The role of institutional entrepreneurs in reforming healthcare.

Science.gov (United States)

Lockett, Andy; Currie, Graeme; Waring, Justin; Finn, Rachael; Martin, Graham

2012-02-01

We draw on institutional entrepreneurship theory to analyse the dynamics of institutional change in a healthcare context. The focus of our interest is in the relationship between an institutional entrepreneur's 'subject position', defined in terms of their structural and normative legitimacy within the existing institutional landscape, and the nature of the change enacted. We develop this approach through an examination of the implementation of new pathways for cancer genetic services within the English National Health Service. Employing comparative case analysis we show that those who have limited structural legitimacy under prevailing conditions are most willing to engender change, but also least able; whereas those who have strong structural legitimacy are most able, but often least willing. However, those who are able rhetorically to combine a balance of structural and normative legitimacy are most able to produce change. In doing so, we demonstrate the importance of the concept of institutional entrepreneurship to understand healthcare reform. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Does the healthcare for rare diseases benefit from the legislative reforms?

Science.gov (United States)

Heyder, Ralf

2017-05-01

The founding of the National Action League for People with Rare Diseases (NAMSE) in 2010 represents the creation of a significant political platform. In addition, recent years had seen Germany and the EU adopt specific legislative measures aimed at improving healthcare for people with rare diseases. In this article we will give an overview of the legislative reforms adopted between 2013 and 2016 and evaluate how the specific healthcare situation of people with rare diseases has been improved. This article analyzes the health care legislative reforms adopted during the 18th term (since 2013) of the German lower house, the Bundestag, as well as their self-governing implementation. The analysis also extends to similar political initiatives of the European Commission. The impact of the recent hospital reforms on the health care received by patients or on the work of health care providers in the field of rare diseases cannot be assessed conclusively at this point (January 2017). One positive feature is that the health care coverage mandate of the university hospital outpatient departments now also comprises rare diseases. Recent legislative measures have created possibilities to improve the economic position of centers for rare diseases and university hospital outpatient departments. What these improvements will look like specifically depends on the implementation within the hospital plans of the federal states as well as on the outcome of the remuneration negotiations between university hospitals and health insurance funds.

Health sector reforms for 21 st century healthcare

Directory of Open Access Journals (Sweden)

Darshan Shankar

2015-01-01

Full Text Available The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India′s health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India′s Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21 st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India′s public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

Health sector reforms for 21(st) century healthcare.

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Shankar, Darshan

2015-01-01

The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21(st) century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

Factors of the medical career choice within the context of ukrainian healthcare reforms.

Science.gov (United States)

Lymar, Lesia; Omelchuk, Sergii

2018-01-01

Introduction: The article is dedicated to the motives of medical career choice studied by Ukrainian and foreign scientists, and by the authors themselves. The authors define the main motives, grouped into the pragmatic, social, scientific and professional ones, paying particular attention to the proposed reforms of the Healthcare of Ukraine "Health 2020". The aim: The study has been aimed at detection of the medical career choice factor groups and their possible correction during the medical training, defining possible influence of the Ukrainian Healthcare reformation onto alterations of the medical career choice. Materials and methods: This article is based on bibliosemantic, dialectical, comparative, analytic, synthetic and comprehensive research methods. Review and conclusion: The authors have analyzed medical career motives according to the A. Maslow hierarchy of needs, comparing the present motives with the motives to be changed after reforming the Ukrainian healthcare. The authors conclude that according to the Maslow's hierarchy of needs, the medical career choice corresponding to the first, second and third needs level would be directly related to the pragmatic, social and scientific motives, further disappointment in career, low professional performance and professional "burnout". The career choice corresponding to the last levels of the needs hierarchy is related to the professional motives and self-actualization, but, due to the applicants' age and financial status of medical specialists in Ukraine, is not likely to occur. Positive changes in medical specialists' salary rise, social protection offered by the State and state support of the profession will provide for correction of motives onto the higher level, in this way, benefiting the patients.

Health reforms as examples of multilevel interventions in cancer care.

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Flood, Ann B; Fennell, Mary L; Devers, Kelly J

2012-05-01

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up

Science.gov (United States)

2014-01-01

Background Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. Methods We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. Results Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. Conclusion Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local

The healthcare experiences of Arab Israeli women in a reformed healthcare system.

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Elnekave, Eldad; Gross, Revital

2004-07-01

Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.

Reliable in their failure: an analysis of healthcare reform policies in public systems.

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Contandriopoulos, Damien; Brousselle, Astrid

2010-05-01

In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

The political economy of healthcare reform in China: negotiating public and private.

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Daemmrich, Arthur

2013-01-01

China's healthcare system is experiencing significant growth from expanded government-backed insurance, greater public-sector spending on hospitals, and the introduction of private insurance and for-profit clinics. An incremental reform process has sought to develop market incentives for medical innovation and liberalize physician compensation and hospital finance while continuing to keep basic care affordable to a large population that pays for many components of care out-of-pocket. Additional changes presently under consideration by policymakers are likely to further restructure insurance and the delivery of care and will alter competitive dynamics in major healthcare industries, notably pharmaceuticals, medical devices, and diagnostic testing. This article describes the institutional history of China's healthcare system and identifies dilemmas emerging as the country negotiates divisions between public and private in healthcare. Building on this analysis, the article considers opportunities for public-private partnerships and greater systems integration to reconcile otherwise incommensurable approaches to rewarding innovation and improving access. The article concludes with observations on the public function of health insurance and its significance to further development of China's healthcare system.

A network approach for researching political feasibility of healthcare reform: the case of universal healthcare system in Taiwan.

Science.gov (United States)

Wang, Guang-Xu

2012-12-01

This study evaluates the political feasibility of healthcare reform taking place in Taiwan in the past decade. Since Taiwan adopted National Health Insurance (NHI) in 1995, it has provided coverage for virtually all of the island's citizens. However, the imbalance between expenditure and revenue has resulted in a cycle of unsustainable spending which has necessitated financial reforms and political confrontations. By applying social network analysis, this paper examines multiple types of ties between policy elites and power distribution that have evolved in crucial policy events of the NHI's financial reforms between 1998 and 2010. Data sources include official documents and 62 social network interviews that were held with government officials and related unofficial policy participants. Blockmodeling and multidimensional scaling (MDS) are used to determine the major participants and network structures in the NHI domain, as well as the influential policy actors, based on information transmission, resource exchange, reputation attribution and action-set coalition networks in Taiwan's current political situation. The results show that although both public actors and all medical associations are the leading actors in the NHI reform, without good communication with societal actors, the promotion of reform proposals ends in failure. As a tool of political feasibility evaluation, social network analysis can map the political conflict between policy stakeholders systematically when policy makers pursue the result of policy adoption. Copyright © 2012 Elsevier Ltd. All rights reserved.

System requirements of diesel reforming for the SOFC

International Nuclear Information System (INIS)

Harasti, P.T.; Amphlett, J.C.; Mann, R.F.; Peppley, B.A.; Thurgood, C.P.

2003-01-01

Diesel fuels are currently a very attractive source of hydrogen due to the global infrastructure for production and distribution that exists today. In order to extract the hydrogen, the hydrocarbon molecules must be chemically reformed into manageable, hydrogen-rich product gases that can be directly used in electrochemical energy conversion devices such as fuel cells. High temperature fuel cells are particularly attractive for diesel-fuelled systems due to the possibility of thermal integration with the high temperature reformer. The methods available for diesel fuel processing are: Steam Reforming, Partial Oxidation, and Auto-Thermal Reforming. The latter two methods introduce air into the process in order to cause exothermic oxidation reactions, which complement the endothermic heating requirement of the reforming reactions. This helps to achieve the high temperature required, but also introduces nitrogen, which can yield unwanted NO x emissions. The components of the reformer should include: an injection system to mix and vaporize the diesel fuel and steam while avoiding the formation of carbon deposits inside the reactor; a temperature and heat management system; and a method of sulphur removal. This presentation will discuss the operating conditions and design requirements of a diesel fuel processor for a solid oxide fuel cell (SOFC) system. (author)

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

Directory of Open Access Journals (Sweden)

Hao Zhang

Full Text Available High drug costs due to supplier-induced demand (SID obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID; this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research

Reforming primary healthcare: from public policy to organizational change.

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Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne

2015-01-01

Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

Interview with a quality leader: Dr. Suzanne Delbanco, on healthcare payment reform. Interviewed by Kevin Warren.

Science.gov (United States)

Delbanco, Suzanne

2011-01-01

Suzanne F. Delbanco is the executive director of Catalyst for Payment Reform (CPR), a nonprofit organization working for coordinated action among the largest purchasers of healthcare and health plans to reform the way we pay for healthcare in the United States to improve quality and cost. In addition to her duties at CPR, Suzanne is on the Advisory Committee to the Director and the National Biosurveillance Advisory Subcommittee of the Centers for Disease Control and Prevention. She also serves on the boards of HCI3, the Anvita Health Advisory Council, the executive committee of the California Maternal Quality Care Collaborative, and participates in the Healthcare Executives Leadership Network. Before CPR, Suzanne was President, Health Care Division at Arrowsight Inc., a company using video to help hospitals measure the performance of healthcare workers and provide them with feedback while they are working to improve adherence to safety and quality protocols. From 2000 to 2007, Suzanne was the founding CEO of The Leapfrog Group. The Leapfrog Group uses the collective leverage of its large corporate and public members to initiate breakthrough improvements in the safety, quality, and affordability of healthcare for Americans. Before joining Leapfrog, Suzanne was a senior manager at the Pacific Business Group on Health where she worked on the Quality Team. Suzanne holds a PhD in Public Policy from the Goldman School of Public Policy and a MPH from the School of Public Health at the University of California, Berkeley. © 2011 National Association for Healthcare Quality.

Policy Capacity for Health Reform: Necessary but Insufficient: Comment on "Health Reform Requires Policy Capacity".

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Adams, Owen

2015-09-04

Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government). I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a) A means of "policy governance" that would promote an approach to cooperative federalism in the health arena; (b) The ability to overcome the "policy inertia" resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c) The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action. © 2016 by Kerman University of Medical Sciences.

Hospital Acquisitions Before Healthcare Reform.

Science.gov (United States)

McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

2015-01-01

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform.

Science.gov (United States)

Wang, Shan; Liu, Lihua; Li, Lin; Liu, Jianchao

2014-09-29

Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. The 2009 Chinese medical reform emphasized the enhancement of basic medical insurance. This study aims to investigate changes in hospital services costs for inpatients with different types of MI before and after the new Chinese medical reform. A total of 532,120 inpatient medical records, completed by 11 different hospitals nationwide in 2008 and 2011, were collected from the Ministry of Health retrospectively. Median and mean values were calculated to describe costs and average length of stay, respectively. A chi-square test was used to compare the distribution of patient visits. Wilcoxon rank-sum tests were conducted to compare costs. The number of patients hospitalized increased. The average cost per stay in the three basic MI schemes increased, while out-of-pocket (OOP) spending decreased (P trends. The purchase of Western medication accounted for the largest proportion of costs in all MI schemes in both years; however, these ratios decreased from 2008 to 2011, while those for other social insurance and OOP patients almost doubled. The average length of stay remained unchanged, and the average lengths of stay in the MI schemes differed before and after the healthcare reform. Healthcare reform with multipartite policies may make interactional impacts on hospitalization services for patients enrolled in MI schemes.

Policy Capacity for Health Reform: Necessary but Insufficient; Comment on “Health Reform Requires Policy Capacity”

Directory of Open Access Journals (Sweden)

Owen Adams

2016-01-01

Full Text Available Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government. I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a A means of “policy governance” that would promote an approach to cooperative federalism in the health arena; (b The ability to overcome the ”policy inertia” resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action.

Florence Nightingale and healthcare reform.

Science.gov (United States)

Kudzma, Elizabeth Connelly

2006-01-01

The purpose of this article was to examine the work of Florence Nightingale in light of her collaboration with William Farr, the eminent medical statistician. Nightingale's epidemiological investigations supported by Farr illustrated that attention to environmental cleanliness was an important factor in preventing spread of disease. Nightingale channeled her investigations to support hospital reforms and the need for an educated nurse who could provide better management of the hospital environment. Statistical support and solicited criticism allowed Nightingale to argue more forcefully for her reforms.

Human resource for health reform in peri-urban areas: a cross-sectional study of the impact of policy interventions on healthcare workers in Epworth, Zimbabwe.

Science.gov (United States)

Taderera, Bernard Hope; Hendricks, Stephen James Heinrich; Pillay, Yogan

2017-12-16

The need to understand how healthcare worker reform policy interventions impact health personnel in peri-urban areas is important as it also contributes towards setting of priorities in pursuing the universal health coverage goal of health sector reform. This study explored the impact of post 2008 human resource for health reform policy interventions on healthcare workers in Epworth, a peri-urban community in Harare, Zimbabwe, and the implications towards health sector reform policy in peri-urban areas. The study design was exploratory and cross-sectional and involved the use of qualitative and quantitative methods in data collection, presentation, and analysis. A qualitative study in which data were collected through a documentary search, five key informant interviews, seven in-depth interviews, and five focus group discussions was carried out first. This was followed by a quantitative study in which data were collected through a documentary search and 87 semi-structured sample interviews with healthcare workers. Qualitative data were analyzed thematically whilst descriptive statistics were used to examine quantitative data. All data were integrated during analysis to ensure comprehensive, reliable, and valid analysis of the dataset. Three main factors were identified to help interpret findings. The first main factor consisted policy result areas that impacted most successfully on healthcare workers. These included the deployment of community health workers with the highest correlation of 0.83. Policy result areas in the second main factor included financial incentives with a correlation of 0.79, training and development (0.77), deployment (0.77), and non-financial incentives (0.75). The third factor consisted policy result areas that had the lowest satisfaction amongst healthcare workers in Epworth. These included safety (0.72), equipment and tools of trade (0.72), health welfare (0.65), and salaries (0.55). The deployment of community health volunteers impacted

Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

Science.gov (United States)

Pritchard, A M; Page, D

2008-05-01

The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

Science.gov (United States)

Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

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Cabieses, Baltica; Cookson, Richard; Espinoza, Manuel; Santorelli, Gillian; Delgado, Iris

2015-01-01

Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population. Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex) and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement). There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors. Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

Directory of Open Access Journals (Sweden)

Baltica Cabieses

Full Text Available Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS in 2000 and 2013, before and after the reform, for the entire adult Chilean population.Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively we estimated Erreygers concentration indices (CIs for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement.There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013. To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria.

