bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetric care in the Netherlands: Manpower substitution and differential costs
Authors: Butter Irene , Lapre Ruud 
Published: May 2007

AbstractTrends in the Netherlands show an expanded role for obstetricians in hospital‐based prenatal and natal care, as well as a shift in postnatal care away from hospitals to domiciliary care. While general practitioners attend a steadily declining share of total births, midwives continue to play a central role in supporting over 40 per cent of all births and in attending nearly two thirds of all home births, which, in the Netherlands, is the preferred option for more than a third of childbearing women. As shown in the figures, shifts of births into hospitals and of postnatal care out of hospitals produce opposite effects on obstetric expenditures. Cost differences are primarily associated with variation in location of care, and only secondarily with variation in provider of care, underscoring the importance of contrasting styles of obstetric management and their influence on costs. In the context of these observed transitions, the increasing popularity of policlinical deliveries constitutes a pivotal force whose impact to date appears to have been neglected by planners and health care decision makers.
Financing health care in the Sudan: Some recent experiments in the central region
Authors: Bekele Abraham , Lewis Maureen A. 
Published: May 2007

AbstractThe macroeconomic difficulties facing the developing countries are having a direct impact on these countries' public health programs. Reduced budgets and rising demands for health care are forcing health ministries to either cut back on already inadequate health care services or identify alternative sources of revenue. This article describes and analyzes a set of experiments designed and implemented by the Sudan's Central Province that have effectively raised the operating budget of the regional health ministry. The seven experiments encompass imposition of fees, cost containment efforts, and local taxes earmarked for health. Together, the revenue generating efforts have improved the efficiency of service delivery, ensured more efficient resource allocation, raised much needed revenue for the health system, and honored the government's commitment to make free health care available to the Sudanese population.
Reimbursement policy of hospitals in the Federal Republic of Germany
Authors: Altenstetter Christa 
Published: May 2007

AbstractThe factors that have contributed to an overhaul of German hospital policy in the last 12 months are both numerous and highly interrelated. Rising health expenditures and inflexible mechanisms for implementing hospital policy are major culprits, as are the considerably changed political and economic circumstances over the last 15 years.Although this overhaul does embody some changes in the direction of German health care policy, they can best be understood as a further manifestation of the continuity that has characterized policy in this area for the past 100 years; a continuity rooted in the widely shared belief that disease, whatever its nature, is beyond the control of individuals.The key to cost containment is considered to lie in the reduction of the average length of stay and in the better utilization of hospital facilities. Payment remains directly related neither to specific diagnoses of individual patients nor to occupancy rates in individual departments, which vary greatly across disciplines and specialities.In the era that is unfolding, one political phenomenon requires close watching in the future: policy coalitions at the Land‐level will become even more important as prime movers than they have been in the past.Demands for Strukturreform are a regular feature of many governmental systems. Yet the capacity of political bodies—whether ministries or parliaments—is severely limited by the distribution of power and control over resources and by the political dynamics which they generate. In the FRG, major reforms will not take place until after the 1987 federal elections, and it is essential to remember that the realms of campaign rhetoric and of policy choice and implementation are governed by entirely different sets of rules and constraints.
Same‐day surgery: Management issues and future growth
Authors: Westman John 
Published: May 2007

AbstractPolicy makers in all countries are searching for cost‐effective, quality health care. In the realm of surgical care, one response to modern cost and quality pressures is same‐day surgery. This article discusses three aspects of same‐day surgery programs: key management issues; analysis of competitiveness; and, the growth potential of same‐day surgery.Today's managers of same‐day surgery programs are most concerned with issues related to their customers, be they physicians, insurers, or patients. Indeed, program managers identify market research, program development, and patient, physician, and facility management as areas critical to success.An exploratory survey carried out of ten same‐day centers indicates that programs must excel in two areas to succeed. First, they must develop efficient and appropriate operations. Second, they must communicate aspects of these operations to different customers, realizing that each customer type is interested in different aspects of the program. This article provides a framework for the analysis of customer interests. It also suggests that surgery centers satisfy customer preferences rather better than do hospital outpatient programs.Same‐day surgery will increase. Uncertainty lies in how quickly and in what form such activities in hospitals and centers will develop. Countries will likely experience different growth patterns, according to the relative power of factors affecting both the supply and demand of same‐day surgery.
Medical technology and health expenditure: An economic review and a proposal
Authors: Doessel Darrel 
Published: May 2007

