Occupational health: offering a spectrum of services

Hospitals must continue to explore ways in which to meet the needs of the employer market. As health care costs (workers' compensation and otherwise) account for a larger portion of a company's total expense dollars, the employer will continue to have a greater voice in how those dollars are expended. Hospitals and occupational health programs that recognize this fact will not only survive, they will prosper.     

Employment in health services: long-term trends and projections.

Demand for health services is expected to grow in response to the increasing number of elderly people; but growth prospects to 1995 for the industry's wage and salary workers are uncertain because of changes in both the financing and delivery of health care.     

Consumer behaviour and the purchasing of dental services: Influences on selection and evaluation of health care services

This paper examines the process of interaction between consumers and providers of dental services in terms of the key selection and evaluation criteria employed by consumers. Focusing on the United Kingdom, it examines the impact of changes in both pricing and provision on the utilisation and evaluation of dental services. Based on a questionnaire survey of dental patients, in the context of the evolving body of literature concerned with consumer behaviour in respect of services, the paper attempts to improve the current understanding of the key factors shaping consumer choice in respect of professional services. Specifically, it argues that the highly complex nature of professional services impacts on patterns of consumer behaviour, resulting in the relationship between the individual service professional and the consumer being the focus of consumer evaluation. This in turn has significant implications for the effective marketing of such professional services.     

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.     

Disaster planning and resource allocation in health services

The increasing prevalence of natural disasters, environmental tragedies, and depraved human behavior has generated excessive costs in both human and material resources at a time when cost-efficiency and control is continually emphasized by managed care contracts, business, and government agencies. As a result, increasing pressure has been placed on hospital material managers to do more with less, while also providing the necessary resources to respond efficiently and effectively during an emergency. A successful comprehensive, risk-based emergency management program of preparedness, response, and recovery will reduce the loss of life and resources.     

Complementary medicine: health care trends for the new millennium

Complementary medicine is emerging as a dominant factor in the health care setting. Although these practices generally are not taught in most medical schools, public interest has generated a necessity for education in this field. The interest in these therapies is reflected in billions of dollars spent out of pocket by the public to obtain these therapies. Many practitioners find themselves uncomfortable discussing these therapies with their patients and/or referring to outside practitioners. Discussion of the modality therapeutic touch has generated interest and controversy. Education helps to bridge the gap between allopathic and complementary medicine. National Center for Complementary and Alternative Medicine practitioner guidelines are presented.     

Perceived risk and consumer decision making related to health services: a comparative study

It is acknowledged[Weinstein, N. and Nicolich, M. (1993) ‘Correct and Incorrect Interpretations of Correlation Between Risk Perceptions and Risk Behaviours’, Health Psychology, Vol. 12, No. 3, pp. 235–45.] that with the development of services marketing specifically related to health services comes a need to understand the aspects of consumer risk behaviour. This paper examines differences in perceived risk between health services, general services and goods and will seek to substantiate and develop a previous US study,[Murray, K. B. and Schlacter, J. L. (1990) ‘The Impact of Services Versus Goods on Consumer's Assessment of Perceived Risk and Variability’, Journal of the Academy of Marketing Science, Vol. 18, No. 1, pp. 51–65.] utilising a quantitative methodology with repeated measures and nested factors. The conclusions support the hypotheses that there are significant differences in perceptions of social and psychological risks when purchasing health services. Copyright © 2000 Henry Stewart Publications     

Planning for education in the health services: a multicriterion approach.

Administrators are often confronted with problems for which there exist several distinct measures of success. Such problems can be expressed in terms of linear programming models with several linear “criterion” functions instead of a single objective function. Although a variety of techniques are available for the solution of multicriterion problems, there exists a need for one which does not assume technical sophistication on the part of the decision maker and which provides valid solutions with minimum effort. “Efficient Manifold Presentation”, the approach used here, is based on the concept that the ideal solution must be a Pareto optimal solution. A method for finding an expression for the finite set of all Pareto optimal solutions to a linear program with multiple linear criteria is presented. Two processes are involved; first, the discovery of all Pareto optimal vertices of the feasible region, and secondly a grouping of these into sets each of which defines a convex polyhedron of Pareto optimal possibilities. Alternate versions of the second process are suggested for use under varying circumstances. An example of the applicability of the method for modeling enrollment and staffing policy in an educational institution is provided.     

The impact of consumer health information on the demand for health services

This paper empirically examines whether consumers use health information, from non-physician information sources, as a substitute or complement for health services – namely for physician visits and emergency room (ER) visits. An indicator of patient trust in physicians is developed and used as a proxy for potential unobserved heterogeneity that may drive both consumers’ propensity to seek information and to use physician services. The results, after correcting for sample selection bias and controlling for unobserved heterogeneity, concur with the literature, that consumer health information increases the likelihood of visiting a physician as well as the frequency of visits on average. However, low-trust consumers tend to substitute self-care through consumer health information for physician services. Further, better-informed consumers make significantly fewer ER visits suggesting that information may be improving efficiency in the market.     

Public sector purchasing of health services: A comparison with private sector purchasing

Recent research has highlighted the existence of important differences between public and private sector procurement practices. Drawing on established transactional and relational conceptual frameworks, this paper examines whether the differing environments confronting public and private sector organisations affects procurement practices. By focusing solely on occupational health services as an example of a complex business service, the research allows the influence of environmental factors, notably policy drivers, to be considered across both public and private sector settings while service specific factors remain largely constant. Utilising a combination of questionnaires and in-depth interviews the research suggests that policy drivers had a major bearing on procurement practices adopted in the public sector, resulting in a very different pattern of engagement with service providers from that prevailing in the private sector. Specifically whereas private sector organisations utilised a range of approaches, which can broadly be classified as relational in nature, public sector organisations almost exclusively relied on transactional-based approaches. The nature of these services suggests that relational based procurement constitutes the optimal approach to the acquisition of such services. However, for public sector organisations the perceived restrictions imposed by public policy on procurement practices resulted in the adoption of an approach which can be viewed as resulting in sub-optimal outcomes.     

