Creating consumer satisfaction in maternity care: the neglected needs of migrants,asylum seekers and refugees

An estimated 190 million people are now living outside their countries of birth or citizenship, and the rate of this migration is expected to remain high. The resulting growing cultural and ethnic diversity in societies adds specific challenges to the requirement of delivering public services such as health care to consumers. Globally, about half of the migrant population are women. Migrants’ outcomes of pregnancy are known to be poor, showing significant disparities when compared with those of native populations. Although these disparities have been noted, knowledge is limited regarding the availability and accessibility of healthcare services, as well as the acceptability of maternity care for women with experiences of free and forced migration. Healthcare research in general, and maternity care research specifically, have often neglected this population. This paper examines the existing international guidelines intended to address inequities in health outcomes, policies which have been introduced at national levels, and the widely used concepts of ‘patient‐centred’ and ‘woman‐centred’ health services. The ideals implicit in those guidelines and concepts are contrasted with the available evidence of many overseas nationals’ experiences with healthcare provisions in general, and maternity care in particular. This is followed by reflections on deficiencies in current studies and on those methodological problems which make research on maternity care for migrant women particularly challenging. The conclusion considers the appropriateness and relevance of guidelines currently promoting equity in maternity care and suggests a future agenda for priority research.     

Financing health care

This article reviews the causes of growth in health care costs and concludes that only changes in the rate of growth in intensity of care are likely to be effective. It proposes a model of consumer choice (with advice) among health plans, and competition among plans on the basis of the rate at which new technology is introduced, as a solution to the problem of picking the appropriate rate. It argues that the existence of the uninsured is evidence of government failure.     

Financing the correct rate of growth of medical technology

This article suggests ways to preserve innovation while partially restraining the impressive growth rate in new medical technology. Health care will soon consume 12 percent of GNP. There is a wide range of opinions as to whether medical technology is a major or minor source of rising health care expenditures. Given our current fiscal problems, health care providers will be in direct competition with education and other domestic programs for a limited supply of R&D funds. More funding will have to come from the private sector. The challenge for prudent buyers of health care services is to control costs without eroding the biomedical capacity of the nation.     

公私医疗卫生支出与经济增长关系的实证分析

众所周知,医疗卫生支出不仅关系到一个国家社会福利政策的规划,还对经济增长具有不可忽略的促进作用。然而,现有文献对于医疗卫生支出与经济增长关系之间的研究结论却是众说纷纭。鉴于此,本文根据医疗卫生支出的支付主体,将其分为政府医疗卫生支出和居民医疗卫生支出,并通过建立双向固定效应模型对公私医疗卫生支出对经济增长的影响进行分析。结果显示：从全国平均水平来看,政府医疗卫生支出每增长100％,带动经济增长12．08％,居民医疗卫生支出每增长100％,带动经济增长15．85％;但与此同时,考虑到不同地区的经济发展非均衡化时,政府医疗卫生支出和居民医疗卫生支出带动经济增长的效应差异甚大,其中政府医疗卫生支出对经济增长呈现“倒U型”效应,而居民医疗卫生支出对经济增长呈现“阶梯型”效应。     

Information search in health care decision-making: a study of word-of-mouth and internet information users

This paper investigates how individual consumers may differ in their information search behavior in health care decision-making. Results indicate that most consumers still use word-of-mouth as a primary information source for health care decisions. However, usage of the Internet is increasing. The results of this study indicate that consumers who are most likely to use the Internet for health care information are single, younger, and less educated, whereas consumers who are most likely to use word-of-mouth are middle-aged, married, with higher income and higher education. Surprisingly, no significant gender difference was found in information search behavior for health care decision-making. The results also suggest that consumers with the highest tendency to use word-of-mouth are also the lowest users of the Internet in health care decision-making. Implications of these findings are discussed.     

Will the Health Care Cost Curve be Bent? Where We Stand at the Start of 2011

This overview shows the change in health care costs in the aggregate, as a share of GDP, and—along with other programs—the share of entitlements in the federal budget. These trends are unsustainable. Many current proposals for reform imply a one-time downward shift in the curve but do not affect its long-run shape. Thus, they simply postpone consequences for a few years rather than solve the main problem. What must be done is to bend the health care cost curve so that its rate of growth is more in line with that of GDP.     

Implementation of quality programs in health care organizations

Any organization??s efforts to achieve continuous quality improvements must involve applying various quality related programs and tools. Such efforts are important for improving quality of products and/or services and increasing business performance. It is especially important for health care organizations as quality of care and service is a top priority. The focus of this study is on the implementation of quality programs which are based on tools, awards criteria, or standards to improve quality of care in the health care industry. Two hundred fifty-four hospitals with more than 100 beds that have quality programs were used to collect data for this study. Two of the most widely used quality programs were quality control (61.8?%) and total quality management (60.6?%). As widely known quality programs have shown to play a role in improving quality of care in the global health care market, some hospitals implement a combination of various quality programs to get certification or an award that helps them enter the international market such as medical tourism.     