AbstractThis paper is an evaluative survey of the economic literature on the relationship between technology and/or innovation and health expenditures. Various types of analysis viz. econometric modelling; three residual approaches; the cost‐of‐illness approach; and the literature on supplier interests are contrasted, and the results presented. The paper concludes with a discussion of the policy and planning implications, and a simple, and conventional, proposal is made that could unambiguously determine this relationship in the case of process innovations.
Physician autonomy in the Federal Republic of Germany, Great Britain and The United States
Authors: Schulz Rockwell , Harrison Stephen 
Published: May 2007

AbstractThe concepts of ‘professionalism’ (including autonomy) and ‘management’ (involving the control of others) are logically opposed; but, in the field of health care, physicians and managers have largely co‐existed without such opposition. International pressures for cost containment, however, now raise questions about the future nature of physician autonomy. This paper attempts, firstly, to conceptualize the nature of clinical autonomy as a number of independent components; secondly, to describe the nature of such autonomy in three countries in terms of these components; and, thirdly, to identify related questions for future research.
Information systems and physician practice patterns: England and America compared
Authors: Martin Anne L. 
Published: May 2007

AbstractThis paper discusses the opportunity for hospital management to make greater use of comparative data on physician productivity. We report findings from a study on utilization information provided to physicians in 19 US and British hospitals. Most doctors reported that they did not receive information comparing their own use of resources with that of their peers. However, our survey found that a significant majority of doctors want more information and find it useful; but, that hospital managers perceive doctors as being uninterested in such information. While there are wide variations between the two countries and between their hospitals in data collection and information systems, most hospitals surveyed could make better use of utilization information to influence physician practice patterns.
Community financing of drugs in sub‐Saharan Africa
Authors: Carrin Guy 
Published: May 2007

Abstract‘Health for all by the year 2000’ is unlikely to be achieved in a number of Third World countries, including those in Sub‐Saharan Africa, if reliance is placed solely on the public health budget. This article looks at a range of alternative and additional sources of revenue and, in particular, at the scope for community financing of drugs. Developments in the region are reviewed for their insights into the strengths and weaknesses of each financing scheme; and, as a guide to shaping policies that make an appropriate choice of method of health care financing.
Health service financing in Poland
Authors: Tymowska Katarzyna 
Published: May 2007

AbstractThe right to a free health service is identified as one of the founding rules of socialism; yet other sources of funding, both public and private, should not be neglected. This article reviews the major sources of financing health services in Poland. In particular, a description is made of the size and composition of funding from non‐governmental sources including: quasi‐budget funds, other funds, and out‐of‐pocket payments; and some proposals are made for change. Further work is needed in developing the criteria by which policy choices can be made, and in developing the information base; at the same time, political and social criteria will still be very important, not least on the issue of user charges.
Mortality and morbidity transition in Kuwait: The role of health and development policies
Authors: Shah Makhdoom Ali , Shah Nasra M 
Published: May 2007

AbstractKuwait has, in recent years, achieved a marked improvement in the health status of its population, as measured by a variety of mortality and morbidity indicators. This can be attributed to the implementation of two sets of policies that impact upon health, namely the health and socio‐economic development plans of the Kuwaiti government. This article seeks to outline these recent changes in mortality and morbidity levels, and traces out the key policies considered to be the major determinants for these changes. Data is presented on health status, and on patterns and trends of health services' utilization. These trends suggest strongly that, for Kuwait, the health goals set for the year 2000 are achievable.
Reviewing the process and outcome of hospital care in Europe: The tracer method
Authors: Sanderson Colin , Bosch Theo , Goosen Jens , Hartwig Rudolph , Schelp Lothar 
Published: May 2007

AbstractA method is described for reviewing and comparing the process and outcome of hospital care, which involves collecting data on a consecutive series of patients with the same medical condition. Criteria for choice of tracer condition are given, and illuminated with reference to fractured neck of femur. The method has been developed in the context of the European Collaborative Health Services Studies, and participants from five countries have been involved. It is concluded that the method is practicable and succeeds in its objectives. The role of health care managers is one of stimulus and support to doctors and nurses who might be interested in carrying out such studies, and a set of stages from the initial idea for a study, through study design and data collection to conclusions for practical change, is described.
Nurse managers and budgeting: Professional/bureaucratic conflict?
Authors: Abernethy Margaret A. , Stoelwinder Johannes U. 
Published: May 2007

