The determinants of nursing home costs in Nebraska's proprietary nursing homes.

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.     

涉外护理教师培养的思路与实践

在涉外护理双语教学过程中,培养双语护理教师是保证涉外护理教学质量的关键。选拔成长全面,专业素质高,语言能力强的教师担任涉外护理专业教师,发挥其表率作用;根据国内外临床、护士培训及教学的发展要求,有针对性地培训全体护理教师;通过个体支持,促进群体的教学水平;定期举办教学基本功比赛,为教师搭建展示自我与互相交流的平台;以评促教,充分发挥反馈的激励作用;稳步适时进行新老交替,不断充实涉外护理教师队伍;将涉外护理教师和出国专业护士培养有机结合,达到教学和就业的双赢。     

Regulatory Effects and Strategic Global Staffing Profiles: Beyond Cost Concerns in Evaluating Offshore Location Attractiveness

The practice of offshoring—staffing all or part of a business outside the home country—has proliferated to such an extent that the question for most multinational corporations (MNCs) is where, not if, some or all of its labor forces should be located beyond geopolitical borders. It remains an open question, however, where and under what conditions the hoped-for advantages of offshore staffing are best realized. While cost savings continue to play the major role for most companies, both quality and availability of worker skills and administrative and regulatory contexts of labor markets have increasingly influenced global staffing decision processes. This paper has two purposes: to examine the extent to which employment laws and other regulatory factors can impact—beyond cost concerns alone—the decision where to offshore, and to offer a methodology for developing attractiveness profiles that can help governments, service providers, and MNCs evaluate and improve the match between staffing needs and labor market characteristics. By examining financial considerations in conjunction with administrative and regulatory effects, the parties can better manage ongoing expansion of offshore staffing arrangements beyond more established locations such as India, China, and Malaysia. Strategic implications of a trend toward nearshoring—relocating offshore operations closer to or within the home country—are also discussed.     

Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains

Over the past 10 years, merger activities in the private for-profit nursing home industry have been increasing in Europe. In this paper, we investigate chain affiliation’s influence on the performance of lucrative nursing homes. We measure performance using a cost frontier estimated by stochastic analysis on a sample of 370 French for-profit nursing homes. We find that cost efficiency decreases with the number of facilities in a chain. We also identify different external actor types in nursing homes’ institutional environment and test their influence. We show that nursing home chains’ cost efficiency improves when local governments and shareholders exert pressure. Our results are robust to alternative model specifications and another definition of costs. Overall, our findings inform researchers, as well as standards setters, of the relevance of chain affiliation and of the role of institutional pressures regarding cost containment at the nursing home level.     

Investigating the impact of endogeneity on inefficiency estimates in the application of stochastic frontier analysis to nursing homes

This paper examines the impact of an endogenous cost function variable on the inefficiency estimates generated by stochastic frontier analysis (SFA). The specific variable of interest in this application is endogenous quality in nursing homes. We simulate a dataset based on the characteristics of for-profit nursing homes in California, which we use to assess the impact on SFA-generated inefficiency estimates of an endogenous regressor under a variety of scenarios, including variations in the strength and direction of the endogeneity and whether the correlation is with the random noise or the inefficiency residual component of the error term. We compare each of these cases when quality is included and excluded from the cost equation. We provide evidence of the impact of endogeneity on inefficiency estimates yielded by SFA under these various scenarios and when the endogenous regressor is included and excluded from the model.     

Creating an efficient market for nursing home care.

This paper reviews the theoretical foundations of the common Medicaid nursing home reimbursement systems: Reasonable cost related, fixed rate and negotiated rate reimbursement. Each reimbursement system is examined in terms of the four reimbursement system design goals: allocative efficiency, appropriateness of care, quality of care and equity of economic rewards. None of the reimbursement approaches are found to be deficient on the theoretical level, but practical problems of implementation are shown to be very difficult. As an alternative, a competitive binding system is proposed which would bring competitive market efficiency to the allocation of Medicaid funds for nursing home care. A mathematical programming model is developed to process the bidding information and to allocate Medicaid funds to nursing homes.     

Aggregate nursing requirement planning in a public health care delivery system.

