Total quality in health care

Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects.     

Environmental laws in health care

Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations. The designated person or department must work closely with the hospital's attorney to make sure that he or she stays current on environmental laws and keeps the institution adequately advised of its legal responsibilities.     

Quality in health care: possibilities and limitations of quantitative research instruments among health care users

Quality in health care has traditionally been dominated by medical profession, where patients’ opinions were labelled as lay evaluation. Patients’ views and opinions are important because they give us an insight into dimensions of quality that are not evaluated by medical profession and often seem to be more important. In health care quantitative methodology is often used to address these quality dimensions and introduce patients’ views and opinions. There are various benefits using quantitative research instruments, such as a detailed analysis of the importance of various quality dimensions for patients and an analysis of factors influencing patients’ satisfaction. On the other hand serious deficiencies can be tackled too, that are usually dealt with qualitative research instruments, because they go deeper into people’s motives and feelings. However, health care service is specific—it is very important to patients (health is one of the most important values), but their participation in health care service is rather low. They also don’t always say and do what they mean. In such a context combination of quantitative and qualitative research instrument does not give satisfactory answers. The importance of complaints is stressed and rewards for taking them seriously and acting upon them is discussed.     

Efficiency and productivity change in Ukrainian health care

The study analyses technical efficiency and efficiency change of 193 community hospitals and polyclinics across Ukraine, for the years 1997–2001. These facilities are a subset of the medical institutions in rural Ukraine; they are identical w.r.t. their function in the health system and share the same departmental structure. The data comprise the number of beds in the hospitals, the number of staff employed in the hospitals as well as the polyclinics connected to the hospitals, the number of inpatient and outpatient admissions as well as the number of surgical procedures, lab tests, X-rays performed and the number of deaths and deaths after surgery. Because of the known sensitivity of traditional nonparametric frontier estimators to outlier observations, we employ an order-m estimator, a robust technique, to assess the efficiency of these health care providers as well as changes of their productivity time. The efficiency scores are calculated with an output-oriented model; they are close to unity for hospitals whereas polyclinics seem somewhat less efficient. The Malmquist-indices averaged over all observations are close to unity indicating that productivity does not change over during our observation period. But, depending on the period and the region, substantial deviations from unity can be observed.

Requirements planning systems in the health care environment

An important problem confronting health care administration is cost containment in hospitals. Much of the current high costs can be traced directly to outdated procedures in materials management leading to waste, excessive inventory and unnecessary obsolescence of expensive short shelf life items. In this paper, we illustrate how a modern requirements planning system for surgical supplies was developed for a private hospital in Houston and used to effectively hold inventory levels to the minimum required to support a detailed schedule of surgical procedures. We also discuss some specific problems involved in the transfer of manufacturing technology to the hospital setting.     

Strategic decision support in preventive health care.

This nontechnical interdisciplinary paper highlights major principles of strategic decision support in preventive health care and points to selected key literature. It begins by looking at preventive health care from strategic perspectives such as determinants of health, health care costs, objectives of prevention, political order constellations and available data. Next, the paper identifies strategic decisions and decision-making to be supported. Having gained strategic perspective, it discusses tools for decision support. These tools are here related to two planning steps (i) assessment, problem and goal analysis; and (ii) design and choice of alternative interventions. Qualitative as well as quantitative aspects of computer-assisted policy analysis in preventive health care are outlined and examples presented.     

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.     

A note on health care inflation

A key issue in health care reform is the need to contain the inflation rate of the CPI for health care services without substantially reducing the quality of health care. Althought the previous literature has widely debated the causes of increasing inflation in the CPI for health care services, very little has been done to empirically test these arguments. We use an econometric framework that allows us to expressly examine the determinants of the inflation rate of the CPI for health care services. The data cover the period from 1960–1994. The main results provide empirical verification for many of the demand-side and supply-side theories of the inflation rate of the CPI for health care services that have been widely discussed in the literature.