AbstractProfessional/bureaucratic conflict theory suggests that the extent to which nurse managers use management control systems will depend on whether their goal orientation is to system rather than output or derived goals. This article examines the use of budgeting as a management control strategy, in relation to the goal orientation of nurse managers, in four large teaching hospitals. The goal orientations and use of budgeting by nurse managers is also compared with those of physician managers and other sub‐unit managers. The results indicate that nurse managers appear to be developing their goals of professionalization without a diminution of their organizational focus or their orientation towards providing a high standard of patient care.
Managing retrenchment in french public hospitals: Philosophical and regulatory constraints
Authors: Sobczak Patrick M. , Fottler Myron D. , Chastagner Daniel 
Published: May 2007

AbstractThe French hospital system is experiencing economic stresses similar to those experienced by US hospitals. Pressures for cost containment have occurred due to changes in health care funding. The public hospital system is facing unprecedented severe retrenchment. Innovative strategies for managing retrenchment have been restricted by regulatory and philosophical constraints. What is needed is to provide moreautonomyfor individual hospital managers together with greateraccountabilityfor achievement of results.
Recurrent costs in the health sector of developing countries
Authors: Waddington Catriona , Thomas Margaret 
Published: May 2007

AbstractWidespread concern exists about the recurrent cost problems faced in the health sector of developing countries, and about the difficulties likely to be faced in the 1990s and beyond in seeking to expand further the movement to primary health care. The article accepts that the problem is a real one, and seeks first to define and measure it, and to put together some of the evidence on the scale of the problem. Next, the analysis involves an examination of its causes, and hence its solutions, exploring in some detail issues of budgetary control, management decision making, project selection, and the prospects for mobilizing additional recurrent funds to, and within, the health sector. The article concludes by drawing attention to the complex aetiology of the recurrent cost problem, and offers a five‐point plan of action if the problem is to be tackled seriously.
The equity principle in the allocation of health care expenditure on primary health care services in Portugal: The human capital approach
Authors: do Rosario Giraldes Mario 
Published: May 2007

AbstractThis article examines the equity principle as it could be applied to the financing of primary health care resources in Portugal. Three resource allocation criteria are considered: namely, the demand/utilization criterion; the health situation criterion; and, the coverage by health services criterion. With data based on health service expenditure, district by district, for 1983, the article shows that quite different results would emerge from the selection of one criterion rather than another. In particular, a policy of positive discrimination would reallocate resources towards the north rather than the south of Portugal, though differences would emerge between districts and between specific activities provided within the framework of primary health care. The results are presented and conclusions drawn.
A price to pay: The impact of user charges in ashanti‐akim district, Ghana
Authors: Waddington C. J. , Enyimayew K. A. 
Published: May 2007

AbstractIn present constrained economic circumstances, many governments have introduced or increased user charges for health services. This has been advocated by the World Bank, justified by reference to the raising of revenue, efficiency and, controversially, even the promotion of equity. This paper examines the impact of user charges on utilisation in the Ashanti‐Akim district of Ghana since the introduction of charges in 1985. In many ways, user charges have been a success: in recovering fees and maintaining urban utilisation. However some advantages have not materialised because the health infrastructure has not changed adequately. More importantly, equity and affordability have been problematical. For some of the population, services are no longer affordable.
Canada's provinces review their health services
Authors: Crichton Anne 
Published: May 2007

AbstractCanada's health system is undergoing stocktaking and adjustment. Ontario and Quebec have recently reviewed their goals and strategies; other provinces have been seeking to control established programs. This article considers the political and social reasons for those reviews. Its themes ultimately concern whether equity is compatible with innovation and choice; whether downplaying technology is harmful; and whether restrictions (e.g. on medical manpower supply) can be achieved relatively painlessly. Changing political traditions in the different provinces have an effect upon their health systems, it is concluded.
From good medical practice to best medical practice
Authors: Jensen Uffe Juul 
Published: May 2007

AbstractMedical and other professionals know what good practice is. It is in accordance with ideal procedures and standards of one's own practice. As actors we assess our practices from inside. If questions of quality assessment or quality assurance are raised at all, they are to be raised and answered by the professionals themselves. From that internal perspective, the idea of better or best medical practice is rejected as superfluous; or, perhaps, even nonsensical.This article suggests that concepts of best medical practice, as expressed from outside the profession e.g. economic efficiency, are not adequate in themselves if our interest lies in changing existing practice. Defined from outside, such concepts would be alien to the medical profession.Going from good practice to best practice, the article proposes, can be done on the basis of expanding the metaphor of self‐transcendence. In self‐transcendence the individual or profession changes or develops strategies and activities by adopting the standpoint of some perspective outside its own practice, and then integrating this perspective into practice.Self‐transcendence by the medical profession can be carried out by their integrating a moral ideal from normal life into professional practice—essentially the notion of prescribing support of the weak. Such integration implies, inter alia, that the profession must take account of the scarcity of resources when assessing their practice.
Best medical practice: The case of Japan
Authors: Ikegami Naoki 
Published: May 2007

