FOCUS: Health Care as Business Introduction

One of the commonest complaints in Britain against the current National Health Service is that business and commercial values are being allowed, and even encouraged, to dominate the more humane values involved in caring for people in their weakness. What is the situation and where are the problems, and what can Britain learn from Germany and Holland? We are grateful to the distinguished author on business ethics and member of our Editorial Board, Professor Tom Sorell, for undertaking the production of this FOCUS section of the October Review on such a sensitive and topical issue.     

德英两国医疗保障模式比较分析:俾斯麦模式和贝弗里奇模式

本文通过对德国社会医疗保障体制(俾斯麦模式)和英国全民医疗保障体系(贝弗里奇模式)的基本理念、筹资、偿付、服务提供规制的描述,勾勒出两大体制的核心特征,分析它们面临的问题和挑战,并对其改革进行了评判,在此基础上指出了对我国医疗保障制度改革的借鉴意义.     

FOCUS: Ethics in Business and Health

"The NHS may not, on a tight definition, be a business, but it has an obligation to its financial stakeholders (the tax-payers), and this implies an ethical obligation to be business- like. This means it must be as well-managed as it is well-meaning." The author is Chairman of St George's Healthcare NHS Trust. Until 1988 she was Head of the Department of Politics at Queen Mary and Westfield College, University of London, where she is now Visiting Professor. She is a non-executive director of Norwich Union and of the HMV Group and her most recent book is Business Ethics at Work , Cambridge University Press, 1995.     

Current Issues in the Provision of Health Care Services

Our society is developing the consensus that adequate health care is the right of all citizens, rather than a privilege of the wealthy or a welfare benefit of the poor. At the same time, the current crisis in health care seems to question the feasibility of making this consensus a reality. A vast array of complex and interrelated issues are involved in the problem of providing health care services. This paper reviews these issues from the consumer's perspective.     

FOCUS: German Banks - What Role do they Really Play?

The Spokesman of Deutsche Bank's Board of Managing Directors delivered The Gilbart Lecture on Banking last year under the auspices of King's College London at an occasion sponsored by the National Westminster Bank plc and organised by the Chartered Institute of Bankers. The text of Herr Kopper's lecture is reproduced here with permission.     

FOCUS: Business Ethics in Europe Current Developments in German Business Ethics

Germany is at the leading edge of European reflection on the nature and requirements of ethical business. Two scholars in the field provide a survey of the main lines of discussion in the current German business ethics scene, and discuss three important books which are helping set the scene for further developments. Prof. Dr. Horst Steinmann holds the Chair for Business Administration and Management at the University of Erlangen-Nürnberg, Lange Gasse 20, D-90403 Nürnberg, and Dipl.-Hdl. Brigitte Kustermann is research assistant to the same chair.     

FOCUS: New Ethics in a Future Dutch Health Market

Changes being introduced to deregulate the Dutch health care system after decades of extensive state control are to be welcomed, and will in future require consumers to be 'well-informed, cost-conscious and assertive patients, who are aware of their responsibility for their own health.' R.B. Kool MD, PhD and E.J.J.M. Kimman PhD are attached to the Department of Business Ethics in the Faculty of Economics and Econometrics at The Free University, P.O. Box 7161, 10107 MC Amsterdam.     

A Synthesis Model of the General Health Care System

A synthesis model of the general health care system is developed based on literature from a variety of disciplines. The synthesis model is then used to create a theoretical framework of fundamental laws and derivative propositions. The integrated synthesis model and the theoretical framework should provide opportunities for future research. For the practitioner, they provide a macro-oriented understanding of the general health care system and the activities that are crucial within the system. Several practical examples that are based on interviews and case studies with health care providers are used to explain the elements in the synthesis model.     

Crossing Industry Borders: German Manufacturers as Services Exporters

Manufacturing firms increasingly engage in service trade activities. Microlevel data show that German manufacturers accounted for nearly 30 billion euros of service exports in 2005. I have found that particular construction, engineering and R&D services are exported. The machinery industries, motor vehicles and chemicals producers dominate the overall pattern. The types of services exported vary strongly across industries. Service exports of advertising, data processing, management and R&D services are found to likely support foreign affiliates of firms. However, these headquarter services are only infrequently observable. Much more important are construction and engineering services exported by machinery firms. These might represent installation and maintenance services complementing exported machinery. R&D services exports generally represent the transfer of knowledge and technology, which is found to be particularly relevant for motor vehicle producers. Beyond the support of foreign production of firms, R&D services might be relevant also in R&D cooperations of firms or when firms have partnerships with foreign suppliers or buyers of intermediate products.     

