Health Care Debate Research Articles

Measuring the effect of pay-for-performance financial incentives on hospital efficiency in the military health system

ABSTRACTThe U.S. military health system implemented a pay-for-performance financial incentive program in 2007 in an effort to stimulate patient quality, access, and satisfaction improvements. This study measures the effect of the monetary incentive model on hospital efficiency and outcomes. Using a retrospective, quasi-experimental design, the empirical analysis incorporates data envelopment analysis with time windows and difference-in-differences estimation. Hospitals are evaluated in the U.S. Army, Air Force, and Navy during the period of 2001–2012. The results indicate a statistically significant reduction in technical efficiency for the hospitals that received pay-for-performance financial incentives. The healthcare policy implications of this study are applicable in light of the national healthcare debate and may assist healthcare policy makers in determining the efficacy and associated trade-offs of pay-for-performance financing models.

Pharmacist Opportunities to Improve Public Self-Medicating Practices in the UAE

Objective: Self-treatment is an important aspect of self-care and one of the vital issues under debate in health care. Self-medication patterns vary among different populations and are influenced by many factors. The objective was to investigate the nature of self-medication behavior among the general public in the UAE and to explore public attitudes, beliefs, and level of knowledge concerning self-medication. Methods: A purposive sample of individuals involved in self-medication who belong to different age, gender, income, education level and health-seeking behaviors. A qualitative approach through individual face-to-face interviews was utilized to investigate participants’ behaviors and attitudes towards self-medication; factors influencing decision to self medicate, sources of information on medications, types of conditions for which self-medication is sought and types of medications used. Participant recruitment continued until theme saturation using content analysis. Findings: Three themes emerged from the data: Reasons for self-medication such as costs associated with visiting a doctor, convenience in visiting a pharmacy and perception of simplicity of the condition; Sources of information: pharmacists as a main source in addition to medication leaflets, family role and previous use, and medicines and medicines’ use: medicines’ use in chronic disease, use of antibiotics, use of herbals and supplements and medicines’ use in children. Conclusion: Findings from this study indicate that self-medication behaviors are common among the population due to several reasons. Inappropriate self-medication practices are evident and may compromise patient care outcomes. Pharmacists play a vital role in intervening to optimize the use of medications and patient education regarding self-care.

의료민영화에 관한 어린이집 부모의 인식 연구

Abstract Health care privatization will have a very significant impact on the quality of medical service and income redistribution and risk diversification. This study was conducted to improve the situation without too much insistence that one did not understand the essence rife about the privatization of health care. In this study, grasp the implications of the current health care debate to be privatized, and dealing with the claims accordingly. Seeks to help establish an objective perspective, looking at the pros and cons at the same time claims for medical privatization policy. The Health and diversification through the capitalist market access as part of the transition process is being overlooked as a new growth engine industries. But health care is constrained to follow the growth of universal access and how to deal with life because it is practical conduct of the person. In addition to services that are not only for the benefit of the profit or government institutions. Keyword : Health Care Privatization, New Growth Engine, Health Care Service, National Medical Expenses

Cries of Crisis: Rethinking the Healthcare Debate

Cries of Crisis: Rethinking the Healthcare Debate

Care transitions in a changing healthcare environment.

Readmissions are a significant element in the ongoing healthcare debate, and new evidence suggests that high readmissions can be a surrogate marker for poor quality healthcare. Additionally, although readmissions can offer a financial incentive for some hospitals, that model is being phased out; readmissions in a pay-for-performance or bundled payment model represent significant financial risk for providers and hospitals. Although no specific strategy at discharge has proven to be effective in reducing readmissions, practices that include good posthospital communication to the patient and care team, access to follow-up, and attention to mobility and self-care deficits are important factors in limiting readmissions. PAs play a key role in assessing for high readmission risk and implementing prevention strategies in real time.