Abstract‘Best medical practice’ can be given three different definitions. Definition A, by the medical profession, emphasizes the maintenance of technical standards in diagnosis and treatment. Definition B, by the essentially healthy general population, emphasizes preventive measures and the reassurance of the healthy status. Definition C, by the chronically sick and disabled, emphasizes rehabilitation and nursing care. Although each has its inherent weakness, each could be said to be describing an essential but distinct aspect of comprehensive health care which can be utilized to legitimize each party's claim for priority in the allocation of resources. Thus, the relative weight that is given to the three definitions of ‘best medical practice’ in society as a whole appears to be ultimately dependent on the social and cultural conditions unique to each country. In the case of Japan, Definition B has become the most dominant: it has resulted in the health care demands of the essentially healthy general population being well taken care of without excessive allocation to high technology medicine. However, a combination of demographic, technological and social changes will necessitate a different emphasis in the future.
Best medical practice in the Netherlands: A decision analyst's view
Authors: Kievit J. , Vissers T. , Casparie A. F. 
Published: May 2007

AbstractOpinions over what is bad, good and best medical practice have varied through time. In older days, medicine aimed exclusively at maximum effectiveness through an aggressive diagnostic and therapeutic approach, irrespective of cost considerations. Budget constraints in health care have put limits on this exhaustive form of medicine. Consequently, considerations regarding the ratio between the quality and the cost of medical care are becoming more and more important in the definition of ‘best medical practice’. Quality standards in medicine thus should not be based exclusively on medical considerations, but should also take cost considerations into account. This balanced integration of quality and cost represents a new challenge in medicine. It demands an active interest and participation of the medical profession in budget affairs, and close cooperation between health care professionals, health economists, and health care administrators. If this integration is done explicitly and quantitatively, it requires the use of decision analysis and cost‐effectiveness analysis techniques.Recent experiments at the department of Surgery at the Leiden University Hospital have demonstrated the feasibility of this approach. Quality standards were set by means of explicit outcome criteria, and policy changes were executed on the basis of cost‐effectiveness analysis. Quality of care could be maintained at the same or higher levels while cost savings of up to 60% were realized.The advance of ‘best medical practice’ in the present and future requires a multidisciplinary approach to medicine, that is best realized by the use of explicit and quantitative quality standards. This approach can only be successful if close cooperation between professionals, administrators, economists and politicians in health care can be realized.
Best medical practice in practice: Measuring efficiency in mammography screening
Authors: Hall Jane 
Published: May 2007

AbstractBreast cancer, screening and mammography have caused considerable debate in several countries. This article explores the concept of best medical practice in the context of mammographic screening for breast cancer. Maximizing the use of technology, ignores the risks intrinsic to technological intervention. To do no harm in modern medical practice means largely doing nothing. Best medical practice, therefore, requires a balancing of benefits and risks so that best practice is that which does more good than harm. At the same time, not all interventions that do more good than harm can be funded out of the current health care budget. Thus, best medical practice is economically efficient practice.From the conceptual notion of what is best medical practice, this article turns to the problem of what that means in practical terms. Can we recognize best medical practice when it occurs? The identification, measurement and valuation of costs and benefits are discussed as a specific case study, in the context of breast cancer screening. Many of the difficulties involved here, particularly on the benefit side, are highlighted, especially in the context of QALYs. Yet, whatever the difficulties involved they have to be seen in the context of otherwise settling for something less i.e. inefficient medical practice.
Using drgs in developing referral policies for coronary care within a local health district
Authors: Bailey T. C. , Glaskin A. , Knowles D. , Kirby B. 
Published: May 2007

AbstractThis paper presents the results of a study into some specific aspects of the management of coronary heart disease within one district health authority. In particular, it is concerned with the appropriate balance of inpatient coronary care between the district general hospital and community hospitals in the light of current and potential changes in the clinical management of coronary cases.The study is an example of a multidisciplinary approach to local health planning which is beginning to emerge within the Exeter Health District, the methodology of which may be applicable to client groups within the medical specialties other than coronary cases, such as strokes or respiratory disorders. It also illustrates the use of spatial analysis and diagnosis‐related groups in local planning.