FOCUS: Not-for-profit Health Services and the German Health Care System

Reforms in the German health care system in the attempt to bring more competition into health care have increased the sovereignty of the insured or patients, who have finally been allowed to make choices. "The start of a reorientation of the statutory health insurance system and hospital care are to be welcomed as first steps towards a supply of health services that reflects individual preferences." The authors can be contacted care of Prof. Dr. Oberender at Rechts- und Wirtschafswissenschaftliche Fakulät, Universität Bayreuth, 95440 Bayreuth, Germany, where Dr Oberender is Professor in the Faculty of Law and Economics, and Ansgar Hebborn is his Assistant. The authors wish to record their gratitude to Jan Hacker for translating this article.     

看病难，看病贵：不能解决，还是不想解决？——关于医改舍本求末、屡改屡败的沉重思考

看病难、看病贵的问题长期困扰着国民,政府主管部门采取的解决措施却是隔靴搔痒,投鼠忌器,职能部门归咎的原因讳莫如深,避实就虚。看病难、看病贵的真正原因是国家医疗卫生体制市场化改革滞后;国家医疗卫生行政部门因保护部门权益不想改革;公立医疗卫生服务行业人员因既得利益不热心改革。当前医患冲突不断升级,已经成为一个社会问题,影响社会的和谐和稳定。针对今后的医疗改革,推行医疗服务市场化是解决看病难、看病贵的根本;实施以技养医是解决看病难、看病贵的关键。     

Bedarfsgerechte Steuerung der Gesundheitsversorgung — Chancen und Hindernisse

On 2 July 2018, the German Council of Health Experts handed over its current report entitled, “Demand-oriented health care management” to the Federal Ministry of Health. The pronounced separation of outpatient and inpatient care, and distinction between private and public health insurance, is typical of the German system. Experts’ recommendations include improved coordination of outpatient and inpatient services, monistic hospital financing and family doctor-centred patient care. The main criticism of the report is that it lacks a regulatory concept with competitive management structures.     

American health politics, 1970 to the present: some comments

This article reviews the attempts of the 1970s and 1980s to rationalize health care provision in the United States. It critically discusses the contorted debate between competition and regulation as a means of controlling health care costs. The second part of the article takes up Eli Ginzberg's contentions about American health care. We agree that the United States has not been able to control medical inflation because it lacks the necessary condition of concentrated finance. But we present evidence from public opinion polls in the 1970s and the 1980s that challenges Professor Ginzberg's contention that "there is no evidence that the American people want to change [their] system" of medical care.     

An integrative model of customers' perceptions of health care services in Taiwan

As the health care service gets more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive the quality and value of their care before building up their satisfaction levels and generating behavioural intentions. Drawing some theories from marketing and health care service literature, this study tries to propose an integrative model of customers' perceptions of health care services based on the established relationship among four key constructs (service quality, perceived value, satisfaction, and behavioural intentions). Structural equation modelling is then used to validate the model. As Taiwan's universal health insurance offers every citizen equal financial access to all health care providers, Taiwan offers a good opportunity to study how the patients' perception model is structured. The findings reveal both perceived quality and value as antecedent variables in this model illustrating direct and indirect paths from perceived quality and value to patient satisfaction and behavioural intentions.     

基于J2ME和PHP技术的移动计算应用解决方案

对以蜂窝网作为承栽网络的移动计算应用平台进行了分析，针对现有J2ME开发平台的复杂性，提出了一种以PHP／PHP JSP作为中间件的完整、高效及便于开发的应用解决方案，同时对相关的技术难点尤其是缓存技术进行了探讨，给出了典型算法。最后给出了一个应用实例——个人健康顾问系统。     

The problem of attaining an efficient capital stock

Serious problems exist with the nature of health care financing in the United States. This article summarizes problems caused by the high cost of serving an aging population, the lack of incentives in insurance plans for preventive care, and the growing number of uninsured people in the population. The article then focuses on efforts to bring about greater efficiency by changing the contractual relations between the principal--either the payor or the patient--and the agent--the provider. These new contracts attempt to place a greater share of the financial burden on the provider. Evidence of the success of these new contracts is mixed. The major point of the article is that real efficiencies will not be reached unless these incentive mechanisms together with competitive market forces relieve the excess capacity in the health care industry.     