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Ejughemre, Ufuoma John

2014-01-01

The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government's commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

Work motivation among healthcare professionals.

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Kjellström, Sofia; Avby, Gunilla; Areskoug-Josefsson, Kristina; Andersson Gäre, Boel; Andersson Bäck, Monica

2017-06-19

Purpose The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted. Findings Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers' positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications Leaders need to consistently translate and integrate reforms with the professionals' drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications The design of the reforms and leadership are essential preconditions for work motivation. Originality/value The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

Requirements for Interoperability in Healthcare Information Systems

Directory of Open Access Journals (Sweden)

Rita Noumeir

2012-01-01

Full Text Available Interoperability is a requirement for the successful deployment of Electronic Health Records (EHR. EHR improves the quality of healthcare by enabling access to all relevant information at the diagnostic decision moment, regardless of location. It is a system that results from the cooperation of several heterogeneous distributed subsystems that need to successfully exchange information relative to a specific healthcare process. This paper analyzes interoperability impediments in healthcare by first defining them and providing concrete healthcare examples, followed by discussion of how specifications can be defined and how verification can be conducted to eliminate those impediments and ensure interoperability in healthcare. This paper also analyzes how Integrating the Healthcare Enterprise (IHE has been successful in enabling interoperability, and identifies some neglected aspects that need attention.

Policy Capacity Meets Politics: Comment on "Health Reform Requires Policy Capacity".

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Fafard, Patrick

2015-07-22

It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise. © 2015 by Kerman University of Medical Sciences.

Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria.

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Atanasova, Elka; Pavlova, Milena; Moutafovа, Emanuela; Kostadinova, Todorka; Groot, Wim

2015-01-01

The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health. Copyright © 2013 John Wiley & Sons, Ltd.

Revitalising primary healthcare requires an equitable global economic system - now more than ever.

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Sanders, David; Baum, Fran E; Benos, Alexis; Legge, David

2011-08-01

The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.

Policy Capacity Meets Politics; Comment on “Health Reform Requires Policy Capacity”

Directory of Open Access Journals (Sweden)

Patrick Fafard

2015-10-01

Full Text Available It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise.

Public healthcare interests require strict competition enforcement.

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Loozen, Edith M H

2015-07-01

Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Health Care Reform: a Socialist Vision

Directory of Open Access Journals (Sweden)

Martha Livingston

2010-04-01

Full Text Available At first glance, it doesn't seem as though socialism and health-care reform have a whole lot to do with each other. After all, the most visible "left" position in the current discussion of health-care reform merely advocates for the government to assume the function of national insurer, leaving the delivery of health care - from its often-questionable content to its hierarchical relationships - firmly in place. As such, a single payer, Medicare-for-All insurance program is a modest, even tepid reform. Those of us on the left who have been active in the single payer movement have always seen it as a steppingstone toward health-care justice: until the question of access to care is solved, how do we even begin to address not only health care but also health inequities? How, for example, can working-class Americans, Americans of color, and women demand appropriate, respectful, humane, first-rate care when our ability to access any health-care services at all is so tightly constrained?

Physician leadership: a health-care system's investment in the future of quality care.

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Orlando, Rocco; Haytaian, Marcia

2012-08-01

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

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Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

2012-01-01

This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

The monopolistic integrated model and health care reform: the Swedish experience.

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Anell, A

1996-07-01

This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a discussion of incentives within Swedish county councils, and of how these incentives have influenced reforms in the direction of more choices for consumers and a separation between purchasers and providers. It is argued that the current incentives, in combination with criticism against county council activities in the early 1990's, account for the present inconsistencies as regards reforms. Furthermore, the article maintains that a weak form of separation between purchasers and providers will lead to distorted incentives, restricting innovative behaviour and structural change. In conclusion, the process of reforming the Swedish monopolistic integrated health-care model in the direction of some form of internal market is said to rest on shaky ground.

Drug pricing reform in China: analysis of piloted approaches and potential impact of the reform

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Chen, Yixi; Hu, Shanlian; Dong, Peng; Kornfeld, Åsa; Jaros, Patrycja; Yan, Jing; Ma, Fangfang; Toumi, Mondher

2016-01-01

Objectives In 2009, the Chinese government launched a national healthcare reform programme aiming to control healthcare expenditure and increase the quality of care. As part of this programme, a new drug pricing reform was initiated on 1 June 2015. The objective of this study was to describe the changing landscape of drug pricing policy in China and analyse the potential impact of the reform. Methods The authors conducted thorough research on the drug pricing reform using three Chinese databases (CNKI, Wanfang, and Weipu), Chinese health authority websites, relevant press releases, and pharmaceutical blogs and discussion forums. This research was complemented with qualitative research based on targeted interviews with key Chinese opinion leaders representing the authorities’ and prescribers’ perspectives. Results With the current reform, the government has attempted to replace its direct control over the prices of reimbursable drugs with indirect, incentive-driven influence. Although the exact implementation of the reform remains unclear at the moment, the changes introduced so far and the pilot project designs indicate that China is considering adaptation of some form of internal and external reference pricing policies, commonly used in the Organisation for Economic Co-operation and Development countries. Several challenges related to the potential new mechanism were identified: 1) the risk of hospital underfunding, if hospital funding reform is not prioritised; 2) the risk of promoting the use of cheap, low-quality drugs, if a reliable quality control system is not in place and discrepancy between the available drugs is present; 3) the risk of increasing disparity in access to care between poor and rich regions, in case of country-wide price convergence; and 4) the risk of industry underinvestment, resulting in reduced competition, issues with quality and sustainability of supply, and potentially negative social impact. Conclusions Foreign pricing policies

National Health-Care Reform

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2009-03-24

and pre/ post partum care during delivery. America should select measures that reflect the health-care goals of the nation. As an example, the Healthy...accidents (8) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression ...reflect the cumulative efforts of different types of individual care. For example, infant mortality is a reflection of pre-natal care, post - natal care

Health care in China: improvement, challenges, and reform.

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Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

What triggers reforms in OECD countries? Improved reform measurement and evidence from the healthcare sector

NARCIS (Netherlands)

Wiese, Rasmus

The main contribution of this paper is the development of a novel and versatile methodology to identify economic reforms. The methodology is a combination of the Bai & Perron structural break filter, and validation of the structural breaks identified using de jure evidence of reforms. The procedure

40 CFR 63.1566 - What are my requirements for organic HAP emissions from catalytic reforming units?

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2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What are my requirements for organic HAP emissions from catalytic reforming units? 63.1566 Section 63.1566 Protection of Environment... are my requirements for organic HAP emissions from catalytic reforming units? (a) What emission...

40 CFR 63.1567 - What are my requirements for inorganic HAP emissions from catalytic reforming units?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What are my requirements for inorganic HAP emissions from catalytic reforming units? 63.1567 Section 63.1567 Protection of Environment... are my requirements for inorganic HAP emissions from catalytic reforming units? (a) What emission...

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

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Bayati, Mohsen

2018-01-01

Objectives One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing. PMID:29631352

The clinical nurse leader: prepared for an era of healthcare reform.

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Jeffers, Brenda Recchia; Astroth, Kim S

2013-01-01

Passage of the 2010 Patient Protection and Affordable Care Act will require change in the healthcare systems. The clinical nurse leader must be prepared to lead and shape the changing environment to achieve maximum outcomes for patients and families. Movement toward integrated care delivery across the care continuum, the transition of the Centers for Medicare & Medicaid Services to a value-based funding model, and accountability for high-quality, cost-effective care are just some of the drivers of this new integrated healthcare system. Reimbursement models that reward those health systems that are able to meet benchmark performance standards will result in major shifts in how health systems operate. Expertise in care coordination across the healthcare continuum is essential for maximum reimbursement. Payment for value instead of volume delivered is a major reimbursement transition coming to the acute care setting, necessitating increased attention to mining data necessary to capture quality patient outcomes for maximum reimbursement. The clinical nurse leader is ideally suited to function within these integrated systems of the future, and possesses the skills needed to assist healthcare systems to meet this challenge. © 2013 Wiley Periodicals, Inc.

Information security requirements in patient-centred healthcare support systems.

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Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

2013-01-01

Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

Workforce flexibility - in defence of professional healthcare work.

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Wise, Sarah; Duffield, Christine; Fry, Margaret; Roche, Michael

2017-06-19

Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity. Design/methodology/approach The paper uses the Weberian tool of "ideal types". Key workforce reforms are held against Atkinson's model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control. Findings Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy. Originality/value The paper questions the conventional conception of "the problem" of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.

Narrativity and the mediation of health reform agendas.

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Hodgetts, Darrin; Chamberlain, Kerry

2003-09-01

Over the last two decades the repositioning of state-funded health systems and the increased use of private services have been the focus of extensive public debate. This paper explores the ways in which media coverage of healthcare reform is made sense of by lower socio-economic status (SES) audiences. We presented television documentaries to participants and analysed their accounts from focus group discussions following the viewing. We explore these discussions as shared social spaces within which participants work through the dilemmas posed by the reforms. In exploring reception as a storytelling process, we link audience and lay beliefs research and investigate how aspects of television coverage are appropriated by viewers to make sense of the causes and implications of healthcare reform.

Healthcare 2025 : buildings for the future

NARCIS (Netherlands)

2008-01-01

Healthcare in Europe is changing. Many countries are introducing reforms, and creating more competition and an open healthcare market. Product pricing is becoming normal; in some cases, such as the Netherlands, capital costs are becoming a component of charges. Experiments with public/private

Bending the curve through health reform implementation.

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Antos, Joseph; Bertko, John; Chernew, Michael; Cutler, David; de Brantes, Francois; Goldman, Dana; Kocher, Bob; McClellan, Mark; McGlynn, Elizabeth; Pauly, Mark; Shortell, Stephen

2010-11-01

In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While more should be done legislatively, the current reform legislation includes important opportunities that will require decisive steps in regulation and execution to fulfill their potential for curbing spending growth. Executing these steps will not be automatic or easy. Yet doing so can achieve a healthcare system based on evidence, meaningful choice, balance between regulation and market forces, and collaboration that will benefit patients and the economy (see Appendix A for a description of these key themes). We focus on three concrete objectives to be reached within the next five years to achieve savings while improving quality across the health system: 1. Speed payment reforms away from traditional volume-based payment systems so that most health payments in this country align better with quality and efficiency. 2. Implement health insurance exchanges and other insurance reforms in ways that assure most Americans are rewarded with substantial savings when they choose plans that offer higher quality care at lower premiums. 3. Reform coverage so that most Americans can save money and obtain other meaningful benefits when they make decisions that improve their health and reduce costs. We believe these are feasible objectives with much progress possible even without further legislation (see Appendix B for a listing of recommendations). However, additional legislation is still needed to support consumers �

Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

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McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

2014-01-01

China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.

Equity in health and health care reforms.

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Glick, S M

1999-01-01

In planning healthcare reforms increasing attention has been focused on the issue of equity. Inequities in the provision of healthcare exist even in relatively egalitarian societies. Poverty is still one of the major contributors to ill health and there are many powerful influences in society that continue to thwart the goal of a maximally equitable system for the provision of healthcare. The principles of equity in a healthcare system have been well articulated in recent years. It is incumbent on healthcare professionals who understand the issues to join the efforts towards a more humane and equitable healthcare system in their societies.

Politics, class actors, and health sector reform in Brazil and Venezuela.

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Mahmood, Qamar; Muntaner, Carles

2013-03-01

Universal access to healthcare has assumed renewed importance in global health discourse, along with a focus on strengthening health systems. These developments are taking place in the backdrop of concerted efforts to advocate moving away from vertical, disease-based approaches to tackling health problems. While this approach to addressing public health problems is a step in the right direction, there is still insufficient emphasis on understanding the socio-political context of health systems. Reforms to strengthen health systems and achieve universal access to healthcare should be cognizant of the importance of the socio-political context, especially state-society relations. That context determines the nature and trajectory of reforms promoting universality or any pro-equity change. Brazil and Venezuela in recent years have made progress in developing healthcare systems that aim to achieve universal access. These achievements are noteworthy given that, historically, both countries had a long tradition of healthcare systems which were highly privatized and geared towards access to healthcare for a small segment of the population while the majority was excluded. These achievements are also remarkable since they took place in an era of neoliberalism when many states, even those with universally-based healthcare systems, were moving in the opposite direction. We analyze the socio-political context in each of these countries and look specifically at how the changing state-society relations resulted in health being constitutionally recognized as a social right. We describe the challenges that each faced in developing and implementing healthcare systems embracing universality. Our contention is that achieving the principle of universality in healthcare systems is less of a technical matter and more a political project. It involves opposition from the socially conservative elements in the society. Navigation to achieve this goal requires a political strategy that

Newspaper advertising by health maintenance organizations during the reform of healthcare services in Israel.

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Reuveni, H; Shvarts, S; Meyer, J; Elhayany, A; Greenberg, D

2001-06-01

On 1 January 1995 a new mandatory National Health Insurance Law was enacted in Israel. The new law fostered competition among the four major Israeli healthcare providers (HMOs or sick funds) already operating in the market due to the possibility that an unlimited number of patients and the relative budget share would shift among the HMOs. This led them to launch advertising campaigns to attract new members. To examine newspaper advertising activities during the early stages of healthcare market reform in Israel. Advertising efforts were reviewed during a study period of 24 months (July 1994 to June 1996). Advertisements were analyzed in terms of marketing strategy, costs and quality of information. During the study period 412 newspaper advertisements were collected. The total advertising costs by all HMOs was approximately US$4 million in 1996 prices. Differences were found in marketing strategy, relative advertising costs, contents and priorities among the HMOs. The content of HMOs' newspaper advertising was consistent with their marketing strategy. The messages met the criteria of persuasive advertising in that they cultivated interest in the HMOs but did not provide meaningful information about them. Future developments in this area should include consensus guidelines for advertising activities of HMOs in Israel, instruction concerning the content of messages, and standardization of criteria to report on HMO performance.

Healthcare Firms and the ERP Systems

Directory of Open Access Journals (Sweden)

A. Garefalakis

2016-04-01

Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

Design requirements for ubiquitous computing environments for healthcare professionals.

