The normalization of deviance in healthcare delivery

Many serious medical adversities result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become “normalized” in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale.     

韩国疗养保健客源市场分析

疗养保健客源市场是发展涉外疗养保健服务贸易的关键所在。早在2000年韩国已经步入老龄化社会,且老龄化趋势持续进一步加剧。利用韩国统计厅公布的资料,从韩国的人口结构、医疗保健、社会环境、社会福利分析入手,深入研究韩国疗养保健客源市场,发现韩国特定的人口结构状况及医疗保健等方面存在诸多问题,可为我国开发韩国老龄人口疗养保健市场提供可能性和必要性。     

Globalization with a human face

This paper has six parts. The first part defines globalization. The second discusses globalization eras. The third discusses the irreversibility and inevitability of globalization. The fourth section discusses the benefits and costs of globalization. The fifth section asks what is to be done. The sixth section contains my conclusions.     

Who has benefited from the health services system for the elderly in Japan?

This paper examines the demand and supply of medical services for the elderly in the health services system characterized by per-month fixed copayment and selective capitation fee scheme for outpatients with chronic diseases. The results indicate that the beneficiary, in particular the household dependent, visits a physician more frequently because the actual copayment decreases for the household dependent, but is nearly the same for the head of the household. Physicians, however, provide more services to the beneficiary partly because of the lowered copayment and partly because of the capitation fee scheme, which they will select instead of the fee-for-service scheme only when capitation is more profitable than Fee-for-Service. As a result, physicians as well as the insured benefit from the health services system.     

The sources of the Kuznets relationship between road fatalities and economic growth

This paper reports the results of an empirical analysis of the Kuznets curve relationship between per capita income and road fatalities across 60 countries over the period 1972-2004. This relationship hypothesizes that the number of road fatalities increases with increasing motorization in the early stages of economic growth. Eventually, due to advances in technical, policy and political institutions, it declines as per capita income increases. The quality of political institutions as well as improvements in medical care and technology are hypothesized to impact road fatalities. Results indicate evidence of a Kuznets curve relationship between per capita income and road fatalities for both highly developed and less developed countries and support our hypothesis that changes in institutional quality and medical improvements underlie the Kuznets relationship. The evidence presented in this study suggests that lowering corruption levels as well as improvements in medical care and technology would help to reduce road fatalities.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Do non-profit hospitals provide more charity care when faced with a mandatory minimum standard? Evidence from Texas

Policymakers often question whether not-for-profit (NFP) hospitals provide enough charity care to justify tax advantages. In 1993, Texas enacted legislation requiring NFP hospitals to provide certain community benefits at levels set forth in specific criteria to retain tax-exempt status; this paper focuses on the effect of the legislation’s requirement that NFP hospitals spend a minimum of 4% of net patient revenue on charity care. We also study a modification of the law passed in 1995, which allows the deduction of bad debts expense when calculating net patient revenue. This change effectively lowers required charity care spending, and our study considers whether Texas hospitals responded by reducing charity care spending.     

Changing laundry habits in Norway

Maintenance is often the most energy‐demanding stage during clothes' life cycle. Therefore, a shift towards more sustainable washing habits has great potential to reduce the consumption of energy, water and detergent. This paper discusses the change in laundering practices during the past 10 years in Norway and suggests strategies to help consumers change their laundry habits to more sustainable ones. Quantitative information of consumers' experiences, habits and opinions concerning clothing maintenance was collected through three surveys in Norway in 2002, 2010 and 2011. The 2010 study was supplemented with qualitative in‐depth interviews of a strategic sample of households. The average washing temperature has decreased slightly during the studied time periods. Some products' washing frequencies remained the same, whereas other products such as jeans were used a few more days before washing. The cotton programme is the most used washing programme, but short programmes are gaining popularity. The laundry sorting processes vary greatly and are influenced by several factors such as washing temperature, colours, fibre type and use area. For some consumers, the use of several different sorting categories made it more difficult to collect a sufficient amount of clothing to fill the machine. They were also afraid that overfilling the machine would result in clothes that were not clean enough or had detergent residues. Detergent dosing practices are far from optimal. In 2010, although the majority of respondents only used eye measure and did not know the water hardness of their area, they still tried to vary detergent dosage based on the amount of laundry and the level of soiling. Different design for sustainable behaviour strategies could be used within detergent dosage systems, care labelling, machine programme selection (such as suggesting lower temperature and eco‐programme), machine filling grade indicators, storage systems for slightly used clothing and textile material choice.     

THE AGEING POPULATION: CRUNCH TIME FOR GOVERNMENT REFORMS

Current discussions about reforms to health and long‐term care miss the most important trends that should be influencing debate. With an ageing population that includes a higher proportion of people with manageable illnesses, health and care costs will rise. Reforms must ensure that existing government spending is used more efficiently and that it harnesses – rather than works against – private financing.     

On the efficiency of the negligence rule

The three versions of the negligence rule discussed in the literature differ regarding whether a negligent injurer is liable for the entire loss or only for the incremental loss; or regarding whether negligence is defined as failure to take at least due care or failure to take a cost‐justified precaution. It is shown in the paper that the incremental version with untaken precaution notion of negligence is not efficient; not even for the unilateral case. The paper also establishes, for the bilateral case, the efficiency of the incremental version with the shortfall‐from‐due‐care way of defining negligence.