Complementary and alternative medicine: Consumers in search of wellness or an expression of need by the sick?

The provision of health care in Western societies is examined in relation to the arrival of complementary and alternative medicine (CAM) as a serious provider in the latter half of the 20th century. This article examines the underlying components of the increasing uptake of CAM and attempts to cluster health‐care consumers according to their attitudes and motivation toward the use of health‐care products and services. The analysis does not support the idea of a widespread uptake of CAM practitioner treatments on the part of the general public except for particular segments of that public, including the seriously ill. There is also little evidence of exclusive use of CAM for personal health care. On the other hand, there is significant evidence for an uptake of non‐practitioner‐based CAM by wider segments of the population. The findings raise issues regarding the evidence for the efficacy of CAM and the methodology for testing it. These are discussed. © 2004 Wiley Periodicals, Inc.     

韩国疗养保健客源市场分析

疗养保健客源市场是发展涉外疗养保健服务贸易的关键所在。早在2000年韩国已经步入老龄化社会,且老龄化趋势持续进一步加剧。利用韩国统计厅公布的资料,从韩国的人口结构、医疗保健、社会环境、社会福利分析入手,深入研究韩国疗养保健客源市场,发现韩国特定的人口结构状况及医疗保健等方面存在诸多问题,可为我国开发韩国老龄人口疗养保健市场提供可能性和必要性。     

Examining the Landscape of Managed Behavioral Health Care Through the Market Paradigm

ABSTRACT

The purpose of this article is to examine the market paradigm's impact on private practicing social workers, psychologists and psychiatrists who are reimbursed for services by managed behavioral health care organizations (MBHCOs). Five hundred eighty-two private practitioners from across the nation responded to a mailed survey in which they were asked a series of questions concerning changes in their business practices subsequent to joining MBHCO provider panels. Results indicate that despite the concerns about MBHC, these practitioners have sustained their practices. The market paradigm's use in explaining MBHC's impact on the private practitioners was found to have limited utility.     

Consumers’ evaluation of allocation policies for scarce health care services: Vested interest activation trumps spatial and temporal distance

The allocation of scarce health care service resources often requires trade-offs between individual and collective outcomes (e.g., when some individuals benefit more strongly from a given policy than others). Based on construal level theory, one would expect that consumers cognitively represent the individual and collective outcomes of an allocation policy at different levels of abstraction and that they evaluate allocation policies more positively when there is congruency between the cognitive representation of the policy??s focal outcome and the spatial and temporal distance inherently present in the policy??s decision context (e.g., allocation decisions on a future policy). However, we hypothesize that this congruency effect can be overruled by a high vested interest mindset that is activated by an individual??s recent personal experience with a health care service provider. Since a high vested interest mindset increases the relevance of the allocation policy implementation for the individual because s/he perceives strong personal consequences, we propose that for consumers with recent experience the evaluation of an allocation policy that focuses on individual outcomes is higher than that of a policy that focuses on collective outcomes irrespective of the spatial and temporal distance in the decision context. Results of a hypothetical experiment among a representative sample of the general population confirm the congruency effects in the new domain of health care service allocation policies, and provide support for the proposed overruling effect of the activation of a high vested interest mindset by recent personal experience on spatial and temporal distance.     

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.     

Hope across the seas: the role of emotions and risk propensity in medical tourism advertising

Rising US medical costs as well as more competition in the health care industry have led many Americans to pursue health care in foreign destinations. As a result, leading countries in medical tourism have begun launching international advertising campaigns. A growing trend in much of this advertising is the use of emotional appeals. The purpose of this research is to examine whether the use of emotional appeals by non-domestic health care providers contributes to more favourable evaluations of the target health care provider than rational appeals. Specifically, two experimental studies investigate the efficacy of advertisements that induce the emotion of hope to determine whether these advertisements increase trust perceptions and reduce perceived risk, given an individual's level of risk propensity. Implications for public policy makers and marketing managers who work in health care are discussed.     