Framing choice: The origins and impact of consumer rhetoric in US health care debates

This paper examines the origins of consumerist discourse in health care from a communication perspective via a historical textual analysis of health writing in popular magazines from 1930 to 1949. The focus is on Consumers Union's Consumer Reports and the American Medical Association's lay health magazine, Hygeia. Findings from Consumer Reports show that the consumer movement of the 1930s–40s staunchly advocated for universal health insurance. Whereas consumer rights language nowadays tends towards individual choice and personal responsibility, consumerism in health care during that era articulated ideas about consumer citizenship, framing choice and responsibility in collectivist terms and health care as a social good. This paper also illuminates the limits and weaknesses of a central tenet in consumerism—freedom of choice—by analyzing stories in Hygeia about the doctor–patient relationship. A textual analysis finds that the AMA's justification in the 1930s–40s against socialized medicine, i.e., the freedom to choose a doctor, was in practice highly controlled by the medical profession. Findings show that long before the rhetoric of the “empowered consumer” became popular, some patients exercised some choice even in an era when physicians achieved total professional dominance. But these patients were few and tend to occupy the upper socioeconomic strata of US society. In reality choice was an illusion in a fee-for-service era when most American families could not afford the costs of medical care.

Health Care Reform as “Socialized Medicine”: The Formative Years of a Political Myth

This essay traces the rhetorical history of “socialized medicine,” offering an explanation for, and critique of, its pervasiveness in contemporary health care debates. My analysis focuses on the well-organized and well-financed lobbying effort by the American Medical Association aimed at defeating reforms during the New Deal era. I focus on how the persistence of “socialized medicine” as a naturalized term in contemporary discourse functions to reinforce a mythic perspective of U.S. democracy as primarily individualistic and resistant to programs aimed at benefiting the larger community. Ultimately, the essay seeks to facilitate critical reflection on this problematic term for the sake of enriching democratic practice in the present.

Cost Comparison of Open and Robotic Partial Nephrectomy Using a Short Postoperative Pathway

To compare immediate perioperative direct costs of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), managed under a common care pathway. Retrospective review of detailed institutional cost data for patients treated with OPN and RPN during 2011 was conducted. Cost and clinical data of OPN and RPN were compared for all patients and for patients stratified by length of stay (LOS), American Society of Anesthesiologists (ASA), and RENAL nephrometry scores. The study cohort included 190 OPN and 63 RPN cases. OPN was associated with higher ASA scores (P <.001), shorter operative times (P = .014), and higher estimated blood loss (P <.001). Median (interquartile range) LOS was 2 days (2-3 days) for OPN compared with 1 day (1-2 days) for RPN (P <.001). Median perioperative cost of OPN was lower than that of RPN with a difference of $3091 (P <.001). Although hospitalization costs were higher in OPN, surgical costs were higher in RPN ($854 and $3695 difference in median costs, respectively; P <.001 for both). The total cost of OPN for patients with an above-average LOS remained lower than that of RPN ($2680 difference in median costs; P = .001). RPN costs remained significantly higher when stratifying patients by their ASA and RENAL nephrometry scores. Despite the shorter hospital LOS associated with RPN, the immediate perioperative cost of OPN was lower than that of RPN for patients managed under a common care pathway, mainly due to high robotic purchase and maintenance costs. In light of the current health care debate, such financial disincentives may compromise the sustainability of advances in medical technology.

Access to Innovation

Healthcare innovation saves lives, saves money, promotes economic growth, and provides hope for hundreds of millions of people (both patients and care-givers) in the United States and around the world. But innovation isn’t easy.There are many roadblocks beyond those of discovery and development. The complicated and conflicting dynamics of politics, perspectives on healthcare economics, of friction between payers, providers, manufacturers, and regulators, the battle for better patient education, and the need for a more forceful and factual debate over the value of innovation all create the need for a more balanced and robust debate.Should we blame our skewed priorities? American healthcare often works miracles when people become very ill, but it needs to do a better job with preventive care. Equally to blame is the fact that we spend a disproportionate amount of our healthcare budget for end-of-life care.Rather than tangle up the already volatile healthcare debate in ethical arguments over whose life is worth more, it would be smarter to shift the focus to keeping people healthier longer. Earlier diagnosis and care are crucial to the future health of both Americans and American healthcare—and pharma has a starring role here.We cannot afford, in terms of dollars or lives, to continue the blame game. In order to deliver on the promise of affordable and quality healthcare for all citizens, all the players in the healthcare debate must work together. At the end of the day, we should unite against our common enemy—disease.And our most potent weapon in innovation.

What Are We Afraid Of?

What Are We Afraid Of?