Health Systems and Health Reform in Europe

The organisation of health care differs widely across Europe. Access to services, financing schemes, incentives for better care, and administrative efficiency are challenges that are being dealt with in a variety of ways. Are insurance-based systems the best solution for balancing resources and services or are national health funds preferable? Does the introduction of competition fulfil high hopes for better service at lower costs? What are the relative advantages and drawbacks of central and local management of health care?     

Gesundheitsfonds — effizientere Steuerung des Gesundheitssystems?

In 2009 the German central health fund was implemented. It was the result of a political compromise. One political party intended to equalise the risk structure among 130 different health care funds, and the other wanted to intensify competition and to improve efficiency among the different health insurances. The fund is flanked by a health-based risk adjustment and is aimed at sustainably ensuring the funding of the statutory health insurance system. It also constitutes the basis for competition among statutory health care funds, securing quality and efficiency in health care provision. To cover additional expenditures, health insurers had to charge flatrate premiums. A new law, which will come into effect in January 2015, will oblige health insurers to charge income related contributions. It is not clear how this will change competition among insurers. The federal government will not need to finance subsidies to low income individuals anymore. Income redistribution will only take place within the public health insurance system, exempting the privately insured and public servants from supporting low income individuals. The authors claim that the health care fund will not succeed in its aim of securing a sustainable financial basis for the statutory health insurance system. Most of the authors argue that there is no evidence of greater efficiency thus far, and they offer proposals on how to achieve improved performance.     

Pick Any Preference Mapping

This article describes a new marketine research tech- nique for consumer mapping that is particularly useful in highly competitive professional servlces markets such as health care, finan- cial 'services; and legal services. The technique is introduced and compared with its predecessors, and a case study of the financial services market is described. Strategic marketing implications of the results are discussed.     

Exploring quality perceptions of health care operations: a study of public hospitals of Mauritius

Patient care has become increasingly important in the health care environment of Mauritius. Patients' satisfaction and their expectations of health care are valid indicators of quality health care. The present paper reports the results of a survey of patient satisfaction with heath care, administered by face-to-face interview to 300 in-patient adults discharged from five main regional hospitals based in Mauritius. It examines the predictors and level of patients' satisfaction across the five regional hospitals of Mauritius. In this study, a modified version of HEALTHQUAL scale was used for determining patient satisfaction with health care in the regional public hospitals. Multiple regression analysis was conducted to understand the relationships among patients' perceptions of in-patient services and their overall perceptions of health care quality, and also satisfaction with their care and willingness to return or recommend the same hospital's services to others. The dimensions labelled as "Patients' perceptions of ward/hospital environment" and "Patients' perceptions of medical and nursing staff" served a significant impact on nearly all measures of patient satisfaction in the regional public hospitals of Mauritius.     

Determinants of knowledge management system adoption in health care

The demand for efficient knowledge management (KM) in health care is increasing because the complexity and scale of the knowledge generated from medical research and clinical practices have resulted in challenges of information overload and medical quality. These critical issues can be improved through the adoption of knowledge management systems (KMS). However, the adoption of technological innovations in health care demands an enhanced understanding of the lagged technology adoption status in the health care sector. This study uses empirical methods to investigate the determinants of KMS adoption on the basis of a national survey. Results suggest that KMS adoption is affected by organizational characteristics, KM enablers, and KMS characteristics. We emphasize that KMS adoption in health care is considerably complex because it largely depends on KM enablers and organizational characteristics and not solely on system characteristics. The implications of the findings for research and practice are outlined in this work.     

The Power of Social Network Construction and Analysis for Knowledge Discovery in the Medical Referral Process

The social network model is powerful enough to provide for the analysis and study of a variety of application domains from daily life, including health care and health informatics. After the widespread appearance of automated tools capable of deriving and analyzing social networks, social network analysis (SNA) and mining in the health care domain has recently received considerable attention for its key role in understanding how various bodies within the health care system form communities and how they are socially connected with each other. This understanding helps enhance the organizational structures and process flows, among others. In this article, we show how SNA techniques can solve issues in the medical referral system in the Canadian health care system and the like, by analyzing the social network of general practitioners (GPs) and specialists (SPs). One of the main targets is to optimize the communication between GPs and SPs with hopes of decreasing the waiting time of patients to be seen by SPs. Various SNA and mining techniques are described and analyzed, backed by reporting some experimental results.     

