A grant rationing model for a health care system.

Most public health programs are created through a political process and the health administrator's resource allocation decision is influenced not only by the relative performance of the subunits but also by political considerations. This paper presents a goal programming model for rationing available grants to competing health care subunits on the basis of performance subject to resource and political constraints. Performance is defined in terms of output adjusted for non-compliance on the identified quality of care and administrative efficiency criteria. The quality and efficiency criteria are those specified by the Federal agency as amended by local funding authorities and subunit administrators through a Delphi process. The model has the advantage of flexibility and can be easily adapted to suit prevailing financial and political conditions. In particular, it can be used as a viable analytical tool in health care and other public service agencies where political considerations are important in resource allocation decisions.     

The effect of holism on the health care system

Despite controversy over its scientific basis, the holistic health movement is having a tremendous impact upon society. With the establishment of the Office of Alternative Medicine within the National Institutes of Health, needed research will provide data to support the validity of various alternative modalities. A growing number of physicians will incorporate the philosophy of holistic health into the current medical model, with some choosing to treat clients with alternative modalities. Finally, consumer demand will lead to an increase in third-party reimbursement for alternative medical treatments.     

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.     

Telemedicine and rural primary health care: an analysis of the impact of telecommunications technology.

A scarcity of health care workers attributable to the present maldistribution of physicians is one of the most pressing health care delivery problems in rural America. Expanded utilization of non-physician primary health care providers is a possible solution to this problem. The capability of satellite clinics staffed by these personnel to provide ambulatory services efficiently and effectively can be enhanced by reducing the need for physical referral of the patients to a physician at a central clinic. The use of telecommunication technologies for conducting consultation between remotely located non-physicians and physicians can potentially reduce the required number of such referrals. This paper describes the procedures used for estimating the impact of alternative telemedicine technologies on the delivery of primary care in rural areas. Non-physician protocols were used to measure the impact of technology.     

物联网技术在农村基层医疗卫生管理中的应用

物联网技术在医疗机构的应用,特别是农村基层医疗卫生管理机构中应用并不广泛。本文主要分析物联网在现阶段农村基层卫生管理中的应用现状;提出物联网技术在农村信息化,医疗管理硬实力和基层医疗机构布局3个方面的可行性应用。并指出了物联网技术在实施农村基层医疗卫生管理中的问题。     

Objectives for a system of health care delivery for HIV infected people.

This paper assumes that the effectiveness and efficiency of an integrated community system of care for HIV infected people may depend to a large extent on common perceptions of the objectives of such a system among three sets of actors--the patient, the professional care manager, and the continual care giver. It discusses a decision analytic inquiry into that concurrence on objectives. The conclusion is that within the community studied there is strong evidence of a significant lack of such common purpose.     

Strategic decision support in preventive health care.

This nontechnical interdisciplinary paper highlights major principles of strategic decision support in preventive health care and points to selected key literature. It begins by looking at preventive health care from strategic perspectives such as determinants of health, health care costs, objectives of prevention, political order constellations and available data. Next, the paper identifies strategic decisions and decision-making to be supported. Having gained strategic perspective, it discusses tools for decision support. These tools are here related to two planning steps (i) assessment, problem and goal analysis; and (ii) design and choice of alternative interventions. Qualitative as well as quantitative aspects of computer-assisted policy analysis in preventive health care are outlined and examples presented.     

Inflation and health care costs in metropolitan areas.

This paper reports on an examination of the relationship between increases in health care costs in 23 Standard Metropolitan Statistical areas and various other changes in these communities over the period 1969-1977. The other changes examined consisted of 145 variables divided into 7 categories. The categories were termed demographic, economic, community illness, prices of other goods and services, hospital, physician, and technology factors. The results show that there was little relationship between rates of medical and hospital inflation and the examined variables. Total hospital costs could be related to several of the factors, the most important of which were demographic, economic, and hospital factors.     

The importance of efficient use in the adoption of technology: A micro panel data analysis

Even after the introduction of the new rice technology (Green revolution) about more than two decades ago, the food shortage problem has not decreased significantly in many developing countries. Obviously, there can be no dispute over the importance of the new rice technology in bringing about improvements in agricultural productivity. But, there are factors other than the choice of technology which are equally important, and a neglect of these factors may lead to a complete negation of any possible gains in productivity arising from the use of new technology. One such factor is the efficient use of the technology. This paper examines farm-specific application of the new rice technology by using a micro-level panel data from a South Indian district. The results show a wide variation in the efficient use of the technology by the sample farmers. Extension and education were identified as two major constraining factors.The refereeing process of this paper was handled through N.R. Adam.     

Forecasting demands for inpatient services in a large public health care delivery system

This paper studies the use of autoregressive integrated moving average (ARIMA) time-series models for forecasting demands for inpatient services in a large public health care delivery system. Here, demands are measured in terms of monthly admissions and patient days by services and forecasts are made yearly. This paper emphasizes the implementation aspect of ARIMA models when they are used on a large scale basis in an institutional setting, and compares forecasts with actuals. For forecasting patient days, the adequacy of an indirect approach using the formula L = λW is also evaluated. Finally, we briefly describe how the forecasts are used in the context of resource allocation.     

