Integrating Management Control and Human Resource Management in Public Health Care: Swedish Case Study Evidence

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.     

SARS,公共财政与公共卫生

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。     

The Role of Prices for Excludable Public Goods

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.     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程,并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例,探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

印度的医疗卫生融资改革

印度公共医疗卫生支出水平较低,且在各邦之间分布不均。中央政府拨款对于各邦政府自身医疗卫生支出具有替代性。本文认为,要推进印度医疗卫生事业改革,必须扩大公共医疗卫生支出,提高政府支出效率,并重新设计转移支付制度。     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程，并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例，探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

Implementing Evidence-Based Practice in Health Care

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.     

Working Across Professional Boundaries: Primary Health Care and Social Care

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.     

From Sickness to Health? Public Health in England

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.     

Accounting, Modernity and Health Care Policy

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.     

The Rise and Rise of Evidence in Health Care

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.     

医保改革面临挑战

当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。     

医保改革面临挑战

当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

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.     

The Marginal Cost of Funds and the Shadow Prices of Public Sector Inputs and Outputs

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.     

Performance Measurement in Health Care: History,Challenges and Prospects

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.     

Performance Measurement in Health Care: History, Challenges and Prospects

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.     

Predicting the Frequency and Amount of Health Care Expenditures

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.