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Bång, Magnus; Larsson, Anders; Eriksson, Henrik

2004-01-01

Ubiquitous computing environments can support clinical administrative routines in new ways. The aim of such computing approaches is to enhance routine physical work, thus it is important to identify specific design requirements. We studied healthcare professionals in an emergency room and developed the computer-augmented environment NOSTOS to support teamwork in that setting. NOSTOS uses digital pens and paper-based media as the primary input interface for data capture and as a means of controlling the system. NOSTOS also includes a digital desk, walk-up displays, and sensor technology that allow the system to track documents and activities in the workplace. We propose a set of requirements and discuss the value of tangible user interfaces for healthcare personnel. Our results suggest that the key requirements are flexibility in terms of system usage and seamless integration between digital and physical components. We also discuss how ubiquitous computing approaches like NOSTOS can be beneficial in the medical workplace.

A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

Science.gov (United States)

Johnston, Sharon; Hogel, Matthew

2016-05-01

In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

Healthcare mergers and acquisitions: strategies for consolidation.

Science.gov (United States)

Zuckerman, Alan M

2011-01-01

The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.

It's all about the money? A qualitative study of healthcare worker motivation in urban China.

Science.gov (United States)

Millar, Ross; Chen, Yaru; Wang, Meng; Fang, Liang; Liu, Jun; Xuan, Zhidong; Li, Guohong

2017-07-07

China's healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken. The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations. The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public. Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.

Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad.

Science.gov (United States)

Naccarella, Lucio; Buchan, James; Newton, Bill; Brooks, Peter

2011-08-01

To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.

Evaluating the medical malpractice system and options for reform.

Science.gov (United States)

Kessler, Daniel P

2011-01-01

The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter?

Science.gov (United States)

Gerry, Christopher J; Kaneva, Maria; Zasimova, Liudmila

2017-11-01

With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia's voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing. Copyright © 2017 Elsevier B.V. All rights reserved.

Redefining Health: Implication for Value-Based Healthcare Reform.

Science.gov (United States)

Putera, Ikhwanuliman

2017-03-02

Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.

Redefining Health: Implication for Value-Based Healthcare Reform

OpenAIRE

Putera, Ikhwanuliman

2017-01-01

Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should ...

Engineering the system of healthcare delivery

National Research Council Canada - National Science Library

Rouse, William B; Cortese, Denis A

2010-01-01

"As the United States continues to debate reform of its healthcare system, this book argues that providing health insurance for all without improving the delivery system will not improve the current...

Welfare Reform and Health

Science.gov (United States)

Bitler, Marianne P.; Gelback, Jonah B.; Hoynes, Hilary W.

2005-01-01

A study of the effect of state and federal welfare reforms over the period 1990-2000 on health insurance coverage and healthcare utilization by single women aged between 20-45 is presented. It is observed that Personal Responsibility and Work Opportunity Act of 1996 which replaced the Aid to Families with Dependent Children program of 1990s with…

Efficiency vs Effectiveness: a Benchmarking Study on European Healthcare Systems

Directory of Open Access Journals (Sweden)

Corrado lo Storto

2017-10-01

Full Text Available ABSTRACT. This paper illustrates a benchmarking study concerning the healthcare systems in 32 European countries as of 2011 and 2014. Particularly, this study proposes a two-dimensional approach (efficiency/effectiveness models to evaluate the performance of national healthcare systems. Data Envelopment Analysis has been adopted to compute two performance indices, measuring efficiency and effectiveness of these healthcare systems. The results of the study emphasize that the national healthcare systems achieve different efficiency and effectiveness levels. Their performance indices are uncorrelated and behave differently over time, suggesting that there might be no real trade-off between them. The healthcare systems’ efficiencies remain generally stable, while the effectiveness values significantly improved from 2011 to 2014. However, comparing the efficiency and effectiveness scores, the authors identified a group of countries with the lowest performing healthcare systems that includes Ukraine, Bulgaria, Switzerland, Lithuania, and Romania. These countries need to implement healthcare reforms aimed at reducing resource intensity and increasing the quality of medical services. The results also showed the benefits of the proposed approach, which can help policy makers to identify shortcomings in national healthcare systems and justify the need for their reform.

Strengthening revenue cycle capabilities in an era of reform.

Science.gov (United States)

Glaser, John

2011-05-01

Strategies that healthcare finance professionals should incorporate to help their organizations respond effectively to payment reforms include: Assessing the organization's ability to capture and share relevant data. Educating themselves, the board of trustees, and the medical staff on pertinent rules as payment reforms are rolled out. Examining inefficiencies related to care processes. Establishing policies and procedures to address "commingled" data.

Health care reform: preparing the psychology workforce.

Science.gov (United States)

Rozensky, Ronald H

2012-03-01

This article is based on the opening presentation by the author to the Association of Psychologists in Academic Health Centers' 5th National Conference, "Preparing Psychologists for a Rapidly Changing Healthcare Environment" held in March, 2011. Reviewing the patient protection and affordable care act (ACA), that presentation was designed to set the stage for several days of symposia and discussions anticipating upcoming changes to the healthcare system. This article reviews the ACA; general trends that have impacted healthcare reform; the implications of the Act for psychology's workforce including the growing focus on interprofessional education, training, and practice, challenges to address in order to prepare for psychology's future; and recommendations for advocating for psychology's future as a healthcare profession.

Telematic Requirements for a Mobile and Wireless Healthcare System derived from Enterprise Models

NARCIS (Netherlands)

Widya, I.A.; van Halteren, Aart; Jones, Valerie M.; Bults, Richard G.A.; Konstantas, D.; Vierhout, P.A.M.; Peuscher, J.; Jevtic, D.; Mikuc, M.

A challenge of current innovation in healthcare processes is to improve the time to treatment. This paper addresses the benefits of telematic services and mobile & wireless devices such as vital sign sensors and head mounted cameras for healthcare processes. It explores the telematic requirements

Hospital reform and staff morale in South Africa: a case study of Dr ...

African Journals Online (AJOL)

2012-02-16

Feb 16, 2012 ... Settings and subjects: This study included all medical and nursing staff working at ... Keywords: hospital reform, staff morale, quality of care, healthcare resources ..... of healthcare workers' goals to cure patients.3 This differs.

Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance.

Science.gov (United States)

Walker, Alexis

2017-08-01

In oral history interviews, Guyanese healthcare workers emphasize continuity in public health governance throughout the late twentieth century, despite major shifts in broader systems of governance during this period. I argue that these healthcare workers' recollections reflect long-term scarcities and the discourses through which both socialist politicians and neoliberal reformers have narrated them. I highlight the striking similarities in discourses of responsibility and efficiency advanced by socialist politicians in 1970s Guyana and by World Bank representatives designing the country's market transition in the late 1980s, and the ways these discourses have played out in Guyana's health system. Across diverging ideologies, politicians and administrators have promoted severe cost-control as the means to a more prosperous future, presenting short-term pains as necessary to creating new, better, leaner ways of life. In the health sector this has been enacted through a focus on self-help, and on nutrition as a tool available without funds dedicated for pharmaceuticals, advanced medical technologies, or a fully staffed public health system. I argue that across these periods Guyanese citizens have been offered a very similar recipe of ongoing sacrifice. I base my analysis on oral histories with forty-six healthcare workers conducted between 2013 and 2015 in Guyana in Regions 3, 4, 5, 9, and 10, as well as written records from World Bank and Guyanese national archives; I analyze official discourses as well as recollections and experiences of public health governance by those working in Guyana's health system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Examining quality and efficiency of the U.S. healthcare system.

Science.gov (United States)

Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

2011-01-01

The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the

Requirements for an evaluation infrastructure for reliable pervasive healthcare research

DEFF Research Database (Denmark)

Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W.

2012-01-01

The need for a non-intrusive evaluation infrastructure platform to support research on reliable pervasive healthcare in the unsupervised setting is analyzed and challenges and possibilities are identified. A list of requirements is presented and a solution is suggested that would allow researchers...

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

Science.gov (United States)

Loganathan, Tharani; Lee, Way-Seah; Lee, Kok-Foo; Jit, Mark; Ng, Chiu-Wan

2015-01-01

While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; pMalaysia.

The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform.

Science.gov (United States)

Eghtesad, Sareh; Mohammadi, Zahra; Shayanrad, Amaneh; Faramarzi, Elnaz; Joukar, Farahnaz; Hamzeh, Behrooz; Farjam, Mojtaba; Zare Sakhvidi, Mohammad Javad; Miri-Monjar, Mohammadreza; Moosazadeh, Mahmood; Hakimi, Hamid; Rahimi Kazerooni, Salar; Cheraghian, Bahman; Ahmadi, Ali; Nejatizadeh, Azim; Mohebbi, Iraj; Pourfarzi, Farhad; Roozafzai, Farzin; Motamed-Gorji, Nazgol; Montazeri, Seyed Ali; Masoudi, Sahar; Amin-Esmaeili, Masoumeh; Danaie, Navid; Mirhafez, Seyed Reza; Hashemi, Hasan; Poustchi, Hossein; Malekzadeh, Reza

2017-11-01

In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD. Copyright © 2017 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Energy Analysis in Combined Reforming of Propane

Directory of Open Access Journals (Sweden)

K. Moon

2013-01-01

Full Text Available Combined (steam and CO2 reforming is one of the methods to produce syngas for different applications. An energy requirement analysis of steam reforming to dry reforming with intermediate steps of steam reduction and equivalent CO2 addition to the feed fuel for syngas generation has been done to identify condition for optimum process operation. Thermodynamic equilibrium data for combined reforming was generated for temperature range of 400–1000°C at 1 bar pressure and combined oxidant (CO2 + H2O stream to propane (fuel ratio of 3, 6, and 9 by employing the Gibbs free energy minimization algorithm of HSC Chemistry software 5.1. Total energy requirement including preheating and reaction enthalpy calculations were done using the equilibrium product composition. Carbon and methane formation was significantly reduced in combined reforming than pure dry reforming, while the energy requirements were lower than pure steam reforming. Temperatures of minimum energy requirement were found in the data analysis of combined reforming which were optimum for the process.

Alerts in mobile healthcare applications: requirements and pilot study.

Science.gov (United States)

Kafeza, Eleanna; Chiu, Dickson K W; Cheung, S C; Kafeza, Marina

2004-06-01

Recent advances in mobile technologies have greatly extended traditional communication technologies to mobile devices. At the same time, healthcare environments are by nature "mobile" where doctors and nurses do not have fixed workspaces. Irregular and exceptional events are generated in daily hospital routines, such as operations rescheduling, laboratory/examination results, and adverse drug events. These events may create requests that should be delivered to the appropriate person at the appropriate time. Those requests that are classified as urgent are referred to as alerts. Efficient routing and monitoring of alerts are keys to quality and cost-effective healthcare services. Presently, these are generally handled in an ad hoc manner. In this paper, we propose the use of a healthcare alert management system to handle these alert messages systematically. We develop a model for specifying alerts that are associated with medical tasks and a set of parameters for their routing. We design an alert monitor that matches medical staff and their mobile devices to receive alerts, based on the requirements of these alerts. We also propose a mechanism to handle and reroute, if necessary, an alert message when it has not been acknowledged within a specific deadline.

Perceived Impact of Health Sector Reform on Motivation of Health ...

African Journals Online (AJOL)

Perceived Impact of Health Sector Reform on Motivation of Health Workers and Quality of Health Care in Tanzania: the Perspectives of Healthcare Workers and District Council Health Managers in Four Districts.

[Private health insurance in Brazil: approaches to public/private patterns in healthcare].

Science.gov (United States)

Sestelo, José Antonio de Freitas; Souza, Luis Eugenio Portela Fernandes de; Bahia, Lígia

2013-05-01

This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.

[Competency requirements for executives in healthcare and social services organizations: Results of a Delphi study].

Science.gov (United States)

Pielach, Martin; Schubert, Hans-Joachim

2018-02-07

Leadership in social services and healthcare organizations is marked by high levels of complexity and contradiction, which cannot be fully explained by politically, economically, and socially induced changes. Rather, it is the particularities of service provision in healthcare and social services that confront executives with specific demands. This study aimed to capture and prioritize required leadership competencies in healthcare and social services organizations. A three-step Delphi study was conducted with executives and managerial staff, who are job holders and thus experts on their occupation. For the first step, an explorative qualitative approach was chosen to record general opinion without prior assumptions. The following two steps weighted and selected the competency requirements in step one using rating- and ranking procedures. Results of the Delphi inquiry imply high relevance of social and personal competencies. Approximately 66 % of the competencies assessed in round three were social and personal competencies. 12 out of the 15 highest rated competencies in Delphi step three can be assigned to these two competency categories. In contrast, the importance of professional as well as methodical competencies was rated as less important. Only two methodical competencies and one professional competency were rated as very important by the panel. Nevertheless, the importance of executive professional and methodical competencies in healthcare and social services organizations is emphasized by high ratings of the competencies "Sector-specific expertise" and "Analytical skills". The methodical competency "Analytical skills" was identified by the Delphi respondents as the most important competency requirement. Social and personal requirements are of primary importance for leadership in healthcare and social services organizations. These results mostly correspond to leadership requirements posited in the literature on leadership skills. Emphasis should be on the

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

Science.gov (United States)

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

The 2015 hospital treatment choice reform in Norway: Continuity or change?

Science.gov (United States)

Ringard, Ånen; Saunes, Ingrid Sperre; Sagan, Anna

2016-04-01

In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: "the treatment choice reform". This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

[Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

Science.gov (United States)

Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

2015-03-01

Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

Science.gov (United States)

Alkhamis, Abdulwahab; Hassan, Amir; Cosgrove, Peter

2014-01-01

This paper presents an analysis of the main characteristics of the Gulf Cooperation Council's (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia. Employing a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries' healthcare indicators falling below those of upper-middle-income countries. Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

Evidence-based health policy: three generations of reform in Mexico.

Science.gov (United States)

Frenk, Julio; Sepúlveda, Jaime; Gómez-Dantés, Octavio; Knaul, Felicia

2003-11-15

The Mexican health system has evolved through three generations of reform. The creation of the Ministry of Health and the main social security agency in 1943 marked the first generation of health reforms. In the late 1970s, a second generation of reforms was launched around the primary health-care model. Third-generation reforms favour systemic changes to reorganise the system through the horizontal integration of basic functions-stewardship, financing, and provision. The stability of leadership in the health sector is emphasised as a key element that allowed for reform during the past 60 years. Furthermore, there has been a transition in the second generation of reforms to a model that is increasingly based on evidence; this has been intensified and extended in the third generation of reforms. We also examine policy developments that will provide social protection in health for all. These developments could be of interest for countries seeking to provide their citizens with universal access to health care that incorporates equity, quality, and financial protection.