Improving accessibility to rural health services: The maximal covering network improvement problem

Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas of lesser-developed countries. In many areas accessibility is diminished by the lack of all-weather roads, making access subject to weather conditions. Location-allocation models have been used to prescribe optimal configurations of health facilities in order to maximize accessibility, but these models are based on the assumption that the underlying transport network is static and always available. Essentially, past work has ignored the potential impacts of improvements to the transport system in modeling access. In this paper we propose a model that treats the opposite side of the location/transport equation; that is, a model that treats existing facility locations as fixed and improves health service accessibility by upgrading links of the transport network to all-weather roads. This new model, called the Maximal Covering Network Improvement Problem (MC-NIP) is formulated as an integer-linear programming problem. An application of the MC-NIP model to the Suhum District of Ghana is presented, which shows that even a modest level of road improvement can lead to substantial increases in all-season access to health service.     

浅谈电缆桥架安装和桥架内电缆敷设

当今社会电缆的发展与经济的发展息息相关,它不但在促进经济发展的方面起着明显作用,同时也是现今世界高速发展的润滑剂和助推力。并且按照现在的发展趋势电缆行业在今后的社会中的作用将会有增无减,甚至其角色还会进一步扩大,渗透到我们周围的众多领域。因此,在以后的经济发展中我们应进一步加强对电缆的建设和完善,从而推动我国其他事业的发展。     

An optimization model for planning community health services.

This article reports results of a project to develop methods of planning health care delivery for a community with emphasis on ambulatory services in a health maintenance organization setting. Some of the special difficulties of the problem are discussed and a linear optimization model is presented that addresses the problem of planning the ambulatory service mix for a specified population. The model accounts for population characteristics, financial data, and system dynamics (including referral patterns). An application is shown for the case of a “model cities” population in Buffalo, New York, and some implications for further research are presented.     

Markov models and the utilization of mental health services: a study of endogenously depressed patients.

Patients in the mental health care system typically make more or less irregularly spaced visits to psychiatrists, both within and between episodes of a given illness. A Markov model is constructed which can predict the utilization of psychiatric services for such patients. Unlike previous Markov models of utilization, the current model takes as its starting point a model of an actual disease, specifically, endogenous depression. It is shown how one can estimate the parameters of both the model of utilization and the model of depression using data which were collected for clinical research purposes. The models provide reasonable fits to the data. Several applications of the models are worked out. In addition to predicting the utilization of mental health services, the models can be used to predict incidence, prevalence and recovery rates and to predict the changes in utilization which parallel changes in treatment regimens.     

Employability and mental health in dismissed workers: the contribution of lay-off justice and participation in outplacement services

The current study’s explored if and how psychosocial resources of employability contribute to mental health of dismissed workers. Degree of outplacement services use, perceived employability and perceived organizational lay-off justice were examined as mediators of the relation between personal employability and mental health. The research involved dismissed workers in the pharmaceutical industry, who joined programs of re-employment sponsored by companies. Structural equation results showed that the lay off workers with higher personal employability were less likely to have mental health deterioration. Furthermore psychosocial resources of personal employability directly increased perceptions of having job available alternatives and was indirectly associated with a higher degree of use of outplacement programs, but these variables didn’t mediate the relation with mental health. Lay-off justice had a direct positive impact on mental health, but it was not relate with employability. Our study contributes to understand some psychological processes that can affect the decision to utilise outplacement programs and offers suggestions for employability profiling.     

A chance-constrained multiobjective model for mental health services planning.

Mental health services planning, and particularly the planning for deinstitutionalization, is a very complex problem. This paper suggests a chance-constrained goal programming (CCGP) approach to mental health services planning. The CCGP approach is based on the sequential solution of a linear programming formulation, allowing efficient solution of large-scale planning problems using commercially available linear programming computer codes. The procedure is demonstrated with a case example and implementation of the approach is discussed.     

A data-driven methodology for supporting resource planning of health services

In recent years, healthcare systems have been forced to better organize their services in the final attempt to maximize both care effectiveness and efficiency. In particular, emergent trends are prompting hospitals to pay more attention to the effective and efficient planning of resources and to the creation of patient-centred services, in which current activities and resources are reorganized around patients.This paper proposes a process mining based methodology to systematically support the resource planning of health services. Specifically, combining Time-Driven Activity Based Costing and process mining approaches, it automatically identifies the patient flow and analytically evaluates activities, service times, and resource consumptions for a specific class (-es) of patients (e.g., a DRG, patients with specific medical condition, etc.). Thus, it allows to reliably estimate the expected resource consumptions for the patient group under investigation. Thanks to process mining, the method overcomes the limitations of existing quantitative approaches that are often time-consuming, based on subjective observations, and too case specific. The method was applied to a real case study of lung cancer patients in an Italian hospital.     

孕产妇围产期服务需求的调查分析

目的 了解孕产妇围产期的服务需求.方法 在2008年6-8月便利抽取全国7个省,2个直辖市中29家医院2436名孕妇,在产后3-5d即将出院时填写一般资料及自行设计的孕产妇围产期服务需求量表.结果 孕产妇围产期服务需求反映在生理需求、心理需求、环境和设备需求及服务需求4个纬度,多数需求条目得分大于3分,处于需要至极需要之间.结论 产科护理人员应从孕产妇生理、心理、环境和设备及服务需求4个方面了解孕产妇围产期的需求状况.以便根据孕妇的意愿制订切实可行的服务计划.使围产期保健工作更加深入地开展.