医疗护理服务可及性对居家老人照料服务选择的影响研究——基于北京市的实证研究

利用课题组2018年在北京市的抽样调查数据,运用Logistic回归方法考察医疗护理服务可及性对居家老人照料服务选择的影响。结果发现,医疗护理服务的便捷性、可支付性与老人照料服务的选择显著相关。住所附近有医疗卫生机构、有提供上门护理服务的机构或是与家庭医生签约的老人,更倾向于选择社会照料服务;支付能力对照料服务的选择呈现"U"型效应:家庭支付能力较强或者经济自评相对不足的老人更倾向于选择社会照料服务。应通过优化医疗护理资源布局、建立并完善社会照料服务的价格机制等措施,推进高效、可持续的社会照料服务体系的构建。     

Risking the Sustainability of the Public Health System: Ethical Conundrums and Ideologically Embedded Reform

The purpose of this paper is to examine the outcomes arising from ideologically driven health reforms, which confronted an enduring socialized model of public health care in New Zealand. The primary focus is on the narratives arising from the unprecedented strike action of junior doctors, symbolic of industrial unrest in the public health sector. Analysis revealed the way in which moral obligations ingrained in the professional identities of junior doctors can be both enacted and persistently challenged by ongoing and extensive ideologically embedded reform. A socialized public healthcare system privileges cooperation and relies on a public service ethos, espousing commitment and goodwill of health professionals. The inverse tenets of a pursuit of efficiency through New Public Management validate an ideology of market principles which legitimate competitive and self-interested behavior. The value-based disconnect that occurred not only affected the goodwill and trust of junior doctors, but also destabilized their commitment to their work in a way that threatened the ongoing sustainability of the public health service. This paper suggests four areas in which research might help solve the ethical conundrums currently undermining a public health service. The suggested direction moves the emphasis on systems and activities toward the cognitive and emotional needs of healthcare professionals.     

Network Development and Application in Health Care

Abstract

Service quality is important to health care. The research took advantage of a unique opportunity to study health care from the perspective of all relevant stakeholders. The major results of this research were insights concerning the structures and processes that characterise successful professional health care services and, more broadly, professional services generally. Rather than just communicating in a system prescribed way, successful professionals combine an ambiguous system with extensive interaction with other stakeholders to develop networks. In this way they achieve superior service quality for their patients.     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

The algebra of health concerns: implications of consumer perception of health loss,illness and the breakdown of the health system on anxiety

The current and expected future state of the American health care system creates much concern and anxiety at the national and individual level among Americans. This study is in response to the call of the Institute of Medicine to further study the lack of confidence among Americans about their future ability to receive high‐quality health care. This study compares perceived anxiety and its amelioration as a result of three possible health situations: illness with infectious disease, losing one's health and a breakdown of the health care system. This empirical study was conducted within the framework of conjoint analysis. We conducted an experimental design of ideas, identified attributes that increased or reduced anxiety in each of the three health‐related situations and then segmented consumers on the basis of their patterns of reactions to the attributes. We found that the highest anxiety was attributed to the breakdown of the health care system. The segmentation further suggested that the anxiety emerging from the breakdown of society's health care system generated a different extent of anxiety than that which emerged from one's illness or one's loss of own health. The attributes that drove anxiety across the health situations were, surprisingly, charities, one's company, the local hospital and supplemental insurance. Attributes that reduced anxiety differed among segments. The attributes were found to be: close friends, family, distribution of information by authorities and the belief in God. At a practical level, these data and patterns of response allow health care policy makers to enhance the coping ability of patients by understanding the nature of what reduces the anxiety of individual types of patients. The approach in this study provides a person‐centred system for communication and anxiety reduction that can be implemented as part of a public health policy.     

Learning,Innovation and Competitive Advantage in Not-for-Profit Aged Care Marketing: A Conceptual Model and Research Propositions

ABSTRACT

The rapid expansion and the increased commercialization of the elderly consumers market have forced not-for-profit organizations (NFPs) to adopt a competitive posture in their operations and to pursue innovative ways of delivering superior aged care to the target market. This paper attempts to model the antecedents of innovation-based competitive strategy in NFPs. Premised on the capability-based model of sustained competitive advantage and incorporating the emerging concept of social entrepreneurship, it is argued that entrepreneurial NFP organizations, in their mission to create social value to multiple stakeholders, build and nurture distinctive learning capabilities that enable them to formulate innovative strategies for superior aged care delivery. Key theoretical constructs within the model are explored and research propositions are presented.