In this paper, we present an aggregate nursing requirement planning model for inpatient services to provide inputs for preparing yearly budgets in a public health care delivery system. A forecasting system using autoregressive integrated moving average time-series models forms the basis of project demands for nursing hours by medical specialities. These projections along with the institutional constraints and patient care requirements are all incorporated in a linear programming model for assessing needs for permanent staff, overtime pay and contracting temporary help—by medical service, nursing skill level and time period (month). We also expand the model to evaluate the sizing of a pool of float nurses. The model is developed within the framework of routine managerial planning process of the system under study (vis-à vis, the data base and the organizational structure). Historical data are used to estimate input parameters for the model. The staffing needs generated from the model for 1978 are compared with the actual system performance.     

如何避免或减少护理差错的发生

护理差错是指护理人员在治疗护理过程中因责任心不强、违反操作规程或技术问题等原因造成工作过失或疏忽,给病人带来或轻或重的伤害和痛苦,影响其治疗,甚至危及生命。那么如何避免或减少护理差错?     

新形势下护士长在护理管理中的角色及作用

社会的发展和医疗模式的改变促使护士长自身的素质和管理能力的提升成为新形势下的必然要求。护士长应当充分发挥其角色作用,将现代的科学管理方式应用到护理管理工作中,同时树立职业的管理形象,以应对新的护理形势。     

护患沟通技巧在门诊输液室中的应用

沟通是指医疗护理工作中同护理有直接联系的人和人之间的沟通,主要包括护患、医护以及护士与医院内其他工作人员的交际和沟通。处理好护士与各方面人员的关系,对提高护理质量、改善服务态度、更好地发挥医院的功能起积极的作用。     

Pricing a contract of linking home reversion plan and long-term care insurance via the principle of equivalent utility

Home reversion plans allow homeowners to tap into the value of their house and live in it until their death. The article considers a contract linking home reversion plan and long-term care insurance, which could better prepare seniors for their retirement and long-term care needs. Here, we assume the product exposes an insurer to two risks: the uncertainty of nursing care cost from disable, and the home value decreasing in real estate markets at the time of sale. Because the market is incomplete, we apply the principle of equivalent utility to price the contract under exponential utility.     

Time costs,aspirations and the effect of economic growth on German fertility

Recent research has shown strong support for the model of reproductive behavior derived from the new home economics, and it is shown in this discussion that the evidence from the Federal Republic of Germany is consistent with the new home economics model. There is little support for Easterlin's relative economic hypothesis, but there is limited endorsement for model which adds the influence of experience based material aspirations to the new home economics model. Easterlin's relative income model is reviewed before directing attention to the new home economics model and an explanation of fertility movements in West Germany. The new home economics model focuses on the family division of labor between home activities and work outside the home. The marked decline in German fertility during the 1970s is mostly attributable to factors such as expanding women's earning capacities which increased the importance of 2 earner families, who have a different family division of labor and possibly preferences biased towards "quality" of children rather than numbers. Also, real wage growth lagged behind the growth in experience based aspirations, and this drop in relative income is more dramatic if it is presumed that material aspirations are based upon the family's income experienced by a young adult during his/her adolescence, rather than just the father's earnings. The mother's contribution to family income will contribute to her family's actual standard of living and the desired standard of living of her children. The labor force participation rates of married, middle-aged German women increased markedly during the 1st half of the 1950s, thus tending to enhance the increase in the standard of living desired by the young adults reaching marrying and childbearing ages in the mid-1960s. The analysis indicates that if there is not a substantial reduction in the proportion of young married women in the labor force, fertility will move countercyclically. In that there must be some floor to fertility, one should be cautious of using these parameter estimates considerably outside the 1950-1977 period. Nonetheless, the estimates indicate that economic growth will not bring a substantial rise in German fertility, and, outside the unlikely situation of sustained economic decline, fertility will remain low.     

LINEX Loss Functions with Applications to Determining the Optimum Process Parameters

In the classical Taguchi quality model, the symmetric quadratic loss function has been used to measure the loss of quality. However, there are a number of situations in which the symmetric quadratic loss may be inappropriate. In this paper, we proposed an asymmetric loss function, called linear exponential (LINEX) loss function, to determine optimum process parameters for the product quality. When the coefficient of LINEX loss function is small, it will be close to the quadratic loss. Moreover, the trade-off problem between quality and cost will be discussed.     