Dilemmas and Delusions Bernard Shaw and Health

Beguiling a Victorian public obsessed with the pursuit of fitness, the International Health Exhibition opened in South Kensington in May 1884. Its expressed intent, to educate the public on a broad range of wellness topics, was greatly overshadowed by its dazzling display of proprietary medical commodities, salutary appliances, and faddish cures. While there were legitimate exhibits that dealt sincerely with issues of sanitation, hygiene, food, drink, and even child care, the event illuminated the extent to which personal and systemic therapeutic remedy and indeed health itself had become a lucrative industry. Less than three weeks before he joined the Fabian Society, the fledgling novelist Bernard Shaw visited one of the exhibition’s prominent attractions, Francis Galton’s Anthropometric Laboratory, to be quantified and measured. Chart 3655, created on 16 August 1884, contains the following collected data:

The social media president: Barack Obama and the politics of digital engagement

PART I: THE HOPE FOR SOCIAL MEDIA IN GOVERNMENT 1. A Wonderful Illusion: Citizen Participation in the Obama Era 2. Scholarship of the New Media Landscape 3. New Media and Electoral Politics: An Abbreviated History 4. The Social Media President PART II: BABY STEPS, DISSAPOINTMENTS, AND POLITICAL GAMES 5. The Citizen's Briefing Book 6. White House Online Town Hall 7. Expert Labs 8. The Supreme Court Vacancies and the Health Care Debate 9. President OBama and the Government 10. Social Media, Policy, and Transparency PART III: ASSESSING PRESIDENT OBAMA'S SOCIAL-MEDIA INITIATIVES 11. A Changes Focus 12. Analytical Perspective 13. Conclusion and Implications

Beyond the Service Process

Understanding patient perceptions of hospital encounters is crucial for the continuous efforts to improve quality of care in the United States. Abundant research has examined the influence of different service process dimensions on customer satisfaction, but scant research has explored how the organizational context affects customer perceptions of service providers. The authors propose a more comprehensive model of customer satisfaction that moves beyond the service process to incorporate organizational and market factors that affect customer experiences directly and indirectly through their influence on the service process. Three organizational and market factors lie at the center of the health care debate: physician ownership, hospital specialization, and market competition. The authors employ the Hospital Consumer Assessment of Healthcare Providers and Systems to determine patient ratings and the American Hospital Association Annual Survey to determine organizational and market factors. The results show that physician ownership, specialization, and market competition positively affect patient ratings. Dimensions of the service process act as a mediator between organizational and market factors and patient ratings. This study provides new insights into the importance of including both organizational and market factors and service process dimensions when examining customer ratings and offers implications for governance and strategy in service organizations.

Management accounting versus medical profession discourse: Hegemony in a public health care debate – A case from Denmark

This study uses discourse, ideology and hegemony as a theoretical foundation to investigate the development of the polarised discourses of management accounting and the medical profession during the introduction of a NPM reform in the public health care debate, using Denmark as a case study. 194 newspaper articles and 73 medical profession articles from 2002 to 2008 are analysed, using critical discourse analysis. The analysis shows that the management accounting discourse becomes the dominating ideology which is embedded in the public rhetorical debate. There are three peculiar outcomes of this domination; the absence of physicians in the general public debate, the creation of a phantom phenomenon meaning that the negative consequences of the reform are blamed on a third person, typically the system, and finally a changing meaning of the health care service quality provided from a medical perspective of a patient oriented focus to a quantitative focus through strong rationalised arguments. This puts the medical profession in a dilemma concerning their ideological Hippocratic Oath versus the NPM efficiency focus. However, they choose to gradually adopt management accounting terms in their own medical professional debate.

Integration of health information technology to improve patient safety

Background: Medical errors and unsafe care continue to harm and kill thousands of patients every year, exceeding deaths attributed to motor vehicle accidents, heart failure and breast cancer. It has been more than ten years since the Institute of Medicine (IOM) released two landmark reports that galvanized attention on the scope and severity of the problem and started a national movement to improve patient safety in healthcare. Both of these reports emphasized the role that health information technology (HIT) can play in improving the quality and safety of patient care. This has lead federal and state legislators to prominently feature HIT, patient safety, and quality outcomes in the current health care debate, laws, and payment schemes. The objective of this systematic literature review is to assess current and proposed use of technology to prevent adverse events and the regulatory drivers that are promoting the use of technology for patient safety. Methods: A systematic literature search from 2010-2013 using CINAHL, Cochrane Library, Medline and Ovid (via EBSCO),Google Scholar and government web sites, was conducted to identify technology drivers, advancements and effects in the patient safety areas of electronic health records, patient identification, patient falls, pressure ulcers, and medication errors. Results: Forty four articles were selected for inclusion in this review addressing legal and regulatory drivers for use of technology to support patient safety, and specific technologies to prevent adverse events related to patient identification, patient falls, pressure ulcers, and medication errors. Search criteria included technology to prevent each of these event types, and the Affordable Care Act (ACA), American Reinvestment and Recovery Act (ARRA), and the Health Information Technology for Economic and Clinical Health (HITECH) provisions related to patient safety. Conclusion: Healthcare reform initiatives are promoting an expanded role for HIT in improving the safety and quality of patient care in the U.S. healthcare system. Findings suggest that there are several technologies currently in development and use to prevent adverse events in patients. While patient safety technology shows great promise in preventing error and injury, it also presents potential to harm if not effectively developed, implemented and used. It is an adjunct to, not a replacement of, a skilled and attentive care giver. Normal 0 7.8 磅 0 2 false false false EN-US ZH-CN X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:普通表格; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";}