40 CFR Table 18 to Subpart Uuu of... - Requirements for Performance Tests for Organic HAP Emissions From Catalytic Reforming Units

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Requirements for Performance Tests for Organic HAP Emissions From Catalytic Reforming Units 18 Table 18 to Subpart UUU of Part 63 Protection of... for Organic HAP Emissions From Catalytic Reforming Units As stated in § 63.1566(b)(2) and (3), you...

Understanding the failure of health-care exceptionalism in the Supreme Court's Obamacare decision.

Science.gov (United States)

Moncrieff, Abigail R

2012-09-01

On June 28, 2012, a mere century after the first presidential proposal for national health insurance, the Supreme Court issued a resounding victory for President Obama and for health-care reform generally, upholding the Patient Protection and Affordable Care Act against a serious constitutional challenge. Nevertheless, the Court also struck a potential blow to future health-care reform efforts in refusing to accept the solicitor general's argument that health care is a unique market with unique regulatory needs that justify special constitutional treatment. The failure of health-care exceptionalism in the Court's opinion might render future reform efforts more difficult than they would have been if the solicitor general's argument had carried the day. This commentary seeks to shed light on the Court's hesitation to recognize the uniqueness of health insurance and health care, noting that market-based exceptionalism in constitutional law has a long, dark history that the Court was understandably loath to repeat. Although the result of Chief Justice John Roberts' one-size-fits-all approach to constitutional analysis in this case is an odd holding that elides some genuine uniqueness of American health care, the alternative of health-care exceptionalism might have been much worse for our overall constitutional system.

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

Science.gov (United States)

Koornneef, Erik; Robben, Paul; Blair, Iain

2017-09-20

The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. From the existing research literature it is not possible to conclude whether UAE health system reforms are

Business Entity Selection: Why It Matters to Healthcare Practitioners. Part III--Nonprofits, Ethics, Practice Implications, and Conclusions.

Science.gov (United States)

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvantages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with organizational mission or vision statements, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Business entity selection: why it matters to healthcare practitioners--part I--Conceptual framework, sole proprietorships, and partnerships.

Science.gov (United States)

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvan- tages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with the organizational mission or vision statement, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Harnessing the privatisation of China's fragmented health-care delivery.

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Yip, Winnie; Hsiao, William

2014-08-30

Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition.

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Rosen, Barry S; Maddox, P J; Ray, Nancy

2013-11-01

Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

Reforming science: methodological and cultural reforms.

Science.gov (United States)

Casadevall, Arturo; Fang, Ferric C

2012-03-01

Contemporary science has brought about technological advances and an unprecedented understanding of the natural world. However, there are signs of dysfunction in the scientific community as well as threats from diverse antiscience and political forces. Incentives in the current system place scientists under tremendous stress, discourage cooperation, encourage poor scientific practices, and deter new talent from entering the field. It is time for a discussion of how the scientific enterprise can be reformed to become more effective and robust. Serious reform will require more consistent methodological rigor and a transformation of the current hypercompetitive scientific culture.

NRCMS capitation reform and effect evaluation in Pudong New Area of Shanghai.

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Jing, Limei; Bai, Jie; Sun, Xiaoming; Zakus, David; Lou, Jiquan; Li, Ming; Zhang, Qunfang; Zhuang, Yuehong

2016-07-01

The Rural Cooperative Medical Scheme (RCMS) had played an important role in guaranteeing the acquisition of basic medical healthcare of China's rural populations, being an innovative model of the medical insurance system for so many years here in China. Following the boom and bust of RCMS, the central government rebuilt the New Rural Cooperative Medical Scheme (NRCMS) in 2003 across the whole country. Shanghai, one of the developed cities in China, has developed its RCMS and NRCMS as an advanced and exemplary representative of Chinese rural health insurance. But in the past 10 years, its NRCMS has encountered such challenges as a spiral of medical expenditures and a decrease of insurance participants. Previous investigations showed that the capitation and general practitioner (GP) system had great effect on medical cost containment. Thus, the capitation reform combined with GP system reform of NRCMS, based on a system design, was implemented in Pudong New Area of Shanghai as of 1 August 2012. The aim of the current investigation was to present how the reform was designed and implemented, evaluating its effect by analyzing the data acquired from 12 months before and after the reform. This was an empirical study; we made a conceptual design of the reform to be implemented in Pudong New Area. Most data were derived from the institution-based surveys and supplemented by a questionnaire survey, qualitative interviews and policy document analysis. We found that most respondents held an optimistic attitude towards the reform. We employed a structure-process-outcome evaluation index system to evaluate the effect of the reform, finding that the growth rate of the insured population's total medical costs and NRCMS funds slowed down significantly after the reform; that the total medical expenditure of the insured rural population decreased by 3.60%; and that the total expenditure of NRCMS decreased by 3.99%. The capitation was found to help the medical staff build active

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

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Tharani Loganathan

Full Text Available While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking.We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia.A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur and rural (Kuala Terengganu setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained.Of the 658 stool samples collected at both centers, 248 (38% were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001. The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33% households in Kuala Lumpur to experience catastrophic expenditure and 11 (3% households to incur poverty. However in Kuala Terengganu, only one household (0.5% experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%. The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03 than at Kuala Terengganu (0.24.While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health

Resisting market-inspired reform in healthcare: the role of professional subcultures in medicine.

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Martinussen, Pål Erling; Magnussen, Jon

2011-07-01

The reorganisation efforts of the hospital sector in many Western countries in recent decades have challenged the role, identity and autonomy of medical professionals. This has led to increased focus on the role and impact of physicians who are also managers and on the unique discourse being formed through the integration of medical and managerial knowledge. Following the line of studies addressing the professional subcultures in medicine, we investigated whether assessments of health reform differ between medical doctors with managerial responsibilities and their colleagues at the clinical level as well as between those involved in direct patient care and those who are not. The analysis was performed within the context of the Norwegian hospital sector, where a major reform was implemented in 2002, and it was based on a survey of a representative sample of hospital physicians in 2006. The analysis focused on how the respondents viewed the overall effect of the reform and on the reform's effect on three central health policy goals: equity, quality and productivity. Combining data from the survey with organisational and financial data from the hospitals, we employed multilevel techniques to control for a number of individual and hospital-specific factors that could explain the physicians' views. As expected, respondents with managerial responsibilities were more positive in their evaluations of the reform, whereas respondents who spent time on direct patient-related work showed the opposite pattern. Of the hospital-specific factors of interest, the share of department managers with medical backgrounds and the economic situation positively affected the evaluations. Our findings support the view that, rather than managerialist values colonising the medical profession through a process of hybridisation, there is heterogeneity within the profession: some physician managers are adopting management values and tools, whereas others remain alienated from them. Copyright �

Healthcare financing in Croatia

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Nevenka Kovač

2013-12-01

Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

Business Entity Selection: Why It Matters to Healthcare Practitioners. Part II--Corporations, Limited Liability Companies, and Professional Entities.

Science.gov (United States)

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvantages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with organizational mission or vision statements, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

The NHS and market forces in healthcare: the need for organisational ethics.

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Frith, Lucy

2013-01-01

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Levelling vs competition – political trend reversal in the German healthcare system?

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Sascha Wolf

2014-12-01

Full Text Available For almost 20 years, the German federal government has declared that competition is the key to ensuring the financial sustainability of the healthcare system. The aim of this paper is to investigate if German government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed. This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the solvency and viability of sickness funds (statutory health insurance funds. In contrast, on the market for selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness funds as well as service providers are often reluctant to enter into selective contracts.

Aligning emergency care with the triple aim: Opportunities and future directions after healthcare reform.

Science.gov (United States)

Agrawal, Shantanu; Conway, Patrick H

2014-09-01

The Triple Aim of better health, better care, and lower costs has become a fundamental framework for understanding the need for broad health care reform and describing health care value. While the framework is not specific to any clinical setting, this article focuses on the alignment between the framework and Emergency Department (ED) care. The paper explores where emergency care is naturally aligned with each Aim, as well as current barriers which must be addressed to meet the full vision of the Triple Aim. We propose a vision of EDs serving as a nexus for care coordination optimally consistent with the Triple Aim and the requirements for such a role. These requirements include: (1) substantial integration in coordinated care models; (2) development of reliable and actionable data on ED quality, population health, and cost outcomes; (3) specific initiatives to control and optimize ED utilization; and (4) payment models which preserve surge and disaster response capacity. Published by Elsevier Inc.

Effective healthcare teams require effective team members: defining teamwork competencies

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Leggat Sandra G

2007-02-01

Full Text Available Abstract Background Although effective teamwork has been consistently identified as a requirement for enhanced clinical outcomes in the provision of healthcare, there is limited knowledge of what makes health professionals effective team members, and even less information on how to develop skills for teamwork. This study identified critical teamwork competencies for health service managers. Methods Members of a state branch of the professional association of Australian health service managers participated in a teamwork survey. Results The 37% response rate enabled identification of a management teamwork competency set comprising leadership, knowledge of organizational goals and strategies and organizational commitment, respect for others, commitment to working collaboratively and to achieving a quality outcome. Conclusion Although not part of the research question the data suggested that the competencies for effective teamwork are perceived to be different for management and clinical teams, and there are differences in the perceptions of effective teamwork competencies between male and female health service managers. This study adds to the growing evidence that the focus on individual skill development and individual accountability and achievement that results from existing models of health professional training, and which is continually reinforced by human resource management practices within healthcare systems, is not consistent with the competencies required for effective teamwork.

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

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Akinci, Fevzi; Patel, Poonam M

2014-01-01

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

Power sector reform in Maharashtra, India

International Nuclear Information System (INIS)

Totare, Ninad P.; Pandit, Shubha

2010-01-01

In early 1990 the power sector in India required an initial set of reforms due to the scarcity of financial resources and its deteriorating technical and commercial efficiency. The Indian power sector is now going through a second stage of reforms in which restructuring of electric supply utilities has taken place. The Maharashtra State Electricity Board (MSEB) initiated reforms in 2005 by dividing the state electricity board into four separate companies. In this paper, the situations that led to the reform of the MSEB and the scope of the work required for an action plan initiated by the state electricity distribution company in the context of the proposed Key Performance Index are discussed. The post-reform status of the distribution company is analyzed with selected key parameters. The study also analyzes the electricity supply model implemented and the effect of a multi-year tariff plan as one of the key milestones of the tariff structure. The various new projects implemented by the distribution company to improve consumer services and the reform experiences of the other states are discussed, along with the future scope of the present reform process. (author)

Sláintecare - A ten-year plan to achieve universal healthcare in Ireland.

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Burke, Sara; Barry, Sarah; Siersbaek, Rikke; Johnston, Bridget; Ní Fhallúin, Maebh; Thomas, Steve

2018-05-22

In May 2017, an Irish cross-party parliamentary committee published the 'Houses of the Oireachtas Committee on the Future of Healthcare "Sláintecare" report'. The report, known as 'Sláintecare', is unique and historic as it is the first time there has been a cross-party political consensus on major health reform in Ireland. Sláintecare sets out a high level policy roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed. Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system 'towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible'. Sláintecare has five interrelated components: population health; entitlements and access to healthcare; integrated care; funding; and implementation. In this article, the authors use documents in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms. It is too soon tell if the political consensus in the policy formation can hold for its implementation. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

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Toyama, Mauricio; Castillo, Humberto; Galea, Jerome T.; Brandt, Lena R.; Mendoza, María; Herrera, Vanessa; Mitrani, Martha; Cutipé, Yuri; Cavero, Victoria; Diez-Canseco, Francisco; Miranda, J. Jaime

2017-01-01

Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

Directory of Open Access Journals (Sweden)

Mauricio Toyama

2017-09-01

Full Text Available Background Mental, neurological, and substance (MNS use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru

Philosophy, medicine and healthcare: insights from the Italian experience.

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Adinolfi, Paola

2014-09-01

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified--the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the 'Postmodern' Era--which can be seen, à la Foucault, as 'fragments between philosophical fractures'. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care.

Leveraging health information technology to achieve the "triple aim" of healthcare reform.

Science.gov (United States)

Sheikh, Aziz; Sood, Harpreet S; Bates, David W

2015-07-01

To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care. The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target. © The Author 2015

Human resources requirements for diabetic patients healthcare in primary care clinics of the Mexican Institute of Social Security

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Svetlana V Doubova

2013-11-01

Full Text Available Objective. To estimate the requirements of human resources (HR of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS. Materials and methods. An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. Results. To provide healthcare in accordance with the patients’ metabolic control, the conventional model required increasing the number of family doctors (1.2 times nutritionists (4.2 times and social workers (4.1 times. The DiabetIMSS model requires greater increase than the conventional model. Conclusions. Increasing HR is required to provide evidence-based healthcare to diabetes patients.

X-PAT: a multiplatform patient referral data management system for small healthcare institution requirements.

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Masseroli, Marco; Marchente, Mario

2008-07-01

We present X-PAT, a platform-independent software prototype that is able to manage patient referral multimedia data in an intranet network scenario according to the specific control procedures of a healthcare institution. It is a self-developed storage framework based on a file system, implemented in eXtensible Markup Language (XML) and PHP Hypertext Preprocessor Language, and addressed to the requirements of limited-dimension healthcare entities (small hospitals, private medical centers, outpatient clinics, and laboratories). In X-PAT, healthcare data descriptions, stored in a novel Referral Base Management System (RBMS) according to Health Level 7 Clinical Document Architecture Release 2 (CDA R2) standard, can be easily applied to the specific data and organizational procedures of a particular healthcare working environment thanks also to the use of standard clinical terminology. Managed data, centralized on a server, are structured in the RBMS schema using a flexible patient record and CDA healthcare referral document structures based on XML technology. A novel search engine allows defining and performing queries on stored data, whose rapid execution is ensured by expandable RBMS indexing structures. Healthcare personnel can interface the X-PAT system, according to applied state-of-the-art privacy and security measures, through friendly and intuitive Web pages that facilitate user acceptance.

A Community Standard: Equivalency of Healthcare in Australian Immigration Detention.

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Essex, Ryan

2017-08-01

The Australian government has long maintained that the standard of healthcare provided in its immigration detention centres is broadly comparable with health services available within the Australian community. Drawing on the literature from prison healthcare, this article examines (1) whether the principle of equivalency is being applied in Australian immigration detention and (2) whether this standard of care is achievable given Australia's current policies. This article argues that the principle of equivalency is not being applied and that this standard of health and healthcare will remain unachievable in Australian immigration detention without significant reform. Alternate approaches to addressing the well documented issues related to health and healthcare in Australian immigration detention are discussed.

