护士自愿离职成本的研究进展

新医改和优质护理工程都要求对护士的离职问题予以重视,但目前的研究多是集中于护士离职的前因变量或结果因素的分析,而对护士离职成本这一组织最关心的问题却很少涉及。根据文献研究和综合分析对护士自愿离职成本的因素和计算进行分类整理,显示护士自愿离职成本可分为直接成本和间接成本。关注护士离职成本,可采取有效措施解决护士离职率过高的问题,对未来的理论研究和医疗实践提供了参考。     

GROUPED VARIATION IN FACTOR SHARES: AN APPLICATION TO MISALLOCATION

A striking feature of microlevel plant data is the presence of significant variation in factor cost shares across plants within an industry. We develop a methodology based on cluster analysis to decompose cost shares into idiosyncratic and group-specific components. We apply our methodology to Chilean plant-level data and find that group-specific variation accounts for approximately one-third of the variation in cost shares. We study the implications of these groups in cost shares on the gains from eliminating misallocation. We place bounds on their importance and find that ignoring them can overstate the gains from eliminating misallocation by up to one-third .     

Cost of hospital care for elderly at risk of falling

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions.     

Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.     

Multi-product costs and standby capacity derived from queuing theory: the case of Belgian hospitals

Empirical hospital cost function studies can be divided into two categories: studies estimating traditional multi-product cost functions and studies including demand uncertainty (assuming that hospitals provide standby capacity to cope with uncertain demand and stressing that the relationship between the uncertain demand, excess capacity and costs should be investigated). Most studies include (the inverse of) the occupancy rate in a relatively basic cost function. The first contribution of this paper is to incorporate an indicator of reserve capacity into a genuine multi-product cost function. The second contribution is to propose an alternative indicator to proxy the reserve margin. The often used occupancy rate has an important shortcoming: the same occupancy rate can hide different turnaway probabilities and waiting times, obscuring the true degree of reservation quality. Since turnaway probabilities and waiting times are typical queuing theory indicators, an indicator for average waiting time (derived from queuing theory) is incorporated into a proper multi-product cost function to capture the degree of standby capacity into a proper multi-product cost function. The study uses 1997 data on Belgian general care hospitals to estimate a multi-product cost function and calculate cost elasticities, marginal costs and the degree of economies of scale. The results further show that providing standby capacity has a significant impact on total costs.     

Estimating an hedonic translog cost function for the home health care industry

Medicare home health care plays an important role in providing cost effective care for the chronically ill and elderly. Long seen as a cost effective substitute for nursing home care, home care has become even more important with expenditures increasing by 31.4% from 1990 to 1996. The purpose of this paper is to provide a short run cost analysis of a sample of home health care providers to gain insight into the efficient provision of home health care services. This paper is a significant improvement over previous studies in that it uses a nationwide database to more accurately represent the multiproduct nature of the industry and uses an hedonic translog cost estimation with desirable economic properties.     

Politics, economics, and nursing shortages: a critical look at United States government policies

The economic concept that the independent actions of buyers and sellers tend to move the market toward equilibrium where there is no shortage or surplus is basic in the classic and current literature of economics. The problem with subsidies is that nurses who receive subsidized educations are able to provide nursing services for less compensation because they paid less or nothing for their educations. Subsidies may be politically appealing, but they override market forces of supply and demand. The demand for nurses and nursing instructors can be met and maintained for generations to come with policies that expand roles and reimbursement for APNs and encourage the nurse and nursing instructor labor markets to correct themselves by providing fair compensation under Magnet status working conditions. Politics and policies meant to correct the nursing shortage should focus less on how to reduce the cost of producing nurses, and more on how to afford to compensate nurses with wages and benefits that achieve market equilibrium.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.     

In or out: efficient inclusion of installations in an emissions trading scheme?

Regulators around the world are currently considering national emissions trading schemes (ETS) as cost-effective instruments to reduce greenhouse gas emissions. In the process, they are confronted with numerous design issues. The coverage of installations in an ETS is one such issue. While “blanket coverage” that includes all industrial emitters of greenhouse gases in an economy has some intuitive appeal, and seems equitable, it does not take into full account all the costs related to the extent of coverage. This paper shows that an alternative approach of “partial coverage” based on benefit–cost analysis can achieve the same emission reduction outcome at lower social cost. The approach is based on maximizing the benefits from inclusion of installations in an ETS at the same time as taking all relevant transaction costs into account. A broad definition of transaction costs is used, which covers the regulatory costs to the government as well as regulatory costs imposed on covered installations. We find that particularly for relatively modest emissions reduction targets the cost savings of a “partial coverage” compared to “blanket coverage” are significant.     

