provider behaviour. Although incentive-reimbursement, which rewards the providers for delivering medical care in a cost-effective way, can be an important step towards a cost-effective health care system, it is not sufficient. As long as the insured consumers have both comprehensive health insurance coverage and freedom of choice of provider, providers will have great difficulty in resisting consumers' demand for ever more costly medical care, and politicians or other decision-makers will have great difficulty in restricting capacity and in preventing overcapacity. Fear of losing patients or voters might dominate. Therefore, in this session we shall focus on the key role of health insurance in a cost-effective health care system and on consumer incentives and insurer behaviour. If the consumers have a choice between several health plans such that the premiums or the out-of-pocket payments reflect the cost-effectiveness of the provider chosen, this will give the provider incentives for cost-effective behaviour. As a result, competition may arise between different providers, between provider-groups, and between provider-insurer organizations. Although market forces do play an important role in a competitive health-care system, competition should not be confused with a “free market”. Besides financial arrangements to protect the poor, procompetitive regulation is needed to guarantee a “fair competition”.

Paying the Price: Medical Care, Minorities, and the Newly Competitive Health Care System

The newly competitive health care system reflects both an excess supply of health care providers and a greater sensitivity to price among those purchasing health services. These dual pressures are felt in public programs as well as in private markets. A competitive ethos is also changing popular expectations of the appropriate relation between health care institutions and their communities. These changes offer opportunities for enhanced access to health care for some black Americans, but portend dire restrictions on access for the least-advantaged blacks. They also threaten to reduce significantly the influence exerted by black communities over their local health care providers.

Politics and Health Care Organization: HMOs as Federal Policy.

Among various health cost containment strategies proposed during the 1970s, none has held more sustained fascination than the health maintenance organization (HMO). For many years, policy analysts in search of market- and incentive-based alternatives to command and control regulation have argued that medical groups combining prepayment and group practice, and offering comprehensive medical services within a fixed budget, would hold down costs both by their own efficient operations and by the competitive pressures they would apply to the conventional systems. During the 1970s, three presidents and five Congresses worked to formulate and implement legislation to increase the HMO presence nationwide, with very modest results. Some observers concluded that but for the well-intended but counterproductive efforts of the federal government, HMOs might thrive. Indeed, the Reagan administration has called for an end to direct federal financial involvement in building HMOsthough it has also promised legislation to promote HMOs and a newly competitive health care system based on revamped financial incentives and reinvigorated markets. In this book, Lawrence D. Brown, a senior fellow in the Brookings Governmental Studies program, examines the interplay between politics and policy in the federal HMO development effort between 1970 and 1980. He argues that the basic explanation for the disappointments of the policy analysts and federal supporters of HMOs lies not in a political miscarriage but in the overambitious promises of the policy strategy itself. Tracing the poor fit between policy and politics revealed by federal efforts to translate the attractive HMO idea into a workable strategy, Brown concludes that the episode augurs poorly for the competitive reforms frequently offered as a nonregulatory solution to rising health care costs in the 1980s.

The Potential for a Competitive Health Care System in Boston, Massachusetts

The Potential for a Competitive Health Care System in Boston, Massachusetts

The Potential for a Competitive Health Care System in Boston, Massachusetts

The Potential for a Competitive Health Care System in Boston, Massachusetts

The Potential for a Competitive Health Care System in Boston, Massachusetts

The Potential for a Competitive Health Care System in Boston, Massachusetts

On broadening the definition of and removing regulatory barriers to a competitive health care system.

On broadening the definition of and removing regulatory barriers to a competitive health care system.