Innovative healthcare delivery

Critics of the American healthcare system recite a long list of problems, including rising out-of-pocket costs, inconvenient access, overuse of emergency departments, uncoordinated medical records, and declining numbers of primary care doctors. To address these issues, some new venues have evolved, such as retail and urgent care clinics; however, the emergency department has become the only service provider available to all patients on a 24/7 basis. It is time to reinvent the system. The concept of patient-centered medical homes offers a structure for integrating innovations that can transform the delivery of healthcare. In this model, each patient develops an ongoing relationship with a primary care physician supported by a team of caregivers. An integral feature is the electronic medical record, which facilitates coordinated communication and decisions. Access expands beyond the traditional physician office visit to satellite services tailored to individual needs. Services center on whole-person care, including wellness and preventive counseling, as well as acute and chronic care. Adoption of the patient-centered medical home transforms healthcare delivery into a system that benefits everyone.     

The competitive solution and the health care problems of today

Mark Pauly claims that a "competitive" health care system will solve the health care cost crisis. This article examines how well the competitive solution deals with the five central problems of the health care system: (1) almost universal lack of adequate health insurance for nursing homes and home care; (2) Medicaid's penurious approach to payment for health services for the poor; (3) the emergence of a dual health care system, especially for children; (4) the entrenched waste and inefficiency of the health care system; and (5) consumers' inability to judge the quality of health care. The competitive solution does not eliminate any of these problems--and may not even improve some of them.     

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.     

Are Patients Traveling Further?

Managed care has been hypothesized to increase patient travel for health care services by steering patients to more distant providers. This raises access concerns. However, if the result is to expand the geographic extent of provider markets, this may ease antitrust concerns about mergers. This research compares travel distances for patients discharged from California hospitals in 1985 and 1991 controlling for payor, diagnosis, and local market conditions. Privately insured patients were more likely to be in managed care than Medicare patients during this period. We expect travel distances to increase for private patients relative to Medicare patients if managed is leading to greater travel. However, for a random sample of patients excluding births and neonatal discharges, we find no evidence relative travel increased. Nor do we find a systematic pattern of increase when we examine travel for specific diagnoses selected on the basis of the urgency and complexity of care.     

The Relationship of Demographic Characteristics and Importance of Services Offered to Unaided Awareness and Recommendation of Public and Private Mental Health Care Providers

The extent to which demographic characteristics and importance of services offered by mental health providers are related to unaided awareness and recommendation of public and private mental health care providers was assessed. Awareness and recommendation of private providers was found to be stronger among men and among higher income groups. Relative to public providers, these factors were stronger among women and lower income groups. While the services offered do not appear to be strongly related to awareness or recommendation of provider types, some differences were found. Those who are aware of and would recommend a private provider gave higher importance ratings to counseling for suicide and life changes - those who are aware of and would recommend a public provider gave higher ratings to counseling for spouse abuse, depression, and eating disorders, and treatment for major mental illness.     

Towards an understanding of health care purchasing: The purchasing behaviour of general practice fundholders 1

In the last few years there have been considerable changes in the National Health Service. Perhaps the most significant of these has been the introduction of competition into health care, that is the split of the health service into purchasers and providers of care. Central to this development has been the introduction of general practice fundholding, whereby practices are able to purchase health care for their patients directly from competing suppliers. Those pradices which have become fundholders have faced considerable challenges in developing their purchasing function. At the same time, provider units in areas where fundholding has become established face an increasingly fragmented purchasing base.

Building on existing theoretical work into the nature of organizational purchasing behaviour and current knowledge of the health care market in Britain, this paper attempts to develop an understanding of the dynamics of GP fundholder purchasing behaviour.     

英国对消费者电子资金划拨不公平合同条款的管制

电子资金划拨是计算机技术和电子网络技术发展的结果。在消费者电子资金划中 ,由于作为消费者的客户与作为服务提供者的银行之间在经济、技术上的不平衡性 ,银行往往利用标准合同条款将使用计算机技术进行资金划拨所带来的风险与不利后果转嫁给客户 ,对其进行管制以成为现实的法律需要。了解英国电子资金划拨标准合同类型及其管制方式 ,从而对我国消费者电子资金划拨得以借鉴     

Exploring the Role of Ownership Structures in the Results of Professional Health Care Franchises from a Multi-Actor Perspective

This paper explores how the ownership structure of professional health care franchises contributes to the achievement of positive results with franchising for the franchisor, the franchisee, professional service provider, and clients. We conducted a comparative embedded case study with three health care franchises in the Netherlands using data from 101 interviews, observations, and document analyses. We show that different ownership structures at the system-level (i.e., plural form, pure franchise, cooperative franchise) and the unit-level (i.e., stand-alone versus fractional, active versus passive, single versus multi-unit) have different effects as perceived by franchisors, franchisees, and professionals. Moreover, we reveal how this variation in experienced effects can be explained by differences in dynamics in regard to management, decision making, control, steering, support, interests, learning, and adaptation. Based on these analyses, we develop new typologies of ownership structures and show how combinations of system-level and unit-level structures can have mutually weakening or strengthening effects.     

