Don't “just say no” to drug testing in the workplace: Some recommendations for developing and implementing policy

The widespread use of contraband substances by organizational members continues to present policy makers with a plethora of legal, moral, and economic issues to contend with when designing and implementing a comprehensive substance abuse policy. This article addresses methods of drug testing and their relative advantages and limitations, the legal ramifications of policy decisions, including union and nonunion concerns, and the costs and benefits associated with drug testing and screening. General guidelines for the design and implementation of a substance abuse policy are offered, and it is suggested that organizations should not summarily dismiss drug testing as a vehicle for the control and elimination of contraband substances and their use in the workplace.     

Quality in health care: possibilities and limitations of quantitative research instruments among health care users

Quality in health care has traditionally been dominated by medical profession, where patients’ opinions were labelled as lay evaluation. Patients’ views and opinions are important because they give us an insight into dimensions of quality that are not evaluated by medical profession and often seem to be more important. In health care quantitative methodology is often used to address these quality dimensions and introduce patients’ views and opinions. There are various benefits using quantitative research instruments, such as a detailed analysis of the importance of various quality dimensions for patients and an analysis of factors influencing patients’ satisfaction. On the other hand serious deficiencies can be tackled too, that are usually dealt with qualitative research instruments, because they go deeper into people’s motives and feelings. However, health care service is specific—it is very important to patients (health is one of the most important values), but their participation in health care service is rather low. They also don’t always say and do what they mean. In such a context combination of quantitative and qualitative research instrument does not give satisfactory answers. The importance of complaints is stressed and rewards for taking them seriously and acting upon them is discussed.     

Ten steps for communicating flex benefits

Many companies are exploring flexible-benefits plans as a way to cut costs and still provide good benefits for their employees. Here are 10 steps for effectively communicating a flex plan.     

Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning

In order to gain a better understanding of the effects of an investment in primary prevention on health, I investigate the impact of treatment of lead-based paint hazards in housing units (the preventive action) on childhood lead poisoning (the health outcome) at the census tract level in Chicago, IL. I use the findings from the analysis to simulate and then weigh the costs of lead interventions against the potential benefits of reducing blood lead levels in children. Childhood lead poisoning presents an interesting case study of the potential of preventive care in reducing the prevalence of a disease. There is a clear, well-defined pathway of exposure (deteriorating lead paint in older homes) and no method of secondary care that effectively mitigates the negative health effects. I find that a one-tenth percentage point increase in the proportion of older housing units that have been remediated is associated with a four-tenths percentage point reduction in the prevalence of childhood lead poisoning, an elasticity of roughly 0.5. Citywide, this is roughly 2.5 cases of lead poisoning averted for every housing unit remediated. Furthermore, I find evidence that the effect of remediations in preventing the disease has improved over time. The lower bound estimates of the benefits associated with the reduction in lead poisoning - increased expected lifetime earnings and reduced medical expenditures - are two to twenty times the estimated costs of the remediations.     

试论上海某10所医院管办分离及效益分析

目的:研究上海10所医院管办分离前后效益对比分析。方法:收集2004～2010年连续7年数据报表,以比率分析法和环比法进行数据分析。结果:投入产出及成本管理总值逐年持续增长,业务收支结余率年均增长0.43%;固定资产投入增长快速,年均增长率在20%以上;无形资产产出保持增长。门急诊次数、出院人数年均增长率分别为12.54%、12.47%;平均住院日、病死率逐年下降,诊疗费用、药占比逐年上涨,环比增长超过上海市人均生产总值。结论:加强资产运营效率,规范医院经营管理自主权,降低医院管理、医疗成本,提高医疗资源利用率,发挥社会效能。     

新医改背景下陕西省基层医疗机构人才建设策略

医疗卫生人才是决定基层医疗卫生服务水平的关键,也是我国医疗改革的核心问题之一。本文通过统计年鉴的数据分析和实地基层医疗机构的调查得到,基层医疗机构人才队伍参差不齐,数量缺乏、能力薄弱等多种问题。为从根本上解决问题,促进基层医疗机构发展和医疗水平的提高,在新医改政策的指导下,本文提出了加快加大基层医疗人才队伍建设几种策略。     

Strategic planning for the material management function

Strategic planning and strategic management are essential if a department intends to adapt and survive in the rapidly changing health care environment. Many hospitals require their individual departments to submit strategic plans and annual budgets. This is a sound management practice. In those institutions that do not require strategic plans, I would suggest that the departments take it upon themselves to go through this exercise. The benefits are tangible and long-lasting.     

Development of an integrated medical supply information system

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.     

Health care and retirement costs in North America spiralling uncontrollably: what are employers to do?

This article addresses some of the issues related to the rising costs of employee benefits in the United States and Canada in terms of the cost of retirement pensions and employer-provided health insurance for employees and retirees. We examine various factors that affect the cost of these services for organizations as well as how these might affect the choices employers might be forced to make. We elaborate on how various factors might compel employers to shift the cost of benefits to employees. Specifically, we elaborate on various legislative, economic, and demographic constraints on these employee benefits and examine in detail two employer practices of concern, namely cash balance retirement plans and consumer-directed healthcare plans.     