Healthcare reform from the inside: A neurosurgical clinical quality program

OpenAIRE

Afsar-Manesh, Nasim; Martin, Neil A.

2012-01-01

During the past decade, the U.S. health care system has faced increasing challenges in delivering high quality of care, ensuring patient safety, providing access to care, and maintaining manageable costs. While reform progresses at a national level, health care providers have a responsibility and obligation to advance quality and safety. In 2009, the authors implemented a department-wide Clinical Quality Program. This Program comprised of an inter-disciplinary group of providers and staff wor...

Balancing influence between actors in healthcare decision making

Directory of Open Access Journals (Sweden)

Babad Yair M

2011-04-01

Full Text Available Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc. motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include

Balancing influence between actors in healthcare decision making.

Science.gov (United States)

Kaplan, Robert M; Babad, Yair M

2011-04-19

Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics.

Science.gov (United States)

Garrison, Louis P; Towse, Adrian

2017-09-04

'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.

Healthcare beyond reform: doing it right for half the cost

National Research Council Canada - National Science Library

Flower, Joe

2012-01-01

... can get there by utilizing the resources we already have. The author provides a comprehensive, positive, and intriguing vision of the future of healthcare for professionals, employers and investors...

Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

Science.gov (United States)

Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

2017-11-24

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National

Do reviews of healthcare interventions teach us how to improve healthcare systems?

Science.gov (United States)

Pawson, Ray; Greenhalgh, Joanne; Brennan, Cathy; Glidewell, Elizabeth

2014-08-01

Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Healthcare and healthcare systems: inspiring progress and future prospects.

Science.gov (United States)

Durrani, Hammad

2016-01-01

Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. A structured review of both peer-reviewed and gray literature on the topic was carried out. On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world's population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population

Relevant factors to consider prior to an investor-owned acquisition of a nonprofit healthcare entity.

Science.gov (United States)

Ault, Kelvin; Childs, Brad; Wainright, Charles F; Young, Marilyn

2011-01-01

The purpose of this article is to explore the factors that affect the negotiations for an acquisition of a nonprofit system by an investor-owned entity. The recent economic downturn, accompanying credit crisis, and healthcare reform legislation will likely encourage and accelerate the pace of merger and acquisition (M&A) transactions between investor-owned entities and nonprofit hospitals. As many nonprofits are smaller, more financially vulnerable, and more limited in their access to capital than their investor-owned counterparts, nonprofits could be prime targets for investor-owned acquirers during the healthcare reform implementation period. In M&A transactions of this type, the investor-owned acquirer typically is motivated to pursue an acquisition when the deal promises an acceptable return on investment and decreased operating costs from economies of scale. Alternatively, the nonprofit target is typically seeking funding for upgrades to facilities and information technology systems as well as a continued commitment to charity care and managed-care contracting leverage. A successful acquisition of a nonprofit hospital by an investor-owned company requires a careful analysis of relevant tax, economic, and strategic factors prior to closing the deal. This article lists the most significant factors to consider in these deals and explains how these factors should influence the purchase price and postacquisition cash flow.

Common morality and moral reform.

Science.gov (United States)

Wallace, K A

2009-01-01

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert's) suggests that there is no reform of morality, but of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

Science.gov (United States)

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-28

Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

High temperature ceramic-tubed reformer

Science.gov (United States)

Williams, Joseph J.; Rosenberg, Robert A.; McDonough, Lane J.

1990-03-01

The overall objective of the HiPHES project is to develop an advanced high-pressure heat exchanger for a convective steam/methane reformer. The HiPHES steam/methane reformer is a convective, shell and tube type, catalytic reactor. The use of ceramic tubes will allow reaction temperature higher than the current state-of-the-art outlet temperatures of about 1600 F using metal tubes. Higher reaction temperatures increase feedstock conversion to synthesis gas and reduce energy requirements compared to currently available radiant-box type reformers using metal tubes. Reforming of natural gas is the principal method used to produce synthesis gas (primarily hydrogen and carbon monoxide, H2 and CO) which is used to produce hydrogen (for refinery upgrading), methanol, as well as several other important materials. The HiPHES reformer development is an extension of Stone and Webster's efforts to develop a metal-tubed convective reformer integrated with a gas turbine cycle.

Stakeholders' views on the strengths and weaknesses of maternal care financing and its reform in Georgia.

Science.gov (United States)

Shengelia, Lela; Pavlova, Milena; Groot, Wim

2017-08-08

The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects. A qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7-8 women. Two focus group discussions were carried out at each of the target settings (i.e. Tbilisi, Imereti and Adjara). Women were selected in each location through the hospital registry and snowballing method. The evidence shows that there is a consensus among maternal care stakeholder groups on the influence of the healthcare financing reforms on maternal health. Specifically, the privatization of the maternal care services has had positive effects because it significantly improved the environment and technical capacity of the maternity houses. Also, in contrast to other former-soviet republics, there are no informal payments anymore for maternal care in Georgia. However the privatization, which was done without strict regulation, negatively influenced the reform process and provided the possibility to private providers to manipulate the formal user fees in maternal care. Stakeholders also indicated that the UHC programs implemented at the last stage of the healthcare financing reform as well as other state maternal health programs protect women from catastrophic health

The declining demand for hospital care as a rationale for duty hour reform.

Science.gov (United States)

Jena, Anupam B; DePasse, Jacqueline W; Prasad, Vinay

2014-10-01

The regulation of duty hours of physicians in training remains among the most hotly debated subjects in medical education. Although recent duty hour reforms have been chiefly motivated by concerns about resident well-being and medical errors attributable to resident fatigue, the debate surrounding duty hour reform has infrequently involved discussion of one of the most important secular changes in hospital care that has affected nearly all developed countries over the last 3 decades: the declining demand for hospital care. For example, in 1980, we show that resident physicians in US teaching hospitals provided, on average, 1,302 inpatient days of care per resident physician compared to 593 inpatient days in 2011, a decline of 54%. This decline in the demand for hospital care by residents provides an under-recognized economic rationale for reducing residency duty hours, a rationale based solely on supply and demand considerations. Work hour reductions and growing requirements for outpatient training can be seen as an appropriate response to the shrinking demand for hospital care across the health-care sector.

Values, participatory democracy, and healthcare resource allocation: an application to a campus community.

Science.gov (United States)

Bentley, J P; Larson, L N; Brenton, M A

1995-03-01

As healthcare reform is debated, it is important that decision makers consider the values of all citizens, that is, what people find desirable or useful about healthcare services. Several states have used town meetings in an effort to determine their citizens' views on the values in the realm of healthcare. In this article, the authors describe a process in which individuals actively participate in an open discussion about issues surrounding allocation of healthcare resources in a university setting. Three different groups from the university community participated in separate, structured meetings to discuss their values concerning the allocation of scarce healthcare resources. Such meetings give participants opportunities to learn about their values and those of other persons in the community.

Targeting Environmental Quality to Improve Population Health and Lower Healthcare Costs

Science.gov (United States)

Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Ye...

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

Science.gov (United States)

Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick

Getting value from health spending: going beyond payment reform.

Science.gov (United States)

Ho, Sam; Sandy, Lewis G

2014-05-01

It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

Medical malpractice reform: the role of alternative dispute resolution.

Science.gov (United States)

Sohn, David H; Bal, B Sonny

2012-05-01

Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to the courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early apology, mediation, and arbitration in the medical arena. (1) Why is ADR needed? (2) Is ADR useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles remain? We performed MEDLINE, PubMed, and Google Scholar searches with key words "medical malpractice", "ADR", and "alternative dispute resolution" to obtain public policy studies, law review articles, case analyses, ADR surveys, and healthcare review articles. Early apology and disclosure programs report 50% to 67% success in avoiding litigation as well as substantial reductions in the amount paid per claim. Mediation boasts 75% to 90% success in avoiding litigation, cost savings of $50,000 per claim, and 90% satisfaction rates among both plaintiffs and defendants. Arbitration is viewed as less satisfying and less efficient than mediation but still more time- and cost-effective than litigation. The current legal environment is favorable to ADR with recent court decisions upholding pretreatment arbitration clauses. The main obstacle to ADR is the mandatory reporting requirement of the National Practitioner Data Bank (NPDB). ADR has the potential to help reform the current tort system, reducing cost and increasing both parties' satisfaction. Easing the reporting requirements for the NPDB would lead to more widespread acceptance of ADR among physicians.

Analysis of Private Sector Care Reform Authorities and Savings

Science.gov (United States)

2016-12-01

coordination, and promotion of health outcomes—in short, it was not a sustainable business model. FFS purchasing remains an element of an overall...primarily focused on the cost (or supply side) of delivering the healthcare services. The reforms examined in this paper (VBP of purchased care) affect ...J. Kerstein. “How do financial incentives affect physicians’ clinical decisions and the financial performance of health maintenance organizations

What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management.

Science.gov (United States)

Gustavsson, Catharina; Nordqvist, Maria; Bröms, Kristina; Jerdén, Lars; Kallings, Lena V; Wallin, Lars

2018-03-21

The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. The study provides knowledge

Knowledge engineering for health: A new discipline required to bridge the “ICT gap” between research and healthcare

DEFF Research Database (Denmark)

Beck, Tim; Gollapudi, Sirisha; Brunak, Søren

2012-01-01

on “knowledge engineering for health” is needed to facilitate knowledge transmission across the research–healthcare gap. This discipline is required to engineer the bidirectional flow of data: processing research data and knowledge to identify clinically relevant advances and delivering these into healthcare...... the key aims and objectives, namely “integrating and interpreting information for individualized healthcare,” by developing the “knowledge engineering for health” domain. Hum Mutat 33:797–802, 2012. © 2012 Wiley Periodicals, Inc........ A series of meetings, culminating in the “I‐Health 2011” workshop, have brought together interdisciplinary experts to map the challenges and requirements for such a system. Here, we describe the main conclusions from these meetings. An “I4Health” interdisciplinary network of experts now exists to promote...

Article Commentary: Integral Healthcare: The Benefits and Challenges of Integrating Complementary and Alternative Medicine with a Conventional Healthcare Practice

Directory of Open Access Journals (Sweden)

Christina L. Ross PhD

2009-01-01

Full Text Available Today's medicine is in the midst of an undeniable crisis. Calls to reform healthcare are in the forefront of economic and political discussions worldwide. Economic pressures reduce the amount of time physicians can spend with patients contributing to burnout among medical staff and endangering the patient iatrogenically. Politicians are getting involved as the public is calling for more affordable healthcare. A new paradigm must be embraced in order to address all aspects of this dilemma. It is clear that science and technology have resulted in vastly improved understanding, diagnosis, and treatment of disease, but the emphasis on science and technology to the exclusion of other elements of healing has also served to limit the development of a model that humanizes healthcare. The healing of a patient must include more than the biology and chemistry of their physical body; by necessity, it must include the mental, emotional and spiritual aspects. Because of these challenges, the development of an integral healthcare system that is rooted in appropriate regulation and supported by rigorous scientific evidence is the direction that many models of integrative healthcare are moving towards in the 21st century.

Data Quality Objectives For Selecting Waste Samples For Bench-Scale Reformer Treatability Studies

International Nuclear Information System (INIS)

Banning, D.L.

2011-01-01

This document describes the data quality objectives to select archived samples located at the 222-S Laboratory for Bench-Scale Reforming testing. The type, quantity, and quality of the data required to select the samples for Fluid Bed Steam Reformer testing are discussed. In order to maximize the efficiency and minimize the time to treat Hanford tank waste in the Waste Treatment and Immobilization Plant, additional treatment processes may be required. One of the potential treatment processes is the fluidized bed steam reformer. A determination of the adequacy of the fluidized bed steam reformer process to treat Hanford tank waste is required. The initial step in determining the adequacy of the fluidized bed steam reformer process is to select archived waste samples from the 222-S Laboratory that will be used in a bench scale tests. Analyses of the selected samples will be required to confirm the samples meet the shipping requirements and for comparison to the bench scale reformer (BSR) test sample selection requirements.

Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics

Directory of Open Access Journals (Sweden)

Louis P. Garrison

2017-09-01

Full Text Available ‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.

Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics

Science.gov (United States)

Garrison, Louis P.; Towse, Adrian

2017-01-01

‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption. PMID:28869571

The development of intelligent healthcare in China.

Science.gov (United States)

Zheng, Xiaochen; Rodríguez-Monroy, Carlos

2015-05-01

Intelligent healthcare (IH) is proposed with the fast application of Internet of Things technology in the healthcare area in recent years. It is considered as an expansion of e-health and telemedicine. As the largest developing country, China is investing large amounts of resources to push forward the development of IH. It is one of the centerpieces of the country's New Healthcare Reform, and great expectation is placed on it to help solve the conflict between limited healthcare resources and the large patient population. Essential policies, milestones, standards, and specifications from the Chinese government since the 1990s were reviewed to show the brief development history of IH in China. Some typical cases and products have been analyzed to present the current situation. The main problems and future development directions have been summarized. The IH industry in China has great potential and is growing very fast, but a lot of challenges also exist. In the future both government support and the active participation of nongovernmental capital are needed to push forward the whole industry.

Multi-fuel reformers for fuel cells used in transportation. Phase 1: Multi-fuel reformers

Science.gov (United States)

1994-05-01

DOE has established the goal, through the Fuel Cells in Transportation Program, of fostering the rapid development and commercialization of fuel cells as economic competitors for the internal combustion engine. Central to this goal is a safe feasible means of supplying hydrogen of the required purity to the vehicular fuel cell system. Two basic strategies are being considered: (1) on-board fuel processing whereby alternative fuels such as methanol, ethanol or natural gas stored on the vehicle undergo reformation and subsequent processing to produce hydrogen, and (2) on-board storage of pure hydrogen provided by stationary fuel processing plants. This report analyzes fuel processor technologies, types of fuel and fuel cell options for on-board reformation. As the Phase 1 of a multi-phased program to develop a prototype multi-fuel reformer system for a fuel cell powered vehicle, the objective of this program was to evaluate the feasibility of a multi-fuel reformer concept and to select a reforming technology for further development in the Phase 2 program, with the ultimate goal of integration with a DOE-designated fuel cell and vehicle configuration. The basic reformer processes examined in this study included catalytic steam reforming (SR), non-catalytic partial oxidation (POX) and catalytic partial oxidation (also known as Autothermal Reforming, or ATR). Fuels under consideration in this study included methanol, ethanol, and natural gas. A systematic evaluation of reforming technologies, fuels, and transportation fuel cell applications was conducted for the purpose of selecting a suitable multi-fuel processor for further development and demonstration in a transportation application.