Requirements planning systems in the health care environment

An important problem confronting health care administration is cost containment in hospitals. Much of the current high costs can be traced directly to outdated procedures in materials management leading to waste, excessive inventory and unnecessary obsolescence of expensive short shelf life items. In this paper, we illustrate how a modern requirements planning system for surgical supplies was developed for a private hospital in Houston and used to effectively hold inventory levels to the minimum required to support a detailed schedule of surgical procedures. We also discuss some specific problems involved in the transfer of manufacturing technology to the hospital setting.     

The causes and development of health care system costs: The danish experience

In most western countries the cost of health care occupies an increasing share of the available resources in the economy. By analysing the pharmaceutical technology, which is one of the technologies in the health care system, it is demonstrated that this development cannot totally or partially be referred to the cost of medicine. On the contrary, medicine occupies a decreasing share of the total health care cost in most countries. It is shown that in the past the use of medicine has considerably reduced the loss in society by reducing the human sufferings and the economic implications of lost working days. But also today real and potential savings exist. By using Swedish findings in the areas of rheumatic illnesses and gastric ulcers it occurs that large savings can be obtained by reducing the losses due to lost working days. The author calls for a more positive understanding of the pharmaceutical industry and the conditions in which it operates. To achieve this the industry itself must be more open minded.     

Intrapreneurship and firm entrepreneurial orientation: insights from the health care service industry

Intrapreneurship affects our daily lives and is a research topic of great importance. Given the current economic climate, its relevance to firm performance has increased considerably both among academics and practitioners. Specifically, our approach has focused on the identification, analysis and explanation of the determinants/variables that influence the intrapreneurship process in the health care service industry, including the private, public and social sectors. The methodology employed consisted of collecting primary data via a questionnaire survey. The questionnaire was sent by e-mail to health care employees and middle managers from the northern and center regions of Portugal, and the study covered 202 professionals from 45 organizations. The results show that the participating health care team members present intrapreneurial behavior, and health care organizations create favorable internal conditions that support the theoretical concepts of intrapreneurship and firm entrepreneurial orientation (FEO).     

Institutional effects in the adoption of e-business-technology: Evidence from the German automotive supplier industry

This article analyzes the adoption of B2B-e-business technology in German automotive supplier companies during the internet hype period, i.e. in the very early stage of technology diffusion. While from the outset e-business was assumed to be used by companies in order to increase efficiency and reduce costs, some previous IOS research and theoretical considerations suggest that both efficiency and environmental expectations can be important reasons for companies to implement e-business. On this backdrop, the paper analyzes the reasons for e-business technology adoption, focusing on the explanatory value of institutional factors like mimesis, coercion, and normative pressures. Theoretically based hypotheses are developed and tested using regression models with a quantitative data set of more than 1900 companies.The article tries to make an innovative contribution to the field of IOS research, first, by drawing on theories of organizational structuring — new institutionalism, social psychology, and transaction cost economics; second, variation of adoption rationales in different types of companies and different business functions inside a company is taken into account.It appears that the adoption of e-business is explained by external pressures from other customers, bandwagon effects and herding behavior during the e-business hype, and expectations and interests of professionals inside a company. In the ‘core’ areas of a firm, efficiency rationales play an important role, too. The data reveals that the reasons of e-business usage differ significantly by department and company type.     

Measuring local health care system development for public policy purposes; an exploratory analysis of physicians and hospitals.

This paper attempts to measure local health care development for public policy purposes using a systems approach. The tools of multivariate analysis including principal components analysis and Guttman Scale techniques are used to construct indices of the development of local systems of medical specialists and of hospital facilities. The data measuring these phenomena were gathered for 243 United States Standard Metropolitan Statistical Areas and for a set of 300 Eastern U.S. Counties. These structural measures of system development were compared and contrasted to the usual aggregate ratio measures and found preferable. The public policy implication of this research are presented.     

Organizational learning and the learning organization in health care

Learning is seen as a systems-level phenomenon that stays within the organization regardless of the "players" involved. However, this article reviews some of the history of organizational learning and the learning organization and makes a proposal for how health care organizations are becoming learning organizations.     

The post-offering performance of IPOs in the health care industry

This paper investigates the post-offering performance of initial public offerings in the health care industry in a sample of 223 IPOs issued between 1985 and 1996. Statistically insignificant abnormal returns for IPOs relative to matched control firms and risk-adjusted health care index are evident for the whole sample. Thus, our empirical results support the overall information efficiency in the IPO market. However, numerical and statistical differences of the IPOs’ abnormal returns are documented in every subgroup specified according to the issuance years and sectors. We conjecture that such differences are due to the growing threat of government intervention and the significant structural changes.(JEL11, C11) The views expressed herein are our own and do not necessarily reflect the views of our colleagues.     

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.