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.     

Health Information Technology and Financing's Next Frontier: The Potential of Medical Banking

Calls to action for widespread adoption of electronic health records have come from a broad spectrum of the private and public sectors. The problem, to date, is not that information does not exist, as much as that the data have not been organized around the patient. An integrated Personal Health Record is a patient- or family-centered technology designed to capture not only the contacts with health care providers, but also personal information on insurance, diet, and personal preferences that a physician's health record will not capture. Medical banking, based on a new technology platform called the Integrated Health Card, is emerging as a solution to the problem of collecting and combining information from the electronic health record with personal health information. It may also be the only way for fledging health savings accounts to enable the price and quality transparency of the medical market that has been called for repeatedly in this decade. In analyzing the political and patient applications of widespread adoption of this new innovation, the positive contributions to social welfare are very likely to outweigh the negative.     

灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

Equality of opportunity and the demand for medical care by race

In this article I estimate the demand for medical care for eight groups delineated by sex and marital status. I use the results to simulate what will happen to black's demand for care if they are given equality of opportunity with whites and the potential impact on their health status. The findings suggest blacks' demand (and therefore health status) may decrease with equality of opportunity because of lack of coordination in social programs.     

Future issues in health economics: one view from Washington

These are comments about how policy issues at the federal level may create a demand for research in several areas of health economics. As background, there is a discussion of the current federal budget situation and the cost-containment pressures this puts on public health programs. The longer-term problem of financing of the Medicare trust fund is also discussed. Four areas where new research may affect future health policy are identified: the market for physician's services, medical technology, competition in health care, and the market for health insurance.     

Paperless healthcare: Progress and challenges of an IT-enabled healthcare system

For most Americans, a trip to the doctor's office or a hospital stay necessitates that medical personnel search through paper charts and records as care is administered. This remains the status quo, despite the increasingly large role that electronic communication plays in other aspects of our business and personal lives. The elevated use of information technology (IT) in healthcare settings—primarily via utilization of electronic health records (EHRs), which allow information to be readily communicated and shared among healthcare providers—has been advocated as a means of improving quality of care and helping to control healthcare costs over the long term. Yet, hastened implementation of healthcare IT will require considerable cost incursion in the near term, and will present various other challenges that must be addressed. Herein, we examine the merits and benefits of healthcare IT, as well as the costs and other challenges that may serve as obstacles to its wider implementation and use. We conclude with a set of recommendations designed to increase the likelihood that extensive expansion in the use of healthcare IT will yield the desired benefits.     

Hope across the seas: the role of emotions and risk propensity in medical tourism advertising

Rising US medical costs as well as more competition in the health care industry have led many Americans to pursue health care in foreign destinations. As a result, leading countries in medical tourism have begun launching international advertising campaigns. A growing trend in much of this advertising is the use of emotional appeals. The purpose of this research is to examine whether the use of emotional appeals by non-domestic health care providers contributes to more favourable evaluations of the target health care provider than rational appeals. Specifically, two experimental studies investigate the efficacy of advertisements that induce the emotion of hope to determine whether these advertisements increase trust perceptions and reduce perceived risk, given an individual's level of risk propensity. Implications for public policy makers and marketing managers who work in health care are discussed.     

A Consumer Evaluation of Quality Indicators for Physician Care

Proposed measures of the quality of physician care have been evaluated, but the discussions in the literature concede that little is understood about how this information, when made available to the health care consumer, will affect the choice of physician. This study presented fifteen indicators, including some suggested by the services marketing literature, to health care consumers and asked them to evaluate the usefulness of each in judging the quality of physician care. It was found that patient experience indicators, medical community indicators and marketing symbol indicators were consistently more useful than legal information indicators and practice characteristic indicators. It was also found that it is possible to discriminate within age, education, and occupation groups on the basis of their responses to these quality indicators.     

