Immigration and health care reform: shared struggles

The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.     

Value-added care: a paradigm shift in patient care delivery

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.     

关于医疗保健范式转型的几点思考

本文以美国为例,初步分析研究了当前“以治疗为主”为核心的医疗保健范式面临的主要挑战及其内在原因,提出了向以“预防为主”为核心的医疗保健范式转型的几点建议,并对整合医学及中医在医疗保健范式转型中的重要作用提出了若干思考.     

The marketplace and health care reform: the unfinished agenda of the '90s

A long-term approach to health care reform demands an agenda that involves purchasers, payers and providers, as well as users. The overall goal of such an effort must be integrating ongoing cost reductions with continuous improvements in quality of care.     

An econometric analysis of health care reform in the U.S.

This paper simulates the effects of funding a comprehensive health plan (CHP) on consumer spending in the U.S. using a demographically enhanced dynamic Almost Ideal Demand System model. Quarterly observations on personal consumption expenditures and the relevant price indices of seven major commodity and service groups in the U.S. for the period 1963. 1 through 1989.4 comprise our data set. Our results show that the CHP financing causes no significant adjustment on the demand-side of the economy, i.e., consumer expenditures on the seven major commodity and service groups would decrease slightly in the short run under the CHP financing. (JEL D00)     

Health care in rural America: a view from the nation's capital

While the nation's health care system has been the subject of significant attention, the needs of rural Americans and the adequacy of their health care delivery system have been largely overlooked. By considering the unique features of rural America, appropriate delivery models can be developed.     

Retiree health care benefits: a new standard of care

Solving the problem of continually rising retiree health care costs may ultimately require a new type of health care system. By monitoring individual behavior and intervening when necessary to modify potentially harmful behavior, we can reduce the present system's wasteful emphasis on hospitals and drugs.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

拉丁美洲1990年代经济改革特点--以墨西哥经济改革为例

拉丁美洲在20世纪90年代前后开始的全面经济改革,新自由主义属性显著。在这一过程中,墨西哥的新自由经济改革颇具代表性。因此,以墨西哥的加工贸易和国有企业私有化为例,分析拉丁美洲经济改革中的特点以及出现的问题。