The effect of physician advice on alcohol consumption: count regression with an endogenous treatment effect

Although there are encouraging trends, alcohol abuse continues to be a significant public health problem. Econometric studies of alcohol demand have yielded a great deal of information for alcohol abuse prevention policy. These studies suggest that higher alcohol taxes and stricter drunk‐driving policies can reduce heavy drinking and drunk driving. In this paper we explore the role physician advice plays in the campaign to prevent alcohol‐related problems. Compared to alcohol taxation, physician advice is a more precisely targeted intervention that does not impose extra costs on responsible drinkers. Compared to the resource costs of arresting, processing, and punishing drunk drivers, physician advice may be a lower‐cost intervention. To provide a basis for alcohol policy analysis, we use an alcohol demand framework to test whether physician‐provided information about the adverse consequences of alcohol abuse shifts demand to more moderate levels. There are three aspects of our alcohol demand model that complicate the estimation: (1) the dependent variable is non‐negative (it is a count variable—number of drinks consumed); (2) a non‐trivial number of sample observations have zero values for the dependent variable; and (3) because the data we use is non‐experimental, the treatment variable indicating receipt of advice from a physician may be endogenous. We implement an estimation method that is specifically designed to deal with these three complicating factors. Our results show that advice has a substantial and significant impact on alcohol consumption by males with hypertension, and that failing to account for the endogeneity of advice masks this result. Copyright © 2001 John Wiley & Sons, Ltd.     

中国医疗卫生事业效益分析之系列研究——2005-2009年中国非营利与营利医疗卫生效益分析

研究2005-2009年全国非营利与营利医疗卫生的发展,中国医疗卫生事业以非营利性为主。医院占据主要床位数。营利医疗机构运用外部资产能力强,非营利机构长期偿债能力强。营利医疗机构有效控制成本费用,就诊方便,住院便捷,以优质医疗服务不断取得社会效益。两类机构还有很大利用资源的空间和提高管理水平。     

Improving health care means spending more time with patients and less time with inventory

In most hospitals and medical establishments, about 35 percent of their budgets are spent on supplies and labor to manage the inventories, material, and information flows; typically, these are managed as multiechelon systems. The importance of reducing inventory costs, among others, has become relevant in today's health care management. This research applies just-in-time concepts to health care inventories.     

Benefits and Strategic Outcomes: Are Supplemental Retirement Plans and Safer Driving Related in the U.S. Trucking Industry?

We suggest that a firm's benefits can relate to important organizational outcomes that have strategic implications. We propose a number of mechanisms that could relate benefits to strategic outcomes, including the notion that benefits can help attract and retain the type of employees who are most likely to perform in ways consistent with the firms’ strategies. We illustrate this with the case of supplemental retirement benefits in an actual setting, the long‐haul trucking industry. We report positive organization‐level relationships associated with the management choice of offering these benefits. Our results show that firms offering supplemental retirement plans engage in significantly safer driving practices, as measured by the proxy of driver insurance costs, as hypothesized. These findings show that benefits can be related to outcomes that have strategic implications for the firm. By showing that retirement plans may be of value to organizations, we help to bridge the academic‐practitioner divide and provide motivation and guidance for additional work on this important but underresearched topic. © 2015 Wiley Periodicals, Inc.     

The ‘postcode lottery’ of the Italian public health bill analysed with the hierarchy Stochastic Multiobjective Acceptability Analysis

Over the last two decades, due to strong decentralization and widespread budget constraints, the Italian co-payment for health care has become a way to finance public health. This phenomenon has provoked a continuous increase of private costs of public health and an evident regional heterogeneity. As a result, a pervasive spatial inequality of access to public health care is becoming increasingly clear. The aim of this paper is to measure this inequality, mainly determined by the differences among regional co-payment prices. Access, equity, and needs are all part of the phenomenon ‘inequality of access’, and they are difficult to define and measure in health care. For this reason, most of the previously proposed measurement methods have inherent limitations and have prompted us to use an innovative approach focused exclusively on the supply side. In particular, we focus only on the cost of health benefits (co-payment). From a methodological perspective, we use a recent new version of the Stochastic Multiobjective Acceptability Analysis (SMAA), which is a methodology mainly used to build composite indicators of multidimensional phenomena out of the market. In order to deal with the hierarchical structure of the Italian health care system, we use the Hierarchy Stochastic Multiobjective Acceptability Analysis (HSMAA), which takes into account the uncertainty with respect to the weights assigned to the considered criteria, as in the standard SMAA, but also the uncertainty with respect to the weights assigned to the considered sub-criteria. Applying for the first time HSMAA to measure inequality allows us to create a unique index for each region and then to make a classification among them. The results show that, since there are different prices for the same health benefits among different regions, there are strong spatial inequalities in the cost of the Essential Levels of health care in Italy.     

