The importance of measuring patient satisfaction

Managed care has demonstrated its ability to contain costs. Its emergence as a dominant factor in the health care marketplace has raised concerns about measuring health care quality. As the field of quality assurance is evolving, it is becoming clearer that patient satisfaction surveys should be an integral component of assessing care.     

Fiscal catastrophe.

The revolt against the catastrophic care law may be less important for what it says about a troubled program than for what it may mean for financing of unmet needs.     

高职院校教学管理的思考

高职院校的教学管理,在学校中是整个教学系统正常运转的纽带和核心,它起着指挥、协调、控制等重要作用。高水平的教学管理,能促进教学改革,提高教学水平,保证教学质量,增加教学效益,是实现人才培养目标的重要保证。     

XBRL鉴证业务理论基础建构

文章在定义了包括鉴证目标、鉴证对象、鉴证层次、标准在内的一系列XBRL鉴证业务基本概念的基础上,构建了由与XBRL实例文档数据相关的认定、与XBRL实例文档元数据相关的认定以及与XBRL分类标准相关的认定构成的管理层认定概念体系,并对XBRL实例文档审计工作的业务承接、计划审计、实施审计程序获取审计证据及审计报告四个主要阶段的特别考虑展开探讨。     

Delivery systems for vision care benefits

The best way to provide a vision care benefit is with a managed care plan. With this type of design, there is cost containment without cost shifting, and quality assurance and member satisfaction are readily attainable at relatively inexpensive rates.     

Evaluate and communicate health care benefits

Both employers and employees need appropriate information to make intelligent decisions about health care benefits. For employers, analysis of health care data offers an approach to monitoring quality care and can provide a tool for controlling costs. For employees, an education and communication strategy is probably the single most important factor influencing both program utilization and employee acceptance.     

In treating the problems of the elderly, there may be no place like home.

When it comes to long-term care for the elderly, the federal government has a one-track mind: it pays for nursing home care through the medicaid program but does little else. Now the government is thinking about taking steps to help the elderly cope outside of institutions.     

对我国石油能源战略和安全体系的探讨

随着我国经济调整和现代化建设的推进，石油资源在国民经济和社会发展中的地位日益重要。因此，认真研究我国石油的发展战略和安全保障问题，已经成为维护国家安全的一项极为紧迫重要的任务。本文论述了我国所面临的石油能源安全方面的威胁，我国建立能源安全保障，从战略上解决我国在非常事态下能源安全问题的若干对策。     

管理医疗模式的影响差异——来自加州医疗救助的经验证据

国际上越来越多的健康保险(医疗保险)采用了管理医疗的方式,目的在于保证健康服务质量并节约成本。尽管该方式在控制成本方面的效果有目共睹,但对于其保证健康服务质量方面的评价则颇为困难。本文使用独特的大样本数据,利用美国加利福尼亚州医疗救助项目(美国最大的公共健康保险之一)从传统按次偿付方式到多种管理医疗模式的转变,来识别不同管理医疗模式对健康服务的使用及服务质量的影响。这对于我国公共健康保险制度(如新型农村合作医疗)的探讨具有一定的借鉴意义。     

Does health insurance matter? Evidence from China’s urban resident basic medical insurance

In 2007, China launched a subsidized voluntary public health insurance program, the Urban Resident Basic Medical Insurance (URBMI), for urban residents without formal employment. We estimate the impact of the URBMI on health care utilization and expenditure by a fixed effects approach with instrumental variable correction, using the 2006 and 2009 waves of the China Health and Nutrition Survey. We explore the time variation of program implementation at the city level as the instrument for individual enrollment. We find that this program has significantly increased the utilization of formal medical services, including both outpatient care and inpatient care, but it has not reduced total out-of-pocket health expense. We also find that this program has improved medical care utilization more for children, members of the low-income families, and the residents in the relatively poor western region.     

Contracting with specialty PPOs: new cost containment options

Specialty PPOs are gaining in popularity as health care payers realize they offer many of the same opportunities for cost savings and quality assurance as hospital and physician PPOs. Physical therapy service is an example of a likely candidate for a specialty PPO.     

Medicaid managed care: effects on children's Medicaid coverage and utilization

We use data from the National Health Interview Surveys (NHIS) to measure the effects of the growth of Medicaid managed care on children. We examine both the probability that individual children were Medicaid-covered and their utilization of care. We find that managed care penetration has significant effects on the composition of the Medicaid caseload: Young children are less likely to be covered, while poor school-age children are more likely to be covered. When we examine coverage by race, we find that black children are less likely to be covered where Medicaid managed care organizations (MMCOs) are more prevalent. These lower Medicaid enrollment rates are linked to increases in the numbers of young children who go without any doctor visits in a year. These results suggest that it is important to examine the potential effects of changes in Medicaid on selection into the Medicaid program, rather than focusing exclusively on the effects of managed care on those who are enrolled. In addition, among those enrolled in Medicaid, higher managed care penetration is associated with an increase in the number of black children with chronic conditions who go without doctor visits, but with decreases in the number of Hispanic children and poor teens who go without care.     