Joining the Party for a More Powerful Left

Joining the Party for a More Powerful Left

Intensive care performance: How should we monitor performance in the future?

Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit (ICU) performance are discussed: (1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations; (2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and (3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.

Why common carrier and network neutrality principles apply to the Nationwide Health Information Network (NWHIN)

The Office of the National Coordinator will be defining the architecture of the Nationwide Health Information Network (NWHIN) together with the proposed HealtheWay public/private partnership as a development and funding strategy. There are a number of open questions—for example, what is the best way to realize the benefits of health information exchange? How valuable are regional health information organizations in comparison with a more direct approach? What is the role of the carriers in delivering this service? The NWHIN is to exist for the public good, and thus shares many traits of the common law notion of ‘common carriage’ or ‘public calling,’ the modern term for which is network neutrality. Recent policy debates in Congress and resulting potential regulation have implications for key stakeholders within healthcare that use or provide services, and for those who exchange information. To date, there has been little policy debate or discussion about the implications of a neutral NWHIN. This paper frames the discussion for future policy debate in healthcare by providing a brief education and summary of the modern version of common carriage, of the key stakeholder positions in healthcare, and of the potential implications of the network neutrality debate within healthcare.

NRJ Book Review: Informing the News: The Need for Knowledge-Based Journalism

Thomas Patterson, Informing News: The Need for Knowledge-Based Journalism (New York: Vintage Books, 2013). Paperback, 233 pages, $15.More than a year after World War I ended, Walter Lippmann and a friend conducted a study of The New York Times to see how most celebrated newspaper in America covered an international event, Russian Revolution. Looking at three years' worth of articles, they discovered a shabby record. Instead of factual reportage, articles appeared to be little more than a collection of rumors, speculation and ideologically tinged observation. For instance, Times told readers no fewer than ninety-one times that Bolshevik regime was on verge of collapse.1 By then, Lippmann was already keenly vexed by paradoxical limitations of press in a democracy, and tried to exorcise demon in works like Liberty and News (1920) and, more famously, Public Opinion (1922). In former, argued for a better, smarter journalism. In latter, seems to have abandoned idea as naive.Harvard professor Thomas Patterson heeds reformer's cry from Lippmann's earlier work and uses quotes from it as epigraphs in half chapters of Informing News, his own foray into tackling puzzle that is American journalism in 21st century. What kind of communication must free people have in order to remain free? What ails American media and how can we address those challenges?The first few essays contain a painfully familiar catalogue of many instances of misinformation, even wholesale deception, plaguing U.S. news outlets today. It's not a pretty picture. From buildup to war in Iraq to furor over death panels in healthcare debate, book whisks you on a tour of American idiocy. Information has been corrupted, Patterson argues, by partisanship, negativity, sensationalism, superficiality and dependency. The negativity and dependency make for a curious and counter-intuitive combination: National correspondents are often too close to their sources, yet rather than provide revealing and intimate portraits of these individuals, journalists instead use them to voice critical comments of others in a vacuous game of political he said, she said.Most of chapters are titled and framed as problems-the information problem, the source problem, the audience problem, the education problem, the democracy problem-but these appear to be loose categories, as author occasionally flits back and forth from one to other. Sourcing is an all-too-frequent weakness in coverage, and journalists are easy prey. There are fewer of them and far more public relations practitioners (3-1, according to one study). …

Provider status effort engaged on Capitol Hill

Provider status effort engaged on Capitol Hill