Healthier futures: primary care nurses’ food knowledge and patient advice

In Finland there are valid questions being asked about the sustainability of the current provision in state healthcare systems. Structurally, lower birth rates and greater longevity mean that populations age and present the challenge of chronic illness management in later life for a larger proportion of the population. Culturally, some 50 years after the introduction of a state healthcare system, ageing populations will have greater expectations of service quality than their predecessors. Paradoxically, they will also have a greater engagement with lifestyles which themselves will bring new challenges to long‐term health status. There is no single solution to the complex problem of service sustainability but undoubtedly health education provides some potential to limit future demands. Diet‐related illness and incapacity are specific health challenges for the coming decades but the problems can be substantially reduced by changing current behaviour. To make such changes possible, knowledge needs to be communicated effectively in terms of simplicity, accuracy and with appropriate timing. Health education can make a major contribution to service sustainability. This paper reports a study of primary care nurses (n = 50) in the Tampere area and examines their capacity to provide healthy eating advice. In this sample, nurses often demonstrated good levels of nutritional knowledge on which to base patient advice, but there was considerable variation. Arguably, focused in‐service training would provide updating on theory and practice for more consistent advice and better prospects for behavioural change.     

Why is there a Separation between Distance Selling in EU Law and the Tourism Industry?

Twelve years have passed since the partial exclusion of most tourist services from the Distance Selling Directive (art. 3 para. 2). The application of a particular right of withdrawal to contracts negotiated away from business premises for the provision of these services was considered inappropriate. Out of this consumer protection will be rather weaker than in other distance contracts. Additional information cannot be required from the service provider and rash decisions resulting from an informational disadvantage, i.e., a lack of personal contact, cannot be rectified by terminating the contract. These difficulties can only be partially resolved by referring to other regulations, such as national norms implementing the E-Commerce Directive (arts. 5 to 11) or the new Timeshare Directive (arts. 4 and 5), among others. Recently, the proposal for a Directive on consumer rights of 8 October 2008 maintains the same approach (art. 20 para. 3, art. 3 para 3) and the Draft Common Frame of Reference also coincides to some extent with the exclusion of some tourist services from distance selling protection. The aim of this paper is to review this exclusion by means of examining the dynamics of tourism services.     

What Makes Logistics Integration More Effective? Governance from Contractual and Relational Perspectives

Third-party logistics (3PL) user–provider integration is attracting increasing attention from both academics and practitioners. However, it remains unclear how best to adopt governance mechanisms to safeguard 3PL user–provider integration (e.g., information sharing and process coordination). Based on transaction cost economics and social exchange theory, this study examined the individual and joint effects of contractual (e.g., detailed contracts and contract application) and relational governance (e.g., trust and relational norms) on 3PL user–provider integration for operational performance. We conducted a survey involving 247 3PL service users and analyzed the conceptual model using the method of structural equation modeling. The results showed that process coordination improved operational performance, while information sharing alone did not significantly improve operational performance but complemented the role of process coordination in improving operational performance. In addition, having detailed contracts was positively related to process coordination, while contract application was positively related to information sharing. Trust was not significantly related to information sharing or process coordination, while relational norms were positively related to both. Finally, three joint effects on 3PL user–provider integration were found. Two of them were substitutional (detailed contracts and relational norms; contract application and trust), and one was complementary (detailed contracts and trust). This study makes several theoretical contributions and provides novel guidelines for 3PL relationship development.     