Staffing and equipment decisions for services: An experimental analysis

Many service-oriented firms face demand/work load variations that occur both within and between days, and seasonally during the year. These service firms tend to develop staffing plans based on peak periods, resulting in substantial idle time during low demand periods. To counter this, some firms hire part-time employees to work peak periods to improve productivity. In this way, the cost per customer/transaction (unit) can be reduced.However, the staffing decision is more complex than just determining the number and timing of the work force. The development of good staffing plans must consider the impact of available work stations like telephone consoles and data entry terminals. To use effectively more personnel during peak periods, the firm must have sufficient work stations to assign this work force. Effective staff scheduling must consider simultaneously the work load variations, employ capabilities, and equipment requirements. This article presents a model that incorporates these factors into the decision-making process and examines their interaction.The model analysis illustrates how uncertainty in work load forecasts and staffing flexibility influence expected cost performance and equipment requirements. A set of computer simulation experiments are conducted using operating data from the proof and encoding departments for Ohio National Bank and Chemical Bank. The results suggest that increased staffing flexibility reduces the needed equipment investment, since part time staff can be scheduled more conveniently to meet varying work loads. Also, basing capital equipment decisions on peak work load levels can substantially increase total operating costs. With these costs explicitly estimated, managers can weigh them against desired service level goals to determine the appropriate balance.     

贸易自由化与中国企业进口中间品质量升级

进口高质量中间品是发展中国家实现技术追赶的重要途径;贸易自由化会降低进口高质量中间产品的贸易成本和相对价格,促进企业进口中间品质量升级。基于此,本文利用细分关税数据、海关数据和工业企业数据,将加工贸易作为控制组、一般贸易作为处理组,采用倍差法经验分析贸易自由化对中国企业进口中间品质量的影响。结论发现：伴随关税下降,中国企业进口中间品质量整体增长,且一般贸易组增长速度远快于加工贸易组。同加工贸易相比,关税下降1%一般贸易进口中间品质量增长高出0.06%~3.74%。这一作用在持续进口企业中,在基础设施完善、市场化水平高、经济集聚程度高的地区更明显。上述结论通过了同趋势假设、内生性等一系列稳健性检验。     

Set the Optimum Process Parameters Based on Asymmetric Quality Loss Function

Recently, Huang has presented a trade-off problem of determining the optimumprocess parameters for the product quality and process adjustment cost. Aboutproduct quality, Huang adopts the symmetric quadratic quality loss function formeasuring the loss of profit. However, he has neglected other types of qualityloss function in the model. In this paper, we will further propose the modifiedHuang's cost model with the linear and quadratic asymmetric quality loss function of product for determining the optimum process parameters.     

A transaction cost analysis of staffing decisions in international operations

This paper analyzes staffing decisions in foreign subsidiaries from the perspective of transaction cost theory. We focus on the ex post transaction costs of the employment relation. Specifically, we look at the monitoring, bonding, maladaptation, and bargaining costs of conducting activities in specific subsidiaries in a foreign country. We hypothesize that the transaction costs of using expatriates are lower than those generated by local employees, especially in the higher managerial echelons of foreign subsidiaries, but also that costs can be reduced as individuals become more experienced. We also conjecture that ex post transaction costs are influenced by cultural differences between the host and the home countries, and by characteristics of the companies and their subsidiaries. The framework is empirically corroborated by survey data on a sample of 145 Norwegian MNCs.     

质量经济性视角下饭店过度服务的修正研究

饭店过度服务给饭店企业利润带来极其不利的影响,其经济学本质是过高的质量成本投入,它违背了质量经济性原则。质量成本投入的正确与否会导致不同的服务价值水平演化效果,且顾客感知的服务价值水平和投入的质量成本并非完全的正相关关系。本文建立的基于质量经济性的过度服务修正体系将对饭店过度服务的修正提供一定的借鉴。     

创“优质护理服务示范病房”实施中的体会

目的:全面履行护理人员职责,提供优质护理服务。方法:在肿瘤中心病房开展"优质护理服务示范病房"活动;修订各项护理职责、制度和工作程序;实行责任大包干,切实落实基础护理职责;加强护理质量管理,拓展护理服务内容。结果:提高了患者对护理工作的满意度和护士对基础护理工作的认识;明确了优质护理的内涵。结论:"优质护理服务示范病房"活动的初步实践提高了护理质量。     

Development of smart nursing homes using systems engineering methodologies in industry 4.0

ABSTRACT

As aged population grows and health informatics advances dramatically, smart nursing homes equipped with electronic devices and intelligent systems turn into a hotspot. In this paper we propose an iterative and life-cycle development process based on the Vee model in Systems Engineering. Some tools like the house of quality matrix are introduced to continuously identify, allocate and refine requirements from elder residents, engineers, and other stakeholders. The development model proposed highlights the synchronization development of cyber phsical system with the smart nursing home. Furthermore, a agent-based simulation is implemented to illustrate feasibility and applicability of our work.