From managed care to "financed care"

Paying for health care in the new millennium may require fundamental restructuring of how costs are managed to avoid rationing and a government takeover.     

Intensive care

America's teaching hospitals are world-renowned for their medical know-how. But they're being thrown for a loop by cost-conscious managed care plans and leaner federal budgets.     

Redirecting health care spending: consumer-directed health care

In an environment of rising health care costs, defined contribution plans and closely related consumer-directed health plans are emerging as a possible next phase in health plan development and offer new opportunities for the nursing profession.     

Modelling care

Kalecki's 1943 essay Political Aspects of Full Employment (PAFE) is widely recognised as a seminal essay in the theory of the political business cycle. The paper argues that PAFE may also be interpreted as an early recognition by Kalecki of the phenomenon of rent seeking. Kalecki's discussion of the rent-seeking behavior of businessmen is shown to have anticipated Olson's subsequent theory of distributional coalitions. A Kalecki-Olson analysis provides an explanation for the movement in income shares in the UK since 1975.     

Value-added care: a paradigm shift in patient care delivery

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.     

Has the affordable care act affected health care efficiency?

Journal of Regulatory Economics - We utilize health care input and output data to evaluate how state-level efficiency in health care has changed in the wake of the Affordable Care Act (ACA). We use...     

Palliative care: a paradigm of care responsive to the demands for health care reform in America

Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.     

Managed care, quality of care, and patient rights

The growth of managed care has been accompanied by calls for increased government regulation because HMOs and other forms of managed care are seen by the public as more concerned about controlling costs than with protecting the rights of patients to quality care. This paper applies a theory of health care rights and clinical evidence of managed care quality in an analysis of public opinion about managed care. The paper concludes that there is no persuasive evidence that managed care has resulted in a general deterioration in the quality of care and that, with one exception, restrictions imposed by managed care plans are consistent with a theory of health care rights. The paper concludes with the recommendation that public policy should dispense with attempts to fine tune managed care and address an unquestionable violation of health care rights, the failure to guarantee a minimum standard of care to some 43 million Americans.     

Retiree health care benefits: a new standard of care

Solving the problem of continually rising retiree health care costs may ultimately require a new type of health care system. By monitoring individual behavior and intervening when necessary to modify potentially harmful behavior, we can reduce the present system's wasteful emphasis on hospitals and drugs.     

Rationing health care

Will America be forced to cut medical care to its neediest citizens? Yes, some critics say, and it already is doing that. They say it's time to face reality.     

Home care reimbursement,long-term care utilization,and health outcomes

Using a substantial change in Medicare reimbursement policy to study the market for home health care, I find that the introduction of tightly binding average per-patient reimbursement caps led to a large drop in the provision of home care, particularly to the least healthy beneficiaries. This decline in home health utilization was not offset by increases in institutional long-term care or other medical care and there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations.     

过度医疗行为的理论、实证与管理式医疗制度

本文是一篇文献综述,主要回顾过度医疗行为的理论与实证研究成果;其次,阐述与分析了以该理论为基础的美国管理式医疗与支付制度。     

Where health care dollars are spent when pediatric palliative care is provided

Although pediatric palliative care has become more accessible over the past decade, little research has been performed that focuses on the financial impact of providing palliative care in an inpatient hospital setting. Using a case-controlled methodology, health care costs and the distribution of these costs were compared between children who received palliative care to those who did not. In comparing children who received palliative services to case controls, the similarities are striking, and the differences may have clinical significance. Children receiving care coordinated by the palliative care program underwent fewer radiology procedures and received greater assistance from pharmacologic services. This reflects greater attention and interventions provided to treat pain and provide comfort.     

24-hour care programs

Twenty-four-hour care programs, which combine group health programs with workers' compensation and disability benefits, hold considerable potential for cost savings and greater efficiency. This article explains these programs and uses a care history to show the savings they can achieve.