Generation Y in healthcare: leading millennials in an era of reform.

Science.gov (United States)

Piper, Llewellyn E

2012-01-01

The healthcare workforce has grown with the addition of a new group of physicians, nurses, allied health professionals, administrators, and support staff who belong to America's youngest generation now in the workforce-generation Y, or the millennials. This generation consists of more than 70 million people, the oldest of whom are now in their late 20s and early 30s. With traits and workplace expectations that differ from those observed in other generations, and with a size that threatens to overtake the total number of baby boomers, generation Yers are positioned to influence (if not drastically change) current leadership approaches. The common traits that define or are associated with generation Y workers are often regarded as barriers yet provide healthcare leaders with a clear guide to understanding these employees and drawing out their best qualities and performance. For the organization to fulfill its social contract to provide high-quality, cost-effective, and safe healthcare, it must satisfy the needs and manage the expectations of those who directly deliver these services. This is especially important in today's environment, which is marked by the still-fluid stipulations of the Affordable Care Act (ACA), changed consumer expectations, and public demands for transparency and accountability.

Health Reform Requires Policy Capacity

Directory of Open Access Journals (Sweden)

Pierre-Gerlier Forest

2015-05-01

Full Text Available Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility

Does the Accountable Care Act Aim to Promote Quality, Health, and Control Costs or Has It Missed the Mark? ;Comment on “Health System Reform in the United States”

Directory of Open Access Journals (Sweden)

Carol Molinari

2014-02-01

Full Text Available McDonough’s perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consumer.

Building an integrated methodology of learning that can optimally support improvements in healthcare.

Science.gov (United States)

Lynn, Joanne

2011-04-01

The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services. Those working in quality improvement have an unusual opportunity to generate substantial input into these processes through professional organisations such as the Academy for Healthcare Improvement and dominant leadership organisations such as the Institute for Healthcare Improvement.

NAFTA and Mexico's Tax Policy Reform

OpenAIRE

Jorge Martinez-Vazquez; Duanje Chen

2001-01-01

The North American Free Trade Agreement (NAFTA) has had a significant effect on Mexico’s economy and institutions. The ongoing consideration of tax reform in Mexico requires an evaluation of the role of NAFTA in Mexico’s economy, including its tax structure; it also requires an assessment of the impact of the Mexico’s tax system on the trade and capital flows between Mexico and its NAFTA partners, the United States and Canada. Clearly, no good tax reform in Mexico can ignore the role of NAFTA...

Do political or economic factors drive healthcare financing privatisations? Empirical evidence from OECD countries

OpenAIRE

Wiese, Rasmus

2013-01-01

This paper adds new empirical evidence to the political economy literature of economic reform. One of the main contributions of this paper is the development of a novel methodology to identify privatisations. The methodology is a combination of the Bai & Perron structural break filter, and validation of the breaks identified by this filter using de jure evidence of reforms. 21 de facto healthcare financing privatisations are identified in a sample of 23 OECD countries. It is analysed which fa...

Interactions: trade policy and healthcare reform after Chaoulli v. Quebec: is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

Science.gov (United States)

Crawford, Mark

2006-01-01

The insulation of Canada's healthcare system from trade treaty obligations is crucial to the legitimacy of Canada's trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exemption of healthcare from trade treaties, but now the potential for private financing of essential medical services indicated by the Supreme Court's decision in Chaoulli v. Quebec has made that line of argument look risky as well. It is apparent that Canada failed to anticipate the possible interactions of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO in 1997. Accordingly, the time has come to acknowledge the fragility of the boundary between health and trade policies, to take the risks and costs associated with trade treaty obligations fully into account when undertaking healthcare reform and to strengthen the separation between private and public health insurance.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

Science.gov (United States)

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Steam Methane Reformation Testing for Air-Independent Solid Oxide Fuel Cell Systems

Science.gov (United States)

Mwara, Kamwana N.

2015-01-01

Recently, NASA has been looking into utilizing landers that can be propelled by LOX-CH (sub 4), to be used for long duration missions. Using landers that utilize such propellants, also provides the opportunity to use solid oxide fuel cells as a power option, especially since they are able to process methane into a reactant through fuel reformation. One type of reformation, called steam methane reformation, is a process to reform methane into a hydrogen-rich product by reacting methane and steam (fuel cell exhaust) over a catalyst. A steam methane reformation system could potentially use the fuel cell's own exhaust to create a reactant stream that is hydrogen-rich, and requires less internal reforming of the incoming methane. Also, steam reformation may hold some advantages over other types of reforming, such as partial oxidation (PROX) reformation. Steam reformation does not require oxygen, while up to 25 percent can be lost in PROX reformation due to unusable CO (sub 2) reformation. NASA's Johnson Space Center has conducted various phases of steam methane reformation testing, as a viable solution for in-space reformation. This has included using two different types of catalysts, developing a custom reformer, and optimizing the test system to find the optimal performance parameters and operating conditions.

Improving the Business Trade Licensing Reform Environment

OpenAIRE

Gamser, Matthew

2003-01-01

This case study of Kenyan business trade licensing shows that red-tape costs can be cut if reform is championed strongly and there is a strong case in terms of costs and benefits. The reform of business registration, trade licensing and other business entry procedures is a cost effective and progressive way to promote indigenous private sector development. But, reform needs more than good cost-benefit analysis and legal drafting; it also requires building constituencies and continuous advocacy.

Specialist participation in healthcare delivery transformation: influence of patient self-referral.

Science.gov (United States)

Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

2014-01-01

Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

The Brazilian electrical system reform

International Nuclear Information System (INIS)

Mendonca, A.F.; Dahl, C.

1999-01-01

Although the Brazilian electrical system has been a public monopoly, the threat of electricity shortages from a lack of investment triggered a comprehensive reform. In 1993 the government began a series of laws, decrees and regulations reforming the tariff policy, allowing privatization of utilities, foreign investments and independent power producers, and creating an independent transmission grid and a new electricity regulatory agency (ANEEL). The new regulatory framework is not completely defined but the proposed model intends to transform bulk electricity supply into a competitive market similar to that adopted in England. Our objective is to evaluate whether the proposed reform will succeed in attracting the required private capital, will allow an unregulated wholesale electricity market and will require a strict regulatory framework. The reform has been quite successful in privatizing the distribution companies but is allowing monopolistic rents, and has failed until now to attract private investments to expand generation capacity. The risk of blackouts has increased, and the proposed wholesale electricity market may not be appropriate because of barriers to constructing new hydroelectric units, now 90% of the system. Therefore, a new regulatory framework and a strong regulatory agency with a well-defined tariff policy should have preceded the privatization. (author)

Organizational culture in the primary healthcare setting of Cyprus.

Science.gov (United States)

Zachariadou, Theodora; Zannetos, Savvas; Pavlakis, Andreas

2013-03-24

The concept of organizational culture is important in understanding the behaviour of individuals in organizations as they manage external demands and internal social changes. Cyprus healthcare system is under restructuring and soon a new healthcare scheme will be implemented starting at the Primary Healthcare (PHC) level. The aim of the study was to investigate the underlying culture encountered in the PHC setting of Cyprus and to identify possible differences in desired and prevailing cultures among healthcare professionals. The population of the study included all general practitioners (GPs) and nursing staff working at the 42 PHC centres throughout the island. The shortened version of the Organizational Culture Profile questionnaire comprising 28 statements on organizational values was used in the study. The instrument was already translated and validated in Greek and cross-cultural adaptation was performed. Participants were required to indicate the organization's characteristic cultural values orientation along a five-point Likert scale ranging from "Very Much = 1" to "Not at all= 5". Statistical analysis was performed using SPSS 16.0. Student t-test was used to compare means between two groups of variables whereas for more than two groups analysis of variance (ANOVA) was applied. From the total of 306 healthcare professionals, 223 participated in the study (72.9%). The majority of participants were women (75.3%) and mean age was 42.6 ± 10.7 years. Culture dimension "performance orientation" was the desired culture among healthcare professionals (mean: 1.39 ± 0.45). "Supportiveness" and "social responsibility" were the main cultures encountered in PHC (means: 2.37 ± 0.80, 2.38 ± 0.83). Statistical significant differences were identified between desired and prevailing cultures for all culture dimensions (p= 0.000). This was the first study performed in Cyprus assessing organizational culture in the PHC setting. In the forthcoming health system reform

Reproductive Health Policies in Peru: Social Reforms and Citizenship Rights

Directory of Open Access Journals (Sweden)

Stéphanie Rousseau

2007-05-01

Full Text Available The article analyzes the case of reproductive health policy-making in Peru in the context of recent social policy reforms. Health-sector reforms have only partially redressed Peruvian women’s unequal access to family planning, reproductive rights and maternal care. The main sources of inequalities are related to the segmented character of the health-care system, with the highest burden placed on the public sector. The majority of women from popular classes, who are not protected by an insurance plan, are dependent upon what and how public services are provided. Simultaneously, the continuing role of conservative sectors in public debates about reproductive health policy has a strong impact on public family planning services and other reproductive rights.

Healthcare in the UK: understanding continuity and change

National Research Council Canada - National Science Library

Greener, Ian

2009-01-01

... of the 1960s The 1970s The 1980s The 1990s The 2000s Conclusion 39 39 39 50 57 58 60 63 66 71 four the double-bed Introduction The relationship between the state and the medical profession The deelopment of the double-bed relationship Deelopments in the 1950s The 1960s and the first organisational reform of the NHS 75 75 77 81 81 84 Healthcar...

Health reform and cesarean sections in the private sector: The experience of Peru.

Science.gov (United States)

Arrieta, Alejandro

2011-02-01

To test the hypothesis that the health reform enacted in Peru in 1997 increased the rate of cesarean sections in the private sector due to non-clinical factors. Different rounds of the Demographic and Health Survey are used to estimate determinants of c-section rates in private and public facilities before and after the healthcare reform. Estimations are based on a pooled linear regression controlling by obstetric and socioeconomic characteristics. C-section rates in the private sector grew from 28 to 53% after the health reform. Compared to the Ministry of Health (MOH), giving birth in a private hospital in the post-reform period adds 19% to the probability of c-section. The health reform implemented in the private sector increased physician incentives to over-utilize c-sections. The reform consolidated and raised the market power of private health insurers, but at the same time did not provide mechanisms to enlarge, regulate and disclose information of private providers. All these factors created the conditions for fee-for-service paid providers to perform more c-sections. Comparable trends in c-section rates have been observed in Latin American countries who implemented similar reforms in their private sector, suggesting a need to rethink the role of private health providers in developing countries. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety.

NARCIS (Netherlands)

Mens, K.; Lokkerbol, J.; Janssen, R.T.J.M.; van Orden, M.; Kloos, M.; Tiemens, B.

2018-01-01

Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental

Measuring the efficiency of a healthcare waste management system in Serbia with data envelopment analysis.

Science.gov (United States)

Ratkovic, Branislava; Andrejic, Milan; Vidovic, Milorad

2012-06-01

In 2007, the Serbian Ministry of Health initiated specific activities towards establishing a workable model based on the existing administrative framework, which corresponds to the needs of healthcare waste management throughout Serbia. The objective of this research was to identify the reforms carried out and their outcomes by estimating the efficiencies of a sample of 35 healthcare facilities engaged in the process of collection and treatment of healthcare waste, using data envelopment analysis. Twenty-one (60%) of the 35 healthcare facilities analysed were found to be technically inefficient, with an average level of inefficiency of 13%. This fact indicates deficiencies in the process of collection and treatment of healthcare waste and the information obtained and presented in this paper could be used for further improvement and development of healthcare waste management in Serbia.

The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China.

Science.gov (United States)

Guo, Zhigang; Guan, Xiaodong; Shi, Luwen

2017-11-13

In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China. The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010. A questionnaire survey developed by the study team was distributed to all of the primary healthcare institutions. Nine indicators from three dimensions as the outcome variables were used and calculated to evaluate the impacts of implementation of policies. All of the outcome variables were tested using independent-samples T test between the treatment group (with the NEMPs implemented) and the control group (without the NEMPs implemented). The ratio of drug sales and institution revenues at primary healthcare institutions was 42.99% in the treatment group, which was significantly lower than the control group (53.90%, p financial subsidies of the treatment group was shown to be higher (30.78% VS 20.82%, p institutions, the improvement of the mechanisms for government investment, and the healthcare pricing system. Meanwhile, the gaps between urban and rural areas need to be addressed. In conclusion, the NEMPs of China are instrumental to the aim of providing basic healthcare services to every citizen.

Gatekeepers in the healthcare sector: Knowledge and Bourdieu's concept of field.

Science.gov (United States)

Collyer, Fran M; Willis, Karen F; Lewis, Sophie

2017-08-01

Choice is an imperative for patients in the Australian healthcare system. The complexity of this healthcare 'maze', however, means that successfully navigating and making choices depends not only on the decisions of patients, but also other key players in the healthcare sector. Utilising Bourdieu's concepts of capital, habitus and field, we analyse the role of gatekeepers (i.e., those who control access to resources, services and knowledge) in shaping patients' experiences of healthcare, and producing opportunities to enable or constrain their choices. Indepth interviews were conducted with 41 gatekeepers (GPs, specialists, nurses, hospital administrators and policymakers), exploring how they acquire and use knowledge within the healthcare system. Our findings reveal a hierarchy of knowledges and power within the healthcare field which determines the forms of knowledge that are legitimate and can operate as capital within this complex and dynamic arena. As a consequence, forms of knowledge which can operate as capital, are unequally distributed and strategically controlled, ensuring democratic 'reform' remains difficult and 'choices' limited to those beneficial to private medicine. Copyright © 2017 Elsevier Ltd. All rights reserved.

Private Healthcare Institutions and Insurance Companies: from Cooperators to Market Competitors

Directory of Open Access Journals (Sweden)

Željko Jović

2015-05-01

Full Text Available The provision of adequate healthcare nowadays has a global character, so the implementation of efficient andwell-formulated health reforms has become of serious importance. Among many contemporary trends in this area, there is a tendency of privatization of health care institutions and growth in private insurance premiums. This raises the necessity of developing a cooperation between private healthcare institutions and insurance companies in order to provide services of an improved quality. This paper emphasizes the extremes of their cooperation, moving from fully integrated systems towards competition over the market. The findings indicate that, due to the insufficient development of Serbian healthcare sector, their cooperation is so far not at a highlevel, which brings many issues into question and that should be legally better defined.