Strategic planning of optimal resource allocation in response to global financial crisis – a study of international tourist hotels

This study is principally designed to examine the changes in the efficiency, effective resource allocation and future operation strategies of Taiwan's international tourist hotel in global economic downturn. At first, we set up critical input and output factors and construct an assessment model using Data Envelopment Analysis (DEA) for analysis of relative efficiency. Further, we apply an allocative efficiency model for additional considerations of each input cost and analyse proper and effective resource allocation. Finally, there are significant changes in overall efficiency of international tourist hotels under global financial crisis. We can also reach an effective allocation of the overall resources. In such cases, lowering cost has become a key issue for sustainable operation of international tourist hotel. Finally, the greatest contribution of this study is to further classify the competitiveness and optimal cost allocation of Taiwan's international tourist hotels into seven categories based on the study results and propose strategic planning of future operations for hotel administrators’ reference in making improvements in the future.     

A magnetic strategy for new graduate nurses

With the shortfall of nurses, more health care organizations are actively recruiting new graduate nurses. To translate active recruitment to successful retention, however, these newest nurses need support to make the adjustment from the security of a protected academic environment to the demands of a professional nursing career. Nursing turnover occurs when their role transition is unsuccessful. A unique model implemented in 2003 transformed new graduate nurses into confident staff nurses in an acute care setting. The insights gained and the investments required for a "magnetic" strategy to make new graduate nurses successful new staff nurses who stay with the organization are revealed.     

Hospital staff shortage: the role of the competitiveness of pay of different groups of nursing staff on staff shortage

Shortages of nursing staff in OECD countries have been a preoccupation for policy makers. Shortages of staff may be the consequence of uncompetitive pay. In the private sector, employers in different regions can offer different pay rates to reflect local amenities and cost of living. Hospitals in the UK however cannot set the pay for their employees, and as a result they might therefore incur staff shortages. Moreover, occupational groups do not operate in isolation. Shortages of staff may also be the consequence of the competitiveness of pay of an alternative group of staff. This is investigated using two distinct groups of nursing staff: assistant nurses (ANs) and registered nurses (RNs) working in English hospitals in 2003–2005 using national-level data sets. We find that an increase by 10% of the pay competitiveness of RNs decreases the shortage of both the RNs and of ANs by 0.6% and 0.4%, respectively.     

公共政策的经济学分析

任何一项公共政策的制定和实施都需要付出一定的代价,关键在于这种代价能不能承受,值不值得承受。经济学与公共政策有着密切的联系,即使是一些看起来与经济问题无关的公共政策,如果细心分析总是可以发现其中的经济学逻辑。这一逻辑告诉我们,公共政策是通过比较其成本和收益而产生的,公共政策存在的理由在于它的社会成本小于以市场和企业自行解决的方式来解决问题。     

商务网站的成本与效益分析

探讨了商务网站成本的构成与测算方法、商务网站效益的构成、体现与分析方法以及商务网站成本与效益的总评价。商务网站成本,根据系统生长阶段分为开发和运行维护成本;根据组成要素分为技术、安全、配送、法律和风险成本,其测算方法有函数法和保本法。商务网站效益由直接、间接经济效益,近期、中期、长期经济效益,有形、准有形、无形经济效益构成,可进行事前、事中和事后评价。商务网站成本与效益的总评价方法有净收益法和边际效益法两种。     

Staff nurse financial management committees--the nurse manager's guide to effective financial performance

As Cohen states (1991, p. 25), "The future role that nursing will play in the health care delivery system is one of many major issues faced by contemporary nursing...Nursing must be able to determine realistically the cost of and evaluate the effectiveness of nursing care provided to its patients." A unit-based financial management committee is one very effective way of teaching the skills needed for the professional nurse to advance the practice in financial management. This will help nursing gain the professional status that they have always worked for. But beyond these very lofty ideals, a staff nurse managed financial management committee can make the nurse manager's life much easier. Staff nurses need to understand and accept the importance of managing the financial as well as the quality side of patient care. When this happens, the budget becomes theirs. Nurses develop a sense of ownership of the budget and learn how to effectively manage the unit's finances. Much staff nurse brain power is not used. Systems must be developed to access nurses' effective ideas for financial management--first in a financial management committee and then on the unit. Not only will this develop the professional status that nurses need and deserve, but it will also impact the cost of health care. In a society where the cost of an appendectomy requires Dayton Hudson to sell 39,000 Ninja Turtle action figures, Atlantic Richfield to sell 192,000 gallons of gas a day, Anheuser-Busch to sell 11,627 6-packs of 12 oz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Uniform Versus Discriminatory Tariffs