Handle with care: Avoiding and managing retaliation claims

Anti-retaliation protections for whistleblowers are routinely included in federal statutes. During the past decade, claims of retaliation in employment-related cases have grown in numbers and in reach, due in part to a seemingly far-reaching commitment by the U.S. Supreme Court to interpret anti-retaliation provisions to provide maximum protection to complainants. Employers must take care not to run afoul of the anti-retaliation provisions; however, that does not mean that employees who complain of discrimination are ‘untouchable.’ This article provides an overview of anti-retaliation law as it relates to the employer–employee relationship and outlines eight practical tips for managing and avoiding retaliation claims. Though anti-retaliation provisions provide ample reason for employers to proceed with caution in the face of employee complaints, employers need not succumb to paralyzing litigation fear when addressing concerns regarding complaining employees’ performance issues.     

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     

Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

关注农村空巢老人—基于湖北省21个村200份问卷的分析

基于湖北省21个村庄的200份问卷,对该省空巢老人的经济收入、健康医疗、养老需求、生活幸福感等方面进行了深入的分析。分析表明：空巢老人的收入水平低,生活负担重;多数老人的健康状况令人担忧;六成以上的老人对养老持悲观心态,且养老观念在转变,＂依靠社会养老＂成为最被认可的养老模式。对此,应该在农村完善各项政策和服务,使农村空巢老人真正得到＂老有所养＂、＂老有所医＂。     

Model of Welfare Capitalism? The United States Rubber Company in Southeast Asia, 1910-1942

Welfare capitalism, the management ethos adopted by Americanbusiness leaders in the early twentieth century, emphasizesthe role of business rather than trade unions or governmentin taking care of its workers. This article focuses on the reasonswhy the United States Rubber Company (USRC), one of the fourlargest U.S. rubber manufacturers, promoted welfare capitalismat its rubber plantations on the east coast of Sumatra and Malayabetween 1910 and 1942. In addition, this study assesses thedevelopment of USRC's system of welfare in the areas of housing,profit sharing, pension plans, health care, and recreation.This article argues that USRC's intention was not to forestallunionization (the intention of U.S.-based companies in adoptingwelfare capitalism), as union formation in Southeast Asia duringthat period was very unlikely, but to overcome labor shortagesand high turnover rates and to ensure labor stability. Withreduced labor costs, the availability of financial resourcesallowed for technical innovations and R & D, which ultimatelywould lead to increased productivity.     

Seeking a Replacement for the Medicare Physician Services Payment Method

Business and government spending on physician services have soared over the last few decades. Most payers for services traditionally peg their payment rates to Medicare. However, most consider the current Medicare single payment rate flawed because it fails to improve health outcomes or control spending. Everyone wants to replace it, but good replacements have not been identified. We estimated elasticities of the single-payment rate with respect to several of its determinants, proposed a replacement—a service-specific payment rate—for the single-payment rate, and estimated the budget implications of this replacement. Key findings are that the single-payment rate is relatively inelastic to the Sustained Growth Rate (SGR)1 and expenditure levels and that the proposed service-specific payment rate promotes primary care, controls spending, and saves money. JEL Classification I11     

The Nature of Ethics Codes in Franchise Associations Around the Globe

The worldwide growth of franchising has been phenomenal during the past decade. At the same time there has been increased media attention to questionable business practices in franchising. Similar to some trade associations and professions, franchising has sought self-regulation by developing codes of conduct or ethics. This study examines the codes of ethics covering franchising activities in 21 countries. The results reveal that there is considerable variation in the activities/issues covered by the codes. Specifically, the codes cover most stages of the franchising relationship, focus on a narrow set of stakeholders, are short on ethical guidance, and offer few enforcement provisions. The implications of these findings for international franchising and research are discussed.     

Accounting and Medicine: An Exploratory Investigation into Physicians’ Attitudes Toward the Use of Standard Cost-Accounting Methods in Medicine