Experimental analysis of an autothermal reformer for automotive purposes

International Nuclear Information System (INIS)

Caners, C.; Peppley, B.; Harrison, S.; Oosthuizen, P.

2004-01-01

This paper describes the experimental analysis, concomitant with modeling research, to determine improved operating parameters and design of an autothermal reformer. The reformer, utilizing both partial oxidation and steam reforming reactions, along with the water gas shift phenomena is well suited for the mobile application of transportation. This is due to the novel geometry of the autothermal reformer, which seeks to improve the heat transfer characteristics of the process, whereby the exothermic partial oxidation reaction provides the heat energy required to drive the steam reforming reaction, to the point of a thermally neutral system. The paper will present data from the experimental results of reforming iso-octane as a surrogate for gasoline in the form of reformate composition, iso-octane conversion percentages and efficiencies in terms of hydrogen realized per mol of fuel input. (author)

Relations between decision indicators for implementing technology in healthcare logistics – a bed logistics case study

DEFF Research Database (Denmark)

Feibert, Diana Cordes; Jacobsen, Peter

2015-01-01

The cost of healthcare is rising and reforms have been introduced across Europe to address the cost issue in healthcare. There is potential to improve logistical processes within healthcare to save costs and at the same time provide services that support high quality patient care. Re......-designing processes and implementing technology can improve the efficiency of processes and reduce costs. A relations diagram has been developed that identifies the effects between the constructs Logistics, Technology, Procedure and Structure. Knowledge about how these constructs affect each other is important when...

[Austerity policies and changes in healthcare use patterns. SESPAS report 2014].

Science.gov (United States)

Urbanos Garrido, Rosa; Puig-Junoy, Jaume

2014-06-01

This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Progress and outcomes of health systems reform in the United Arab Emirates: A systematic review

NARCIS (Netherlands)

E.J. Koornneef (Erik J.); P.B.M. Robben (Paul); Blair, I. (Iain)

2017-01-01

textabstractBackground: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent

Analysing a Chinese Regional Integrated Healthcare Organisation Reform Failure using a Complex Adaptive System Approach

Directory of Open Access Journals (Sweden)

Wenxi Tang

2017-06-01

Full Text Available Introduction: China’s organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS provides a new perspective and methodology for analysing the health system and policy implementation.  Methods: We observed the typical case of Qianjiang’s Integrated Health Organization Reform (IHO for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS.  Results: The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision.  Discussion and Conclusions: The traditional 'organised health system' is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a s'emi-organised system'. Medical institutions and professionals operate in a middle ground between complete adherence

Healthcare in Asia: a perspective from primary care at the gateway to a continent.

Science.gov (United States)

Jiwa, Moyez; Othman, Sajaratulnisah; Hanafi, Nik Sherina; Ng, Chirk Jenn; Khoo, Ee Ming; Chia, Yook Chin

2012-01-01

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.

48 CFR 801.602-73 - Review requirements for scarce medical specialist contracts and contracts for health-care resources.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Review requirements for scarce medical specialist contracts and contracts for health-care resources. 801.602-73 Section 801.602... Responsibilities 801.602-73 Review requirements for scarce medical specialist contracts and contracts for health...

Reforms for competitive markets in Pakistan

OpenAIRE

Haque, Nadeem; Ahmed, Vaqar; Shahid, Sana

2011-01-01

While Pakistan has taken several steps to promote competition in its markets, further reforms are required in improving domestic commerce, agricultural markets and industries. With increasing risks and cost of doing business due to deteriorating law and order situation as well as massive energy shortages, Pakistan needs to compensate its entrepreneurs and investors by enhancing its investment and business climate. By adopting certain administrative and legal reforms, Pakistan can considerably...

Carbonaceous deposits on naptha reforming catalysts

International Nuclear Information System (INIS)

Redwan, D.S.

1999-01-01

Carbonaceous deposits on naphtha reforming catalysts play a decisive role in limiting process performance. The deposits negatively after catalyst activity, selectivity and the production cycle of a semi regenerative reformer. The magnitude of negative effect of those deposits is directly proportional to their amounts and complexity. Investigations on used reforming catalysts samples reveal that the amount and type (complexity of the chemical nature) of carbonaceous deposits are directly proportional to the catalysts life on stream and the severity of operating conditions. In addition, the combustibility behavior of carbonaceous deposits on the catalyst samples taken from different reformers are found to be different. Optimal carbon removal, for in situ catalyst regeneration, requires the specific conditions be developed, based on the results of well designed and properly performed investigations of the amount and type of carbonaceous deposits. (author)

Catalytic autothermal reforming of hydrocarbon fuels for fuel cells

International Nuclear Information System (INIS)

Krumpelt, M.; Krause, T.; Kopasz, J.; Carter, D.; Ahmed, S.

2002-01-01

Fuel cell development has seen remarkable progress in the past decade because of an increasing need to improve energy efficiency as well as to address concerns about the environmental consequences of using fossil fuel for producing electricity and for propulsion of vehicles[1]. The lack of an infrastructure for producing and distributing H(sub 2) has led to a research effort to develop on-board fuel processing technology for reforming hydrocarbon fuels to generate H(sub 2)[2]. The primary focus is on reforming gasoline, because a production and distribution infrastructure for gasoline already exists to supply internal combustion engines[3]. Existing reforming technology for the production of H(sub 2) from hydrocarbon feedstocks used in large-scale manufacturing processes, such as ammonia synthesis, is cost prohibitive when scaled down to the size of the fuel processor required for transportation applications (50-80 kWe) nor is it designed to meet the varying power demands and frequent shutoffs and restarts that will be experienced during normal drive cycles. To meet the performance targets required of a fuel processor for transportation applications will require new reforming reactor technology developed to meet the volume, weight, cost, and operational characteristics for transportation applications and the development of new reforming catalysts that exhibit a higher activity and better thermal and mechanical stability than reforming catalysts currently used in the production of H(sub 2) for large-scale manufacturing processes

Understanding requirements of novel healthcare information systems for management of advanced prostate cancer.

Science.gov (United States)

Wagholikar, Amol S; Fung, Maggie; Nelson, Colleen C

2012-01-01

Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.

Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

2011-01-01

As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...

The importance of measuring unmet healthcare needs.

Science.gov (United States)

Gauld, Robin; Raymont, Antony; Bagshaw, Philip F; Nicholls, M Gary; Frampton, Christopher M

2014-10-17

Major restructuring of the health sector has been undertaken in many countries, including New Zealand and England, yet objective assessment of the outcomes has rarely been recorded. In the absence of comprehensive objective data, the success or otherwise of health reforms has been inferred from narrowly-focussed data or anecdotal accounts. A recent example relates to a buoyant King's Fund report on the quest for integrated health and social care in Canterbury, New Zealand which prompted an equally supportive editorial article in the British Medical Journal (BMJ) suggesting it may contain lessons for England's National Health Service. At the same time, a report published in the New Zealand Medical Journal expressed concerns at the level of unmet healthcare needs in Canterbury. Neither report provided objective information about changes over time in the level of unmet healthcare needs in Canterbury. We propose that the performance of healthcare systems should be measured regularly, objectively and comprehensively through documentation of unmet healthcare needs as perceived by representative segments of the population at formal interview. Thereby the success or otherwise of organisational changes to a health system and its adequacy as demographics of the population evolve, even in the absence of major restructuring of the health sector, can be better documented.

Comments on regulatory reform

Energy Technology Data Exchange (ETDEWEB)

Hendrie, J.M.

1982-01-01

Nuclear regulatory reform is divided into two parts. The first part contains all those matters for which new legislation is required. The second part concerns all those matters that are within the power of the Commission under existing statutes. Recommendations are presented.

Comments on regulatory reform

International Nuclear Information System (INIS)

Hendrie, J.M.

1982-01-01

Nuclear regulatory reform is divided into two parts. The first part contains all those matters for which new legislation is required. The second part concerns all those matters that are within the power of the Commission under existing statutes. Recommendations are presented

Healthcare reform. Is the NHS ready for US business guru's strategy?

Science.gov (United States)

Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

2006-12-07

The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

Electricity reform in developing and transition countries: A reappraisal

International Nuclear Information System (INIS)

Williams, J.H.; Ghanadan, R.

2006-01-01

Since about 1990, many developing and transition countries have undertaken market-oriented reforms in their electric power sectors. Despite the widespread adoption of a standard policy model, reform processes and outcomes have often failed to meet expectations. Drawing on an extensive literature review and case studies in Asia, Africa, Latin America, and Eastern Europe, this paper describes common features of non-OECD electricity reform and reappraises reform policies and underlying assumptions. Comparison with the sector-focused policy goals of deregulation in OECD countries highlights the importance of national fiscal crises, macroeconomic reforms, and persuasion by multilateral lenders in shaping non-OECD reforms. It also makes clear reform's dependence on attracting foreign capital, and consequent vulnerability to volatile international financial conditions. Case studies of Bolivia, Ghana, India, Poland, and Thailand illustrate reform's diverse pathways and problems in different settings. A broad range of non-OECD reform experiences indicates that disappointing results have often resulted from a narrow focus on finance and cost recovery, inflexibly applied. The paper concludes that improving reform will require emphasizing a broader set of objectives, including service provision, public benefits, effective regulation, and social/political legitimacy. Above all, reforms must be based on realistic assessments of national needs and capabilities. (author)

Agent-Oriented Privacy-Based Information Brokering Architecture for Healthcare Environments

Directory of Open Access Journals (Sweden)

Abdulmutalib Masaud-Wahaishi

2009-01-01

Full Text Available Healthcare industry is facing a major reform at all levels—locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc. that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

Agent-oriented privacy-based information brokering architecture for healthcare environments.

Science.gov (United States)

Masaud-Wahaishi, Abdulmutalib; Ghenniwa, Hamada

2009-01-01

Healthcare industry is facing a major reform at all levels-locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc.) that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

Corruption in health-care systems and its effect on cancer care in Africa.

Science.gov (United States)

Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

2015-08-01

At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China.

Science.gov (United States)

Zhang, Shengfa; Zhang, Weijun; Zhou, Huixuan; Xu, Huiwen; Qu, Zhiyong; Guo, Mengqi; Wang, Fugang; Zhong, You; Gu, Linni; Liang, Xiaoyun; Sa, Zhihong; Wang, Xiaohua; Tian, Donghua

2015-05-05

In 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China's health reforms are influencing village doctors' income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors' income structure and analyse how these health policies influenced it. Based on a review of the previous literature and qualitative study, village doctors' income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors' income structure were analysed and determined by a thematic analysis approach and group discussion. Several policies launched during China's 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors' role. Moreover, integrated management of village doctors' activities by township-level staff has reduced their independence, and different counties' economic status and health reform processes have also led to inconsistencies in village doctors' payment. These changes have dramatically reduced village doctors' income and employment satisfaction. The health-care reform policies have had lasting impacts on village doctors' income structure since the policies' implementation in 2009. The village doctors have to rely on the salaries and subsidies from

National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

Directory of Open Access Journals (Sweden)

Darko Gvozdanovi_

2007-09-01

Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

Science.gov (United States)

Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

2015-01-01

To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

Demonstration of direct internal reforming for MCFC power plants

Energy Technology Data Exchange (ETDEWEB)

Aasberg-Petersen, K.; Christensen, P.S.; Winther, S.K. [HALDOR TOPSOE A/S, Lynby (Denmark)] [and others

1996-12-31

The conversion of methane into hydrogen for an MCFC by steam reforming is accomplished either externally or internally in the stack. In the case of external reforming the plant electrical efficiency is 5% abs. lower mainly because more parasitic power is required for air compression for stack cooling. Furthermore, heat produced in the stack must be transferred to the external reformer to drive the endothermic steam reforming reaction giving a more complex plant lay-out. A more suitable and cost effective approach is to use internal steam reforming of methane. Internal reforming may be accomplished either by Indirect Internal Reforming (DIR) and Direct Internal Reforming (DIR) in series or by DIR-only as illustrated. To avoid carbon formation in the anode compartment higher hydrocarbons in the feedstock are converted into hydrogen, methane and carbon oxides by reaction with steam in ail adiabatic prereformer upstream the fuel cell stack. This paper discusses key elements of the desire of both types of internal reforming and presents data from pilot plants with a combined total of more than 10,000 operating hours. The project is being carried out as part of the activities of the European MCFC Consortium ARGE.

Banking system reform, earnings quality and credit allocation

Institute of Scientific and Technical Information of China (English)

Xiuli Zhu; Lianjun Li; Yunkui Xue

2012-01-01

This paper investigates credit allocation before and after the 2003 banking system reform in China. We find that relationships between earnings quality and new short-term loans, long-term loans and total loans in listed companies changed significantly after the banking system reform, especially in stateowned listed companies. Further investigation shows that due to the influence of rent-seeking, banks have eased the earnings requirements of non-stateowned listed companies. These findings enhance our understanding of the economic consequences of the banking system reform and of credit discrimination under the new regime.

Health Reform and its Impact on Healthcare Workers: A Case Study of the National Clinical Hospital of Cordova, Argentina

Directory of Open Access Journals (Sweden)

Carlos Álvarez

2007-10-01

Full Text Available Since the mid 1990’s, health in Argentina has no longer been considered a social function of the State but was transformed into a market commodity. Neoliberal decentralization favored the introduction of corporate methods and incentivized privatization. In practice, this led to self-management for hospitals, deregulation of social services and incorporation of private capital to the public health business. This exploratory study looks at the impact of these reforms in the public health services sector. It analyzes living and working conditions, changes produced in the organization of work and their effect on labor relations and on participation in union, political and social activities by workers at the National Clinical Hospital of Cordoba, Argentina. Data was primarily collected through an interview survey of a convenience sample of 68 workers from the non-teaching staff; this represents 10% of the total professional, administrative and maintenance staff of the hospital. The interviews demonstrate deterioration in income and living conditions. Hospital self-management for these workers led to increased competition, the fragmentation in the work spaces, tension and the distrust between co-workers, as well as increased intensity in the workload of some employees. The profile of these healthcare workers is structured and marked by silence, the resolution of the conflicts by means of individual action in the workplace, and minimal participation in social-political-union or community organizations.

Healthcare. State Report

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

South Africa's universal health coverage reforms in the post-apartheid period.