对未来中国养老照护需求的估计

应对人口老龄化国家战略将中期目标定位在2035年、长期目标定位在2050年,从现在开始到2050年只有30年的时间。应对人口老龄化中长期规划的落脚点应该放到老年人身上,目标是解决好老年人的养老问题,并围绕这一目标制定相应的体制和机制,构建养老服务体系,并制定规划。然而,制定规划的起点应该是了解和掌握现在到未来的养老需求。对未来中国人口和老年人口的规模和结构进行估计,在此基础上对未来需要照护的老年人规摸和结构进行估计,结合需要照护老年人的收入情况,估计了不同收入水平下需要照护老年人未来的变化情况,并对不同收入水平下需要照护老年人的特点和获得照护服务的方式进行了分析。     

Economic Perspectives on Health Information Technology

It seems paradoxical that health care spending and examples of inferior health care have been rising rapidly at the same time. An important factor is the slow pace at which the health care system has adopted information technology (IT). This paper discusses the dimensions of the problems that could be mitigated by effective use of IT in the health care system, their consequences, and their potential solutions. It also discusses the economic and institutional barriers to deploying IT and how the inherent economies of scale in IT are likely to lead to new problems of competition within the health care system. Inasmuch as this paper was based on an address followed by a question-and-answer period, it also includes an edited version of the recorded questions and answers.JEL Classification I180, I190     

The organization of relational contracts: The allocation of rights in franchising

Franchising contracts are designed to bring together two kinds of entrepreneurs, the franchiser and the franchisee, and to maintain their relationship in the long run. In contrast to standard exchange contracts in law, which are specifically designed to bring about the completion of an exchange efficiently, franchise contracts are designed to make it possible for the entrepreneurs to initiate, to maintain, and to eventually terminate their relationship without dispute. The research reported in this article is an attempt to see how the dual purpose of franchising contracts are achieved. The article first describes the internal organization of franchise contracts (what we called the micro-contractual aspects) and how different kinds of rights and obligations are allocated to accomplish these multiple ends. The second part of the article provides an empirical examination of 30 franchise contracts to see if the internal organization of the contracts influence both the expansion of the franchise operations through new franchises and the amount of dispute between the two sides of franchise contracts.Every franchise contract includes a set of provisions that define the commencement, termination, and ongoing operations of franchise relations. The internal organization of franchise contracts specifies what kinds of rights and obligations are distributed to the parties and the nature of this allocation within each domain of provisions. We argue that the commencement and termination aspects of franchise contracts are usually written in order to make the relationship between the parties clear, and the contingencies specific. In these provisions, the contract is written in discrete terms in which each party's rights and duties are specifically delineated. The contractual provisions dealing with the ongoing operations and the conduct of the parties, on the other hand, cannot be made specific because it is impossible to define all the future contingencies and possible business opportunities. Under these conditions, the contract is usually written in relational terms in which each party's rights and obligations are defined in terms of powers and liabilities towards each other rather than in terms of specific duties and rights.One critical consequence of writing contracts that include powers and liabilities, however, is that it may lead to disputes and undesirable conflict that are detrimental to the success of the franchise. In order to deal with these conflicts among the parties, the contract needs to specify conflict resolution mechanisms that are an integral part of franchise contracts.These general arguments are tested with the use of 30 randomly selected franchise contracts from a diverse set of businesses. Our results show that, indeed, different parts of franchise contracts allocate rights and obligations differently and the more relational a contract becomes the more likely that it would include various dispute resolution mechanisms. We also found that the success of a franchise contract, which is measured by the number of legal disputes it generates and the growth of franchised units, is influenced by the existence of relational provisions and the explicit dispute resolution mechanisms included in the contract.We recommend that franchise contracts should be written to make the commencement and termination aspect of the relationship as discrete as possible. The operations and conduct provisions of the contract, on the other hand, should be written in relational terms to give the parties the ability to respond to changes in business conditions without renegotiating the contract.It is usually the tendency on the part of franchise lawyers to write discrete contracts that attempt to specify every conceivable contingency to avoid future disputes. We argue here that a better strategy is to limit the discrete aspects of the contract to the commencement and termination clauses and to concentrate more on the dispute resolution mechanisms that can become an integral part of the contract. Thus, we also recommend that various dispute resolution mechanisms, such as franchisee associations, franchisee councils, and third party arbitration should be set up within the contract to address the possible disputes early on rather than to wait for potentially very costly court proceedings for both parties.