市场竞争性和我国的医疗体制改革——经济学视角下的医疗体制改革模式

市场的竞争性不仅取决于市场结构,还取决于价格信息在消费者之间的传播速度。由于医疗服务的价格信息在患者之间的传播是一个缓慢的时间过程,所以医疗服务市场看似有竞争而实际上竞争程度远比一般商品和服务市场低得多。在说明医疗服务市场的高价格水平形成机制的同时,指出政府只要能够改变医疗服务价格信息的传播机制,就能够建立一个以市场机制为基础的高效率的医疗卫生体制。     

Hospital Positioning and Integrated Hospital Marketing Communications: State-of-the-Art Review,Conceptual Framework,and Research Agenda

In the light of patient empowerment and channel fragmentation, hospitals struggle to target patients in their new role as active, knowledgeable consumers. As market differentiation via traditional marketing mix variables such as price is hardly achievable in healthcare, superior communication grounded on sound positioning is a more promising lever for competitive advantage. Yet, research on marketing-driven communication from provider to patient lacks synthesis and critical reflection. Drawing upon evidence from previous research, this article unites 62 articles from medical and social sciences covering aspects of hospital marketing communications. Derived from qualitative content analysis, findings on the effectiveness of specific communication channels and contents are portrayed. This article further uncovers the characteristics of four evolving archetypes for hospital positioning and illustrates the implementation of integrated hospital marketing communication strategy. The elaborated conceptual framework can be used as a managerial tool for tailoring hospital communications. The article closes by highlighting future research directives.     

A Social Marketing Template for Solving the Musicians’ Dilemma Through Nonprofit Healthcare Networks

The Musicians’ Dilemma—the lack of affordable healthcare for the uninsured or underinsured musical entrepreneur—is actually a common problem plaguing not only 33% of musicians, but approximately 19% of the American population as a whole. The current research uses social marketing principles to conceptualize a template for designing a marketing program that meets the healthcare needs of the target market. Health Alliance for Austin Musicians (HAAM) is a nonprofit organization that links healthcare providers, local businesses, and community donors in a network providing basic preventive health services to this essential segment of the community. HAAM's business model is analyzed and cast on the social marketing framework so that it can be adapted for use by other music cities. Although the template could also be applied to serve other uninsured populations, it is critical that research be undertaken to understand the specific characteristics and needs of each target market and used to adapt the model to those populations.     

Value co‐creation in online healthcare communities: The impact of patients’ reference frames on cure and care

The gradual transition of health care toward businesses during the past 50 years has converted passive patients into active customers. In our digital society, patients increasingly use online health communities to satisfy complex needs that healthcare professionals leave unmet, including the creation of cure‐oriented (i.e., functional) and care‐oriented (i.e., emotion) value. This research investigates patients’ reference frames (self versus other) as an information processing mechanism and their impact on value creation in online communities. The analysis of 1,687 online postings of a leading healthcare platform shows that self‐referencing is typical for information obtained through an individualistic, patient–doctor encounter; other‐referencing emerges when patients focus on the needs of their peers. Information gathered through the patient–doctor encounter and processed with a self‐referencing frame accordingly enhances cure‐related value, but limits care‐oriented value co‐creation. Other‐referencing does exactly the opposite: it creates a barrier to cure‐related value, but stimulates care‐related value. A patient's experience with the community largely moderates the impact of both self‐ and other‐referencing on cure‐ and care‐related value. These findings show that online health communities can identify and address unmet patient needs, but healthcare professionals still play a critical role in terms of ensuring information quality in online health communities.     

Empowering health care consumers in the era of Internet of Things

The Internet of Things (IoT) is emerging as a significant development in information technology that aims to link the digital world with the real world to improve human life. IoT refers to digital tools collecting data and providing hyper-personalized information to its users. With the rapid integration of the IoT in the healthcare sector (HIoT), it has been presumed that HIoT devices have an empowering effect on patients; however, this has yet to be investigated. Furthermore, the literature reveals a lack of consistency regarding the definition of patient empowerment. This study aims to fill these gaps and investigates whether HIoT systems increase user empowerment for individuals suffering from chronic illnesses. It also examines how empowerment is defined for HIoT users. To answer these two research questions, we conducted a qualitative research study consisting of 20 semi-structured, in-depth interviews carried out with individuals suffering from Type 1 diabetes (T1D). The interviews were transcribed and content analysis was conducted on the data. The study enabled us to examine whether and how the HIoT triggered empowerment for patients suffering from T1D. Findings reveal four main dimensions of empowerment for HIoT users: (1) self-efficacy, (2) patient control, (3) knowledge development and (4) participation in the decision-making process along with the doctor. Results also highlight that participants feel empowered by personal acceptance of living with their health condition and social support. In addition, the analysis led to the identification of the barriers which need to be overcome to ensure that HloT systems improve patient empowerment.     