Measuring efficiency with a linear economic model

This paper modifies and interprets Data Envelopment Analysis (DEA) using a linear economic model. This approach is similar to the cone input/output and assurance region approaches to DEA, but it is implemented so that the multipliers are measured in the same units across all linear optimization problems. This approach allows one to interpret alternatives as profit maximizing organizations and the DEA multipliers as prices that are comparable across the alternatives. This is a useful extension of the assurance region concept, but more important, is that our approach enhances communication with decision-makers. The improved communication is illustrated by applying the model to the siting of a long-term health care facility. This application is interesting because the multiplier bounds make practical sense, and because the problem has dimensions that sometimes lead to interpretation problems with the traditional DEA model. For example, the site characteristics do not result from coordinated decisions, some sites exhibit zero values for some variables, and the problem has many variables compared with the number of potential sites. Problems with these dimensions have, at times, been deemed unsuitable for DEA, but they are handled without problem by the linear economic model.     

Long‐term care and pay‐for‐performance programs

Pay‐for‐performance programs are gradually spreading across Asia. This paper builds on the longer experience in the United States to offer lessons for Asia. The Center for Medicare and Medicaid Services has introduced several pay‐for‐performance programs since 2012 to encourage hospitals to improve quality of care and reduce costs. Some state Medicaid programs have also introduced pay‐for‐performance for nursing homes. Long‐term care providers play an important role in hospital pay‐for‐performance programs because they can affect the readmission rate and also total episode payments. A good pay‐for‐performance program will focus on improving quality of care that affects health outcomes. In addition, that quality must vary across providers and be measurable. Furthermore, it is important that the measures be reported in a timely way, that both demand and supply respond to the measures, and that the measures be risk adjusted. Empirical data from Medicare beneficiaries in the state of Michigan show that mean episode payments and readmission rates in skilled nursing facilities vary widely and are sensitive to the number of observations. These practical matters create challenges for implementing pay‐for‐performance in practice. There is an extensive literature review of pay‐for‐performance in long‐term care in the United States and in Asia.     

北京市人口老龄化及对社会保障支出的影响

北京市人口老龄化形势日益严峻,北京市老年人口的高龄化、空巢化和庞大的老年人口基数和发展速度使北京市的社会保障体系面临很大压力。就北京市人口老龄化程度对社会保障支出的定量关系分析做了探索,对北京市未来社会保障支出比重作了预测。对北京市人口老龄化特点和社会保障问题提出了建议。     

The political economy of long-term care

We build a two-dimensional political economy model to explain the provision and financing of long-term care and income redistribution. Voting agents differ in need and income opening up two conflicts: one sets families with disabled parents, who are in favor of a public long-term care program, against the ones without such parents who oppose public financing. The other sets the poor against the rich with the former preferring heavier income taxation than the latter. We show that a structure induced equilibrium always exists and that it is unique if informal care is provided in equilibrium. The equilibrium not only explains the negative association of income inequality and long-term care financing but also allows predictions about how demographic change might impact long-term care arrangements and expenses.     

Not your father's HMO

It's new. It's improved. And it's coming to medicare beneficiaries everywhere. It's the next generation of managed care, and it will happen even if Congress does nothing to reshape the medicare program this year.     

“过度医疗”的制度根源与医生声誉激励机制

近年来,"看病贵"成为我国医疗服务中的突出问题,导致"看病贵"的一个直接推动因素是医疗服务中的"过度医疗"问题。医疗服务具有显著的信息不对称特征,在此背景下会形成医患之间合约谈判权的非对称分布,形成"权责不对等"的"委托困境"问题,从而引发"过度医疗"和医疗市场中"富人驱逐穷人"的现象。在此情况下,政府管制并不能改变医患之间合约谈判权的非对称分布格局,解决过度医疗问题的核心应该是建立以医生声誉激励机制为核心的制度体系。     

OPTIONS IN THE DESIGN OF COMPETITIVE-BIDDING PROCESSES FOR INDIGENT MEDICAL CARE

This paper discusses competitive-bidding systems for indigent medical care. Theoretical and empirical research which applies to the specific characteristics of these systems is limited. In particular, it is not clear which set of bidding rules would result in the lowest program costs for the state. Effectively implementing competitive bidding is difficult, given the ambiguity of available research results, since such bidding creates the appearance that policymakers have relinquished budgetary control.     

Pieces of the shortage puzzle: aging and shift work

Addressing issues important to the aging nurse and night-shift worker is imperative for retention success. It is important for nurse leaders to create an environment that will keep older nurses and night-shift workers working. The good news is that health care leaders are talking. Research is being done and will hopefully continue. Now it is time for health care leaders to welcome nurses, educators, and policymakers into their circle of discussion to preserve quality health care and retain our nurses at the bedside.