Health Care Matters: Supply Chains In and Of the Health Sector

Providing health care involves a complex enterprise, and the trade‐off between quality and cost has been particularly stark compared to other industries. However, a recent focus on health sector supply networks is now producing significant innovations and improvements. This Special Topic Forum illustrates for the academic and practitioner community how health care supply chain research can benefit from our evolving understanding of supply chains and help push that understanding even further. We classify health care supply chain research into two broad categories—supply chain in health care and supply chain of health care—to set an agenda for future research.     

Customer Perception in the Health Care Sector:

Customer perceptions of quality play a major role in the success or failure of an organization. Their perception also serves to determine their level of satisfaction or dissatisfaction. This paper will discuss those factors that the customer perceives as "quality" factors and how those factors affect satisfaction. The second section of the paper will look at who is (or should be) responsible for implementing and carrying out the goals of a quality improvement program. A case study of a large hospital located in the American Midwest is also presented. Finally, recommendations for the best way to begin a quality improvement program (i.e., measure customer perceptions of quality, involving everyone, and making a real commitment to this program--forever) will be given.     

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。     

Consumer Attitudes Toward Health and Health Care: A Differential Perspective

Measures of attitudes of health care consumers toward their own health behaviors and health care institutions reveal the overall pattern of their views as well as their segmented views. Results suggest that some consumers may take a more scientific approach to health care and prevention than others and that demographics, health status, and health consciousness are partial predictors of that consumer approach. Policy makers for health care should formulate and target programs with different segments of the population in mind.     

美国医疗保障制度现状、问题与改革

美国的医疗保障体制是以私人商业医疗保险为主,由公共部门、私人部门和非营利性组织共同构成的,是全世界最复杂的医保体系。长期以来,美国的医疗体制因其高投入低产出———不覆盖全体国民、医疗保健可及性差以及制度缺乏公平性而为人垢病。因此,扩大医保的覆盖率和遏制费用飞涨成为医改主攻方向,美国政府和保险组织进行了一系列诸如管理保健和按病种付费等宏、微观的尝试和改革。从中我们可以得到一些对中国医疗体制改革有益的启示。     

养老服务业发展背景下智能系统的市场分析

随着老龄化程度的愈发严重,我国老年人基数急剧上升,加上地方性的独生子女政策,越来越多的老年人为了减轻子女的压力选择去养老院。但市面上大多数的养老院并未拥有完整的智能化管理系统,本文所设计和阐述的智能系统可以实现在生活照料、营养膳食、文化生活、健康管理及医疗服务等方面的智能一体化管理。从管理机制、优势、风险及应对策略、可行性等方面展开分析,探讨其市场优势。     

Local Care Services: A Reflection on the Conditions for their Emergence and Development

Local care services are making a comeback in the headlines (with the Borloo plan, CAE report). The development of this market (or markets) and the policies linked with them nonetheless give rise to problems. This article seeks to identify the levers on which current policy can rely to become effective and emphasises the shortcomings that need to be resolved to ensure impetus. It attempts to specify certain macrosociological and macroeconomic conditions, and analyse the conditions specific to demand and the constraints in building efficient supply that may explain the failures of the policies implemented so far.     

Bending and Stretching the Health Care Cost Curve

The Patient Protection and Affordable Care Act of 2010 (PPACA) has a number of provisions that aimed at slowing the rate of growth of health care spending. This paper examines the most prominent of these provisions and finds them to be seriously flawed and unlikely to deliver savings as intended. They are either too weak or liable to compromise quality. Moreover, some of the most important drivers of health care costs, such as fee for service payments to physicians under Medicare or limitations on physician liability are not addressed adequately. Thus, it is unlikely that the PPACA in its present form will do much to reduce the growth rate of health care expenditures.