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。     

Adoption and Diffusion of Telemedicine Technology in Health Care Organizations: A Comparative Case Study in Hong Kong

Rapidly changing dynamics and turbulence in the business environment have made technology management increasingly critical to the bottom-line survival and competitiveness of many organizations. Adoption and diffusion are 2 challenging technology management issues facing health care organizations. As health care is becoming an increasingly important sector of the national and the global economy, contemporary problems in access, equality, and costs have demanded innovativeness from health care organizations that, in response need to adopt and institutionalize appropriate technological innovations for service improvement and expansion. A case in point is telemedicine technology that has the potential to support physicians' patient care and improve health care organizations' competitiveness.     

Technology as culprit and benefactor

Technologies can be viewed as a mixed blessing: rising health care costs versus improved diagnosis, treatment, and health status. This article briefly discusses the influence of key factors on the demand for technology and its utilization. These factors include rising health expenditures, changes in populations, and the development of cost containment strategies. Resulting shifts in incentives and utilization are examined. Because of the difficult and complex issues associated with the increasing use of medical technologies, hard choices will need to be made about quality of life, technology assessment, and the allocation of health resources to the terminally ill.     

The Marketing of an Assisted Living Facility–An Exploratory Study

ABSTRACT

Because of the aging population, demand for retirement and medical care services will continue to escalate during the next century. One of the fastest growing areas in terms of elderly care are assisted-living facilities. However, there is a scarcity of empirical research related to assisted-living facilities (ALF). The objectives of this exploratory study were to determine the factors that impact the purchase decision of an assisted living facility and the relationships among those variables. The study indicated that individuals were more likely to utilize an assisted living facility if they had visited an ALF in the past, had developed a positive attitude toward ALFs and if the elderly person needing health care had experienced major medical problems within the last five years. Differences were found between respondents 55 and over and respondents under 55. The impacts of these findings are discussed with managerial implications of the research.     

Effects of hospital leadership,organizational systems,and ESWOS on medical error reduction

One of the major elements of care quality provided by health care organizations is the reduction of medical errors. This study empirically examines the effect of leadership, organizational systems, and employee satisfaction with organizational support on medical error reduction. A set of hypotheses is tested based on data collected from 208 medical staff of hospitals with more than 300 beds in South Korea. Data were analyzed by confirmatory factor analysis and path analysis using SPSS 17.0 and Mplus 5.1. One of the major findings of this study was that medical error reduction could be achieved by effective leadership. Leadership and operational efficiency drive reduction in medical errors in the health care industry. The comparison between large- and small-sized quality assurance teams’ roles indicated that there was a significant difference in their effect on medical error reduction. The results of the study shed light on some practical implications for management professionals in hospitals.     

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.     

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。     

A dynamic forecasting model for nursing manpower requirements in the medical service industry

Today there is an increasing demand for quality health care throughout the world. Such demand requires the medical service industry to equip with high technologies and high caliber professionals (e.g., doctors and nurses), to contain cost and improve quality of care. Since the medical service industry constantly suffers from the shortage of nursing manpower, forecasting the supply and demand of nursing manpower is an important issue. This study proposes a forecasting model for nursing manpower requirement using system dynamics. Data were collected from authorized institutions in Korea and were used as inputs of the model. The results show that the demand for nursing manpower exceeded the supply during the forecasting period (2006–2020), which requires both national and the medical service industry attention for sustained quality health care.     

US health care policy in 1990: looking back, looking ahead

Health policy in the United States is best understood as a policy of incrementalism with major interventions occurring only in response to crisis, as in the case of the Medicare legislation that profoundly altered our historic financing of health care. The characteristically minor, unplanned, adjustments that are made often have major unanticipated consequences, and these serve to explain the radical transformation of the nation's health system in the half-century since World War II. The main elements in this change--the evolution of employment-tied private insurance for the majority of the population, the predominance of specialism and superspecialism in medical practice, the expansion of the voluntary hospital system with capital liberally raised through tax-exempt bond issues, advancing technology and medical capability are reviewed. The major persistent policy issues--uncontrolled expenditures and the increasing numbers of uninsured--will ultimately precipitate change, perhaps by the end of the decade, very likely a minimum benefit, universal federal-state insurance system, supplemented by the private market--hardly radical systemic reform.     

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.