The impacts of benefit plans on employee turnover: a firm-level analysis approach on Taiwanese manufacturing industry

Employee turnover is a serious problem and the question of how to retain highly talented and valued people is very important. Previous employee turnover studies were mostly focused on the individual level but rarely from the standpoint of the business or firm. This study examines the impacts of four kinds of benefit plans on firm-level employee turnover issues, namely, retirement fund, pension, severance pay and fringe benefit. The present study uses the Census Bureau Employment Movement Survey of the Directorate General of Budget, Accounting and Statistics in Taiwan. The two models used to examine the overall manufacturing industry were: (1) the inducement model which tests the ‘with or without’ effect; and (2) the investment model which tests the ‘the more the better’ effect. Results reveal that, with respect to the firm's employee turnover rate, retirement fund and fringe benefits are negative while severance plans are significantly positive. These results are consistent with the transaction costs theory that total expenditure on these plans to retain employees (bureaucratic cost) is less than the market arrangements (transaction cost). In addition, the impact of pension plans is negative in respect of employee turnover in larger or more highly educated firms, but positive in firms with a lower educational level. Moreover, the firm size is negative while the firm's average employees' educational level is positive with respect to the workforce leaving their jobs. These results are consistent with the perspective of resource-based theory and human capital theory. Incidentally, this study also reveals insignificant differences between the ‘with or without’ effect and the ‘the more the better’ effect existing as a sub-group industry rather than across the entire industry.     

Assessing the effects of power grid expansion on human health externalities

Generation expansion planning is the framework under which power grid capacity expansions are made. Under this framework, mathematical optimization tools are used to determine the type of generation technology to invest in, and when and where these investments should be made in order to minimize market costs such as investment costs, fixed and variable operating & maintenance costs, and fuel costs over a long term planning horizon. Given the current infrastructure and policies, fossil fuels (such as coal, oil, and natural gas) are among the most economical sources of electricity. Thus, under these assumptions, these energy sources dominate the resulting expansion plans. However, fossil fuel combustion creates by-products contributing to ground-level ozone, particulates, and acid rain, which have harmful health implications such as premature death, respiratory-related illnesses, cardiovascular injuries, pulmonary disorders, and autism leading to lost days at school or work on a daily basis. In this research, we formulate a linear program to solve a multi-period generation expansion planning problem minimizing market costs for a centrally dispatched power system. We can then assess the human health externalities of the resulting expansion plan by studying the model output with an Environmental Protection Agency (EPA) screening tool that determines the human health externalities from the electricity sector. Results with and without emission limits and other policies can then be evaluated and compared based on predicted societal costs including human health externalities. This research enables policy makers to directly assess the health implications of power grid expansion decisions by explicitly estimating the total societal costs by quantifying externalities as part of the investment strategy.     

Mitigating factors in substance abuse discharge grievance arbitrations

One response to the problem of substance abuse is simply dismissing those employees who misuse or abuse drugs or alcohol. If the dismissal is challenged before an arbitrator, what particular grievant factors affect the outcome? Analyzing a recent data set, this research note suggests that arbitrators are influenced by grievant-specific factors, but most significantly by the nature of the substance in question. It is argued that this result may be discriminatory in that misuse of drugs or alcohol pose more or less similar health and safety risks to the employer, the public, and other employees. This result may reflect general societal values, mirrored by arbitrators, of which grievants, their representatives, and their employers ought to be aware.     

Why do some hospital leaders “speak no evil” about their organizations' medical errors?

Sentinel events, preventable medical errors resulting in serious disability or death, are a significant problem for hospital leaders. Accreditation agencies, such as the Joint Commission, urge hospitals to voluntarily disclose information about medical errors. However, some healthcare leaders “speak no evil” by choosing not to release sentinel‐event data. In an effort to increase the reporting of medical errors, several states passed laws mandating disclosure of sentinel events to the government. The state‐reported medical error rates of Indiana hospitals were compared with their leaders' perceptions of quality of care. Regardless of the number of sentinel events occurring at their hospitals, leaders consistently claimed their organizations provided high‐quality care. Two theories, rationalization and gaming, are presented to explain why leaders do not acknowledge the presence of serious quality‐management problems in their organizations.     

How are pension integration and pension benefits related?

Pension integration is the ability to allow differentiated pension benefits across earnings groups. In the academic literature, it is often described as a way for firms to reduce pension benefits (and therefore costs). Justified by the requirement that firms pay half of Social Security payments, integrated pensions are typically found to reduce benefits for lower income workers. Data on retirees from the Health and Retirement Study, however, reveal a more complex picture where some individuals receive more benefits when one of their pension plans is integrated, ceteris paribus. Some reasons are discussed why this might be the case.     

Entrepreneurship for Long-term Care in Sharing Economy

Entrepreneurs always look for business opportunities. Long-term care is a serious problem in many countries and exhausts various resources. Hence, though the governments of these countries resort to solve the problem, it remain an impact to their government finance. Meanwhile, the sharing economy is popular for resource sharing. The sharing can greatly reduce costs. Hence, this study proposes a conceptual framework to apply the sharing economy to lower the costs and to increase the efficiency of the long-term care. The proposed framework sheds some light to the opportunities for entrepreneurs.