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Sven Modell 《Financial Accountability and Management》2000,16(1):33-53
The debate on management reforms in the public health care sector has largely overlooked the role of human resource management (HRM) and its potential interaction with traditional management control (MC) mechanisms. This paper explores which factors associated with the integration between MC and HRM may foster organisational learning in a public health care setting. A case study in a public dental practice is used for examining this issue. Apart from highlighting the influence of various task characteristics, the case study suggests that the vertical as well as horizontal dimensions of integration are important to consider in this context. Implications for further research are discussed. 相似文献
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为应对SARS危机,中央财政已从多方面采取措施。其中,有关税收政策方面的调整颇为引人注目。SARS危机的发生,对我们的公共卫生服务体系的冲击是巨大的,同时,对我国财政支付的能力也提出挑战。 相似文献
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When a public good is excludable it is possible to charge individuals for using the good. We study the role of prices for publicly provided excludable public goods within an extension of the Stern-Stiglitz version of the Mirrlees optimal income tax model.We show that for a public consumer good there is a range of circumstances in which charging a price for the public good decreases welfare. We find that a necessary condition for a positive price to be desirable is that the marginal valuation of the public good is increasing in leisure. However, even under this condition, welfare is initially decreasing in the price, implying that charging a lower than optimal price may be less efficient than setting a zero price. Thus, even when there is a case for charging a price for the public good, an attempt to implement the optimum in practice may be risky, as even setting a modest price to avoid overshooting the optimum may be Pareto inferior to charging no price at all. The policy case for a price may thus appear rather weak. We also find that producers using an intermediate excludable public good as an input should not be charged a price for using the good. 相似文献
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This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application. 相似文献
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Effective joint working between health and local authorities, and between health, social services and housing professionals, has long been recognized as vital to the provision of 'seamless' services for the most vulnerable members of society. Unfortunately, the history of formal joint working over the past 20 years has been largely a poor one. In this article the authors outline the findings from a recent study of working alliances across the primary health care/social care boundary. They examine how obstacles are being overcome and how, in some localities, the essential ingredients of inter-professional and inter-organizational trust are leading to the improved integration of services. 相似文献
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Rob Baggott 《公共资金与管理》2005,25(4):229-236
Public health is currently high on the political agenda, perhaps at its most prominent for a generation. Yet various policy initiatives to improve public health have been regarded as unsuccessful, while the National Health Service is still seen as a 'sickness service'. This article explores the development of public health policy in England and asks whether it is likely to become a key driver of policy and service provision in the future. 相似文献
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Irvine Lapsley 《Financial Accountability and Management》2001,17(4):331-350
The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy. 相似文献
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Health care practitioners (especially doctors) have always given assurances that what they do is efficacious. But in the past 50 years justification of the effectiveness of health care interventions has attained a new prominence. Evidence, at least notionally, now lies at the heart of health care policy and practice. This article provides an overview of the generation and use of evidence on effectiveness in health care. It explains why rigorous methodologies have taken hold and describes the major preoccupation with trying to ensure that research evidence has an impact on clinical practice. The strengths and weaknesses of evidence-based health care are explored to identify the opportunities for profitable transfer of experience across the public sector. 相似文献
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This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers. 相似文献
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Liqun Liu 《International Tax and Public Finance》2004,11(1):17-29
Existing studies on the marginal cost of funds (MCF) do not incorporate the public sector inputs explicitly. Incorporating labor and capital as public sector inputs raises questions concerning the definition and the usage of the MCF, and its relation to public sector shadow prices. This paper finds that the MCF should be defined based on the excess revenue rather than the gross revenue; that general equilibrium effects on individuals' net income and government's inframarginal expenditures should be incorporated; and that the MCF measures an element in the shadow price that is solely attributable to the marginal financing, justifying the role of the MCF in cost-benefit analysis and tax reform. 相似文献
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Peter C. Smith 《公共资金与管理》2013,33(4):213-220
A confluence of forces has resulted in massive changes to the collection and use of performance data in the UK health system over the past 25 years. Performance measurement offers major potential benefits for clinical professionals, managers, regulators, politicians, researchers, patients and citizens. However, uncritical reliance on performance data can lead to a number of unintended and adverse consequences. The National Health Service has pioneered the assembly and dissemination of performance data from the early 1980s. This article summarizes the history of performance measurement in the NHS, assesses its effectiveness to date, discusses the major challenges in deploying performance measures, and highlights priorities for policy-makers. 相似文献
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Peter C. Smith 《公共资金与管理》2005,25(4):213-220
A confluence of forces has resulted in massive changes to the collection and use of performance data in the UK health system over the past 25 years. Performance measurement offers major potential benefits for clinical professionals, managers, regulators, politicians, researchers, patients and citizens. However, uncritical reliance on performance data can lead to a number of unintended and adverse consequences. The National Health Service has pioneered the assembly and dissemination of performance data from the early 1980s. This article summarizes the history of performance measurement in the NHS, assesses its effectiveness to date, discusses the major challenges in deploying performance measures, and highlights priorities for policy-makers. 相似文献
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Edward W. Frees PhD FSA Jie Gao PhD Marjorie A. Rosenberg PhD FSA 《North American actuarial journal : NAAJ》2013,17(3):377-392
Abstract This article extends the standard two-part model for predicting health care expenditures to the case where multiple events may occur within a one-year period. The first part of the extended model represents the frequency of events, such as the number of inpatient hospital stays or outpatient visits, and the second part models expenditure per event. Both component models also use independent variables that consist of an individual’s demographic and access characteristics, socioeconomic status, health status, health insurance coverage, employment status, and industry classification. The second part of the model also includes a variable representing the number of events to predict the expenditure per event, thus capturing dependencies between the first and second parts. This article introduces closed-form predictors of annual total expenditures and demonstrates how to create simulated predictive distributions for individuals and groups. The data for this study are from the Medical Expenditure Panel Survey (MEPS). MEPS panels 7 and 8 from 2003 were used for estimation; panels 8 and 9 from 2004 were used to validate predictions. This annual expenditures model provided a better fit to the data than standard two-part models. The count variable was significant in predicting outpatient expenditures. The aggregate expenditures model provided better point predictions of held-out total expenditures than competing models, including the standard two-part model. The predictive distribution for aggregate expenditures for small groups is long tailed, with both the variability and skewness decreasing as the group size increases, an important point for programs designed to manage expenditures. 相似文献