Health as a consumption object: research notes and preliminary investigation

Through the processes of commodification and marketization, materials and human activities are brought within the domain of market exchange. The results of these accelerating processes are observed in the consumer culture centred on objects of consumption. We contend that, in addition to healthcare, health itself has become yet another object incorporated within consumption space. This contention is consistent with the perspective of consumption as the dominant social paradigm in the structuring of health and healthcare practices. In this paper we present the conceptual backdrop for our contentions, together with details of a heuristic study. Our findings support the view that people regard health as a consumption object. Furthermore, the evidence suggests a patterning of responses by social grade and gender. Given our wider interest in class‐based health inequalities, we use our results to comment on the broader policy debate concerning this phenomenon in relation to consumerism.     

International Trade and Health Policy: Implications of the GATS for US Healthcare Reform

This paper examines the implications of the General Agreement on Trade in Services (GATS), the World Trade Organization’s agreement governing trade in health-related services, for health policy and healthcare reform in the United States. The paper describes the nature and scope of US obligations under the GATS, the ways in which the trade agreement intersects with domestic health policy, and the institutional factors that mediate trade-offs between health and trade policy. The analysis suggests that the GATS provisions on market access, national treatment and domestic regulation, which are designed to eliminate ‘regulatory barriers’ to global trade in health services, limit the range of options that state and federal regulators and legislative bodies can employ to regulate the health sector and implement healthcare reforms. As such, the paper identifies the broader social and ethical implications of free trade policy.     

Exchanging knowledge through healthcare manager placements in research teams

This study contributes to service industry theory by revealing how employers in the health service understand knowledge exchange as ‘transaction’. Although under pressure to deliver better services without additional resource, health service providers do not seek customers, making them unlike commercial service industries. This paper reports a UK knowledge exchange programme designed to bring together healthcare managers and researchers. Case study data were gathered from 36 semi-structured interviews with health services managers (Fellows) embedded in research teams, research team leads, and Fellows' workplace line-managers. Interviews were analysed thematically using a coding frame. The importance of personal contact in knowledge exchange mechanisms was confirmed but the knowledge model varied by interaction pairings (Fellow/research team; Fellow/health service). When with researchers, an exchange model was commonly in operation, marked by collaborative engagement. In contrast, line-managers tended to adopt a transactional approach, driven by instrumental motives. This transactional model merits further research.     

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.     

The influence of hospitable design and service on patient responses

ABSTRACT

A study of 216 respondents examined a medical center environment’s influence on patient responses. A stimulus–organism–response (S-O-R) model was adapted to the theory that more hospitable healthcare servicescape elements will affect patients’ overall satisfaction with healthcare experience, loyalty intentions, and willingness to pay out-of-pocket expenses for healthcare services. Servicescape elements included atmospherics of the healthcare environment, service delivery by healthcare staff, physical design of the healthcare environment, and wayfinding. Results of structural equation modeling confirmed that the four servicescape elements – had a significant impact on patients’ overall satisfaction with the healthcare experience. Furthermore, overall satisfaction with the healthcare experience predicted patients’ loyalty intentions and willingness to pay out-of-pocket expenses for healthcare services. The study makes a significant contribution to the empirical modeling of patients’ behavioral responses to hospitable healthcare environments.     

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.     

Organisational form and industry emergence: Nonprofit and mutual firms in the development of the US personal finance industry

Economic theories of commercial nonprofits and mutuals usually emphasise the advantages of such organisational forms in reducing agency and monitoring costs in markets that suffer from information asymmetries in exchanges between firms and their customers. This article examines the ability of such transaction cost theories to account for historical variations in the ownership and governance of firms in the US personal finance industry between the early nineteenth century and the Great Depression. It focuses, in particular, on mutual savings banks and their role in the development of the intermediated market for savings accounts. While I find some evidence in support of transaction cost theories of organisational form, I also find that entrepreneurial and socio-political factors played crucial roles in the choice of ownership and governance structures; mutual savings banks predominated in the early years of the industry because the form offered entrepreneurial advantages over investor-owned corporations and because in some states they benefitted from regulatory and political advantages that joint-stock companies lacked. Their relative decline by the early twentieth century was the result of increasing competition in the market for savings deposits, the loosening of regulatory barriers to entry, and changes in public policy that reduced the transaction, innovation and regulatory advantages that the mutual savings bank form had once held. The article draws out the theoretical implications for our understanding of the historical role of nonprofit and mutual firms.     