Research studies demonstrate wide variation in how physicians diagnose and treat patients with similar medical conditions and suggest that at least some of the variation reflects inefficiencies and unnecessary medical costs. Health care researchers are actively examining ways to reduce variations in practice through standardization of medicine to reduce the cost of treatment and ensure the quality of outcomes. The most widely accepted form of this standardization is Evidence Based Best Practices (EBBP). Furthermore, financial health care providers such as hospitals and managed care organizations are investigating methods to tie resource usage to medical protocols in their efforts to monitor and control health care costs. Such proposals are contentious because they report on physicians’ medical practice behaviors (such as the number of tests ordered, use of specific therapies, etc.) and such reports could potentially be used to influence their clinical behaviors. The intent of this exploratory study was to examine physicians’ perceptions about linking a standard costing system to EBBP guidelines. The authors interviewed nine practicing physicians asking each physician to respond to the question, ‘As a physician working in a hospital environment, what are your reactions to and concerns with combining standard costing techniques with EBBP?’ The interviews were in-depth and free form in nature. The physicians’ responses were recorded and analyzed using Grounded Theory Methodology. Using this methodology the field data was categorized into two major themes. The most important theme centered on ethics and the second theme was concerned with the implementation and use of a standard cost system in regard to EBBP. If physicians’ worries about ethical dilemmas and implementation issues are not resolved, then it is likely that doctors would be unwilling to participate in any efforts to develop or use a standard cost-reporting system in medicine. While this study was exploratory in nature, it should provide future guidance to accountants, health care researchers and health care providers about physicians’ issues with the use of standard costing methods in medicine.     

Identifying uniform employment-termination practices for multinational employers

After a review of the diverse laws governing termination of employment in 11 countries, the authors note patterns across the different legal systems. For example, all but two of the eleven countries required some form of just cause for dismissing an employee. Several mandated various forms and schedules of notice, and a few required some form of remuneration or severance payment—sometimes in lieu of notice. Additionally, some countries gave the workers the chance to appeal their dismissal, often with the assistance of third parties. Although the authors consider it unlikely that the severance-pay idea will become a blanket policy (since some countries don't require severance pay), they adduce a set of standards that could provide a uniform termination process across all 11 nations. The strategy underlying such a uniform policy is to make its provisions fit the laws of the most restrictive nation, by using a just-cause standard in all dismissals. While that adds some personnel cost, on balance, the authors argue that establishing cause for dismissal protects the employer from future claims and could save money in the long run. It also forces managers to make a specific effort to remediate employment issues and to try to help struggling employees.     

Is there an easy cure for low growth?

The U.S. economy faces sizeable headwinds to keeping GDP growth even at 2% over the next decade. Demographics imply that labor force growth will be much slower than historical norms. The enormous twentieth century increase in average educational attainment is unlikely to be repeated. And the best guess for productivity growth is that it will continue to be modest—perhaps along the lines seen in the 1970s to early 1990s, or since 2004. There are no easy cures for low growth. We can hope for another wave of broadbased IT-linked innovation. But while there is enormous uncertainty, even worthwhile policy steps are unlikely to move the dial very much on their own.     

An Emerging Model for Purchase and Consumption of Non-Prescription Drugs

This paper presents the results of exploratory surveys which describe the behavior of the buyer and consumer of over-the-counter (OTC) drugs. The results are summarized in a simple decision model which describes the information search process under various conditions of symptom severity, user satisfaction and brand familiarity. Implications are discussed for regulating problem consumption. In particular, advertising and labeling regulations seem unlikely to reduce patterns of heavy usage observed in the research. Problems arising from the self medication process must be examined in a broader context of health care behavior.     

Making Health Care More Affordable Through Health Insurance Finance Reform

The way that we finance health insurance today is both unfair and inefficient. The tax code subsidizes the most expensive employment-based policies while penalizing those who buy insurance on their own or choose more basic policies. By reforming this system, we can both make health care more affordable for millions of people and get higher-value care for the money that we spend. These reforms should be coupled with policies to ensure that basic private insurance is affordable for everyone, including those with chronic health conditions or low income, and to ensure that patients and physicians have the tools that they need to make well-informed decisions. JEL Classification I11     

Theoretical considerations for a meaningful code of professional ethics

The professions have focused considerable attention on developing codes of conduct. Despite their efforts there is considerable controversy regarding the propriety of professional codes of ethics. Many provisions of professional codes seem to exacerbate disputes between the profession and the public rather than providing a framework that satisfies the public's desire for moral behavior.After examining three professional codes, we divide the provisions of professional codes into those provisions which urge professionals to avoid moral hazard, maintain professional courtesy and serve the public interest. We note that whereas provisions urging the avoidance of moral hazard are uncontroversial, the public is suspicious of provisions protecting professional courtesy. Public interest provisions are controversial when the public and the profession disagree as to what is in the public interest. Based on these observations, we conclude with recommendations regarding the content of professional codes.Karim Jamal is an Associate Professor in the Department of Accounting at the University of Alberta. His research interests are in modelling judgment processes of individuals in professional firms and financial markets. He is currently involved in research on the auditor-client negotiation process, the role of framing effects in masking fraud as well as the means by which frauds are detected, and tensions in professional codes of conduct especially between confidentiality and public disclosure.Norman E. Bowie is the Elmer L. Andersen Chair in Corporate Responsibility at the University of Minnesota. He is the co-editor ofEthical Theory and Business and has published numerous books and articles in business ethics and political philosophy. His most recent book isUniversity Business Partnerships: An Assessment.