We analyze the non‐cooperative interaction between two exporting countries producing differentiated products and one importing country when governments use optimal policies to maximize welfare. The analysis includes product differentiation, asymmetric costs, and Bertrand competition. For identical exporting countries we demonstrate that the importing country always prefers a uniform tariff regime while both exporting countries prefer a discriminatory tariff regime for any degree of product differentiation. If countries are asymmetric in terms of production cost then the higher‐cost exporter always prefers the discriminatory regime but the lower‐cost exporter prefers the uniform regime if there is a significant cost differential. With cost asymmetry the announcement of a uniform tariff regime by the importer is not a credible strategy since there is an incentive to deviate to discrimination. This implies an international body can play a role in ensuring that tariff agreements are respected.     

以交易成本理论探究网路消费者行为

本研究旨在结合交易成本理论与其它影响因子（如产品品质、知觉风险与知觉价值）,试图发展整合型研究模式以探究网路消费者行为。实证分析方法主要运用叙述性统计分析、因素分析、信度分析与路径分析。研究发现网路服务品质、产品品质与交易成本均对于知觉风险与知觉价值存在显着的地影响效果。其次,知觉风险与知觉价值也会对网路购买意图产生显着影响效果．此外,实证分析结果亦显示网路服务品质、产品品质与交易成本均可透过知觉风险与知觉价值,对于网路购买意图产生影响效果。     

Violence against nurses and its impact on stress and productivity

The purpose of this study was to examine how violence from patients and visitors is related to emergency department (ED) nurses' work productivity and symptoms of post-traumatic stress disorder (PTSD). Researchers have found ED nurses experience a high prevalence of physical assaults from patients and visitors. Yet, there is little research which examines the effect violent events have on nurses' productivity, particularly their ability to provide safe and compassionate patient care. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. Participants were asked to complete the Impact of Events Scale-Revised and Healthcare Productivity Survey in relation to a stressful violent event. Ninety-four percent of nurses experienced at least one posttraumatic stress disorder symptom after a violent event, with 17% having scores high enough to be considered probable for PTSD. In addition, there were significant indirect relationships between stress symptoms and work productivity. Workplace violence is a significant stressor for ED nurses. Results also indicate violence has an impact on the care ED nurses provide. Interventions are needed to prevent the violence and to provide care to the ED nurse after an event.     

The impact of public information on bidding in highway procurement auctions

A number of papers in the theoretical auction literature show that the release of information regarding the seller's valuation of an item can cause bidders to bid more aggressively. This widely accepted result in auction theory remains largely untested in the empirical literature. Recent theoretical work has also shown that this effect can be more pronounced in auctions with larger common cost uncertainty. We examine the impact of a policy change by the Oklahoma Department of Transportation that led to the release of the state's internal estimate of the costs to complete highway construction projects. We perform a differences-in-differences analysis comparing bidding in Texas, a state that had a uniform policy of revealing the same information all throughout the period of analysis, to bidding in Oklahoma. Our results show that, in comparison to Texas auctions, the average bid in Oklahoma fell after the change in engineers’ cost estimate (ECE) policy. This decline in bids was even larger for projects where the common uncertainty in costs is greater. Moreover, the within-auction standard deviation of bids fell after the change in ECE policy with the most significant decline observed again in projects with greater common cost uncertainty.     

Estimating the time involved in managing the 'unoccupied bed:' a time and motion study

Occupied bed days are often used as a demand indicator when calculating the number of nurses required to provide safe care. However, such calculations fail to take into account the amount of nursing time consumed by the "unoccupied bed." This study used direct observation time-and-motion methods to estimate the time and costs associated with a bed that is unoccupied. The average time taken to complete all of the activities associated with a bed that was unoccupied due to an internal transfer was 8.65 minutes, for a patient discharge 26.27 minutes, and for a patient admission 37.7 minutes. An average daily cost for activities surrounding these patient movements was approximately $386/day (AUD) in registered/enrolled nursing salaries alone. The unoccupied bed is not resource neutral and time associated with its maintenance should be considered when calculating nursing requirements to provide safe care.