Rating healthcare services: consumer satisfaction vs. health system performance

The complex healthcare services and the consumer’s lack of technical knowledge to assess them engender a debate over using consumer satisfaction ratings as a quality-of-care marker. This paper aims firstly to investigate the effect of socio-demographic, socio-economic and spatial characteristics on the perception of quality of healthcare and secondly to evaluate the relationship between consumer satisfaction and health system performance. Reporting a Eurobarometer survey and the scores of the Euro Health Consumer Index, the finding is that some socio-demographic groups are more likely to get unsatisfied with healthcare services than others (e.g. women, those over 24 years old, those who self-define themselves as working class). Moreover, a strong relationship is revealed between consumer satisfaction and health system performance. The higher the performance of a health system, the higher the propensity to have consumers with positive perception of the healthcare services (satisfied consumers). The implications of the findings are then discussed.     

CONSISTENT MARKET EXTENSIONS UNDER THE BENCHMARK APPROACH

The existence of the growth optimal portfolio (GOP), also known as the Kelly portfolio, is vital for a financial market to be meaningful. The GOP, if it exists, is uniquely determined by the market parameters of the primary security accounts. However, markets may develop and new security accounts become tradable. What happens to the GOP if the original market is extended? In this paper we provide a complete characterization of market extensions which are consistent with the existence of a GOP. We show that a three fund separation theorem applies for the extended GOP. This includes, in particular, the introduction of a locally risk free security, the savings account. We give necessary and sufficient conditions for a consistent exogenous specification of the prevailing short rates.     

Which consumers are willing to pay for smart car healthcare services? A discrete choice experiment approach

The technology adoption lifecycle model categorizes consumer groups in the new concept products and services market, based on different characteristics and needs, into innovators, early adopters, early majority, late majority, and laggards, in order of adopting new products and services. This study aims to estimate heterogeneous consumer preferences and willingness to pay for a new concept convergence service, the smart car healthcare service, using a choice experiment questionnaire and a hierarchical Bayesian mixed logit. We found that consumers were willing to pay an additional 3000 to 6000 KRW/month (2.65–5.29 USD/month) for a service that measured both physical movement and vital signs compared to either the former or the latter. It was also found that they were willing to pay about 3000 KRW/month (2.65 USD/month) more for a service that provides health condition predictions compared to one that provides only the current health condition. In addition, customers who were young, innovative, and favored the utility of healthcare services showed a lower sensitivity to service fees than those who were not. Thus, they were found to have a greater willingness to pay for advanced smart car healthcare services.     

User-generated content in the era of digital well-being: A netnographic analysis in a healthcare marketing context

The disruptive strength of digital technologies in healthcare has led to valuable changes in the search for information and the application of these technologies. The introduction of these technologies has altered, sometimes even inverting, the doctor–patient relationship. User-generated content on social media and online communities represents a form of disruptive cooperation that has huge potential benefits for the future growth of society. Using netnographic analysis of smart patients and data from an online survey of Italian oncologists and health professionals, this paper shows the impact of user-generated content on the pursuit of personal well-being. The linkages between new forms of knowledge, business, and innovation are highlighted. Based on an analysis of the emerging concept of systems medicine, this paper focuses on the dimension of participation. A data-driven approach is adopted, and the data, information, knowledge, and wisdom framework is used to explain how people employ user-generated content in their pursuit of well-being. Managerial perspectives and suggestions for future research developments are discussed.     

Efficiency and quality in health services: a crucial link

The relationship between quality and efficiency in the health sector is influenced by various conditions. The objective of this paper is to analyse the evolution of efficiency and quality in the Andalusian Hospitals during the years 1997–2004 and to study the association between efficiency and quality indicators. Hospital performance is analysed using data envelopment analysis and the Malmquist productivity index. Technical efficiency as well as healthcare quality increased during the analysed period. A weak association between efficiency and quality indicators exists. The results obtained rule out the existence of an efficiency–quality trade-off.     

Transformative service research and service design: synergistic effects in healthcare

ABSTRACT

This conceptual paper answers the question: How do we design service experiences in whole to increase the well-being of all participants in the healthcare system – patients, families, and caregivers? In order to do so, we position service design as an essential tool and even a mindset needed for transformative service research success. We discuss the transformative role service design plays in improving service and consumer entities’ well-being with a focus on how this approach can lead to improved healthcare service outcomes. We also add to the conversation surrounding service and consumer entities’ well-being by broadening the concept and application of service design to consider social, existential, psychological, and physical well-being. We particularly explore how healthcare services can benefit from further consumer engagement and collaborative patient–provider relationships, two key factors essential for redesigning the industry.     

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.     

Households' Decisions on Savings Accounts After Negative Experiences with Banks During the Financial Crisis

During the 2007–2008 financial crisis, consumers in many countries were suddenly confronted with the fact that their bank needed government support or had even failed. Using a detailed survey among households in the Netherlands, we show how these unexpected negative experiences have changed consumers' handling of their savings accounts. Our findings suggest that respondents who were customers of troubled banking institutions were subsequently more likely to spread their savings across accounts at several banks. They were also more likely to move funds across banks. Our results also suggest that the size of the shock is important as the strongest effects are found for respondents who experienced both a bank bailout and a bankruptcy.