Science.gov (United States)

van den Heever, Alexander Marius

2016-12-01

In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme. This contrasts with the post-apartheid period from 1994 to 2008 where pooling weaknesses were to be addressed using pooling schemes, in the form of government subsidies and risk-equalisation arrangements, external to the public and private purchasers. This article reviews both reform paths and attempts to reconcile what may appear to be very different approaches. The scale of the more recent set of proposals requires a very long reform path because in the mid-term (the next 25 years) no single scheme will be able to raise sufficient revenue to provide a universal package for the entire population. In the interim, reforms that maintain and improve existing forms of coverage are required. The earlier reform framework (1994-2008) largely addressed this concern while leaving open the final form of the system. Both reform approaches are therefore compatible: the earlier reforms addressed medium- to long-term coverage concerns, while the more recent define the long-term institutional goal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Faith-Based Organizations and the Affordable Care Act: Reducing Latino Mental Healthcare Disparities

Science.gov (United States)

Villatoro, Alice P.; Dixon, Elizabeth; Mays, Vickie M.

2014-01-01

The Patient Protection and Affordable Care Act (ACA) is expected to increase access to mental healthcare through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino non-elderly adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental healthcare disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental healthcare of Latinos by increasing help-seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental healthcare disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered medical homes (PCMH) may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and PCMH providers need to overcome in order to be partners in integrated care efforts. PMID:26845492

Opportunities in Reform: Bioethics and Mental Health Ethics.

Science.gov (United States)

Williams, Arthur Robin

2016-05-01

Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. © 2015 John Wiley & Sons Ltd.

Strategic planning: how medical practices can succeed in a post-healthcare-reform world.

Science.gov (United States)

Howrigon, Ron

2013-01-01

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

Lean six sigma in healthcare.

Science.gov (United States)

de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

2006-01-01

Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

Healthcare Data Analytics on the Cloud

Directory of Open Access Journals (Sweden)

Indrajit Bhattacharya

2012-04-01

Full Text Available Meaningful analysis of voluminous health information has always been a challenge in most healthcare organizations. Accurate and timely information required by the management to lead a healthcare organization through the challenges found in the industry can be obtained using business intelligence (BI or business analytics tools. However, these require large capital investments to implement and support the large volumes of data that needs to be analyzed to identify trends. They also require enormous processing power which places pressure on the business resources in addition to the dynamic changes in the digital technology. This paper evaluates the various nuances of business analytics of healthcare hosted on the cloud computing environment. The paper explores BI being offered as Software as a Service (SaaS solution towards offering meaningful use of information for improving functions in healthcare enterprise. It also attempts to identify the challenges that healthcare enterprises face when making use of a BI SaaS solution.

Consumer choice among Mutual Healthcare Purchasers: a feasible option for China?

Science.gov (United States)

Xu, Weiwei; van de Ven, Wynand P M M

2013-11-01

In its 2009 blue print of healthcare reform, the Chinese government aimed to create a competitive health insurance market in order to increase efficiency in the health insurance sector. A major advantage of a competitive health insurance market is that insurers are stimulated to act as well-motivated prudent purchasers of healthcare on behalf of their enrolees, and that consumers can choose among these purchasers. To emphasize the insurers' role of purchasers of care we denote them, as well as other entities that can fulfil this role (e.g. fundholding community health centres), as 'Mutual Healthcare Purchasers' (MHPs). As feasible proposals for creating competition in China's health insurance sector have yet to be made, we suggest two potential approaches to create competition among MHPs: (1) separating finance and operation of social health insurance and allowing consumer choice among operators of social health insurance schemes; (2) allowing consumer choice among fund-holding community health centres. Although the benefits of competition are widely accepted in China, the problematic consequences of a free competitive health insurance market - especially in relation to affordability and accessibility - are generally neglected. To solve the problems of lack of affordability and inaccessibility that would occur in the case of unregulated competition among MHPs, at least the following regulations are proposed to the Chinese policy makers: a 'standard benefit package' for basic health insurance, a 'risk-equalization scheme', and 'open enrolment'. Potential obstacles for implementing a risk equalization scheme are examined based on theoretical arguments and international experiences. We conclude that allowing consumer choice among MHPs and implementing a risk equalization scheme in China is politically and technically complex. Therefore, the Chinese government should prepare carefully for a market-oriented reform in its healthcare sector and adopt a strategic approach

Banking system reform, earnings quality and credit allocation

Directory of Open Access Journals (Sweden)

Xiuli Zhu

2012-09-01

Full Text Available This paper investigates credit allocation before and after the 2003 banking system reform in China. We find that relationships between earnings quality and new short-term loans, long-term loans and total loans in listed companies changed significantly after the banking system reform, especially in state-owned listed companies. Further investigation shows that due to the influence of rent-seeking, banks have eased the earnings requirements of non-state-owned listed companies. These findings enhance our understanding of the economic consequences of the banking system reform and of credit discrimination under the new regime.

Implementing health care reform: implications for performance of public hospitals in central Ethiopia.

Science.gov (United States)

Manyazewal, Tsegahun; Matlakala, Mokgadi C

2018-06-01

health care reform has laid the groundwork for health system improvement, but progress was slow and the health care delivery system was still fragile. Healthcare reform efforts in such settings are feasible, but with regular mapping of programmatic outcomes and bringing a common understanding of the reform among stakeholders.

Bureaucratic Reform in Irrigation: A Review of Four Case Studies

Directory of Open Access Journals (Sweden)

Diana Suhardiman

2014-10-01

Full Text Available Poor performance of government-managed irrigation systems persists globally. This paper argues that addressing performance requires not simply more investment or different policy approaches, but reform of the bureaucracies responsible for irrigation management. Based on reform experiences in The Philippines, Mexico, Indonesia, and Uzbekistan, we argue that irrigation (policy reform cannot be treated in isolation from the overall functioning of government bureaucracies and the wider political structure of the states. Understanding of how and why government bureaucracies shape reform processes and outcomes is crucial to increase the actual significance of reforms. To demonstrate this, the paper links reform processes in the irrigation sector with the wider discourse of bureaucratic reform in the political science, public administration, and organisational science literature. Doing so brings to light the need for systematic comparative research on the organisational characteristic of the irrigation bureaucracies, their bureaucratic identities, and how these are shaped by various segments within the bureaucracies to provide the insights needed to improve irrigation systems performance.

Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review.

Science.gov (United States)

Zhang, Mingji; Yang, Rongrong; Wang, Wei; Gillespie, James; Clarke, Susan; Yan, Fei

2016-02-01

In 2009 China introduced a new round of healthcare reform to strengthen primary care networks through the development of Community Health Services (CHS). This study aimed to measure the degree of overall job satisfaction and also satisfaction dimensions and then find common causes of dissatisfaction among Community Health Workers (CHWs) in urban China by conducting a systematic review of relevant studies on CHWs' job satisfaction. Web of Science, PubMed, Google scholar, Wanfangdata and CNKI were searched. Publications about job satisfaction of CHWs were screened and assessed. Finally 18 Chinese articles and 4 English articles were included. Quantitative and qualitative data were extracted for nine themes concerning job satisfaction. Narrative synthesis was employed to analyze the data. CHWs were generally neither satisfied nor dissatisfied with their work after 2009. Financial rewards and opportunities for professional development were the most important determinants of job dissatisfaction. Workers were generally satisfied with interpersonal relationships in the workplace. The expanded public health services package and human-resources related regulations, e.g. the professional rank promotion system, government-controlled staffing policy (i.e. staff-quota system) and government-controlled budgetary planning (i.e. the Separation of Revenue and Expenditure), were policies that had an effect on job satisfaction. Financial rewards and professional development were the two main predictors of job satisfaction. To improve CHS in China, policy-makers (especially the central government) need to consider the impact of current policies on job satisfaction in order to reduce job dissatisfaction. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis.

Science.gov (United States)

Zandian, Hamed; Takian, Amirhossein; Rashidian, Arash; Bayati, Mohsen; Zahirian Moghadam, Telma; Rezaei, Satar; Olyaeemanesh, Alireza

2018-03-01

One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (pfinancing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Teenagers and Welfare Reform.

Science.gov (United States)

Offner, Paul

This report examines the extent to which welfare reform is changing adolescent behaviors that lead to welfare dependency. It begins by discussing the provisions in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that require teenagers to stay in school and live with a parent, concluding that relatively little can be…

Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health-care reform in China.

Science.gov (United States)

Li, Qing; Babor, Thomas F; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F; Nelson, Toben F; Shen, Weixing; Li, Bing

2015-01-01

Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies. © 2014 Society for the Study of Addiction.

Time for TIGER to ROAR! Technology Informatics Guiding Education Reform.

Science.gov (United States)

O'Connor, Siobhan; Hubner, Ursula; Shaw, Toria; Blake, Rachelle; Ball, Marion

2017-11-01

Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond. In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER. Copyright © 2017 Elsevier Ltd. All rights reserved.

Telecom Reform

DEFF Research Database (Denmark)

Telecom Reform: Principles, Policies and Regulatory Practices, provides a comprehensive and definitive review and assessment of the unfolding telecom reform process, and its implications for information society development. It is an invaluable resource and authoritative reference on telecom reform...... and information infrastructure issues - for people in government, academia, industry and the consulting community. This book addresses the process of policy and regulatory reform in telecom that is now in its formative stage. It draws on detailed knowledge of industry development and regulatory experience......, as well as expertise in the new technologies, industries, economics, policy development, and law to present and critique the principles, policies and regulatory practices associated with telecom reform. Twenty six international experts address thirty two topics that are essential to successful telecom...

Steepest Ascent Tariff Reform

DEFF Research Database (Denmark)

Raimondos-Møller, Pascalis; Woodland, Alan

2014-01-01

. In undertaking this task, and by focusing on tariff reforms, we introduce the concept of a steepest ascent policy reform, which is a locally optimal reform in the sense that it achieves the highest marginal gain in utility of any feasible local reform. We argue that this reform presents itself as a natural......The policy reform literature is primarily concerned with the construction of reforms that yield welfare gains. By contrast, this paper’s contribution is to develop a theoretical concept for which the focus is upon the sizes of welfare gains accruing from policy reforms rather than upon their signs...... benchmark for the evaluation of the welfare effectiveness of other popular tariff reforms such as the proportional tariff reduction and the concertina rules, since it provides the maximal welfare gain of all possible local reforms. We derive properties of the steepest ascent tariff reform, construct...

Nickel catalysts for internal reforming in molten carbonate fuel cells

NARCIS (Netherlands)

Berger, R.J.; Berger, R.J.; Doesburg, E.B.M.; Doesburg, E.B.M.; van Ommen, J.G.; Ross, J.R.H.; Ross, J.R.H.

1996-01-01

Natural gas may be used instead of hydrogen as fuel for the molten carbonate fuel cell (MCFC) by steam reforming the natural gas inside the MCFC, using a nickel catalyst (internal reforming). The severe conditions inside the MCFC, however, require that the catalyst has a very high stability. In

Public-Privat e Partnership in the System of Regional Healthcare Financing

Directory of Open Access Journals (Sweden)

Margarita Yur’evna Molchanova

2016-05-01

Full Text Available Healthcare financing reform in the Russian Federation, besides its positive consequences, has led to the emergence of several major organizational and economic problems that hinder the expansion of financing sources for this sphere, which also involves public-private partnership (PPP. The paper highlights the regional specifics of such healthcare projects compared to similar projects of other spheres of the national economy. The author describes the problems of PPP projects implementation in healthcare; they include the insufficiency of substantiation of public-private partnership application in healthcare, and the absence of typical models for establishment of relations between PPP participants. The paper presents the healthcare priorities put forward by the author; these priorities are based on the theory of the life cycle of a service. The author presents her own model for organizing a regional concession, which is the most common form of public-private partnership in healthcare so far. The cluster brings together on a voluntary basis the legally independent organizations that are interested in improving the quality and increasing the accessibility of health services. These can include medical institutions of various forms of ownership located in the region, clinics, facilities, institutions that train healthcare workers, authorities, etc. The author shows that a favorable environment for the formation and implementation of PPP projects can be created under the cluster approach to the organization of healthcare. When establishing the medical cluster, the main task is to organize interaction between all its subjects in the interest of the overall development of healthcare in the region and the implementation of one’s own interests

Reforming the health care system: implications for health care marketers.

Science.gov (United States)

Petrochuk, M A; Javalgi, R G

1996-01-01

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

Controlling healthcare professionals: how human resource management influences job attitudes and operational efficiency.

Science.gov (United States)

Cogin, Julie Ann; Ng, Ju Li; Lee, Ilro

2016-09-20

We assess how human resource management (HRM) is implemented in Australian hospitals. Drawing on role theory, we consider the influence HRM has on job attitudes of healthcare staff and hospital operational efficiency. We adopt a qualitative research design across professional groups (physicians, nurses, and allied health staff) at multiple levels (executive, healthcare managers, and employee). A total of 34 interviews were carried out and analyzed using NVivo. Findings revealed a predominance of a control-based approach to people management. Using Snell's control framework (AMJ 35:292-327, 1992), we found that behavioral control was the principal form of control used to manage nurses, allied health workers, and junior doctors. We found a mix between behavior, output, and input controls as well as elements of commitment-based HRM to manage senior physicians. We observed low levels of investment in people and a concentration on transactional human resource (HR) activities which led to negative job attitudes such as low morale and frustration among healthcare professionals. While hospitals used rules to promote conformity with established procedures, the overuse and at times inappropriate use of behavior controls restricted healthcare managers' ability to motivate and engage their staff. Excessive use of behavior control helped to realize short-term cost-cutting goals; however, this often led to operational inefficiencies. We suggest that hospitals reduce the profusion of behavior control and increase levels of input and output controls in the management of people. Poor perceptions of HR specialists and HR activities have resulted in HR being overlooked as a vehicle to address the strategic challenges required of health reform and to build an engaged workforce.

Non-catalytic recuperative reformer

Science.gov (United States)

Khinkis, Mark J.; Kozlov, Aleksandr P.; Kurek, Harry

2015-12-22

A non-catalytic recuperative reformer has a flue gas flow path for conducting hot flue gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is embedded in the flue gas flow path to permit heat transfer from the hot flue gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, extended surfaces of metal material such as stainless steel or metal alloy that are high in nickel content are included within at least a portion of the reforming mixture flow path.

Healthcare payments under the budget deal: mostly good news for physicians

Directory of Open Access Journals (Sweden)

Robbins RA

2018-02-01

Full Text Available No abstract available. Article truncated after 150 words. In the early morning hours last Friday (2/9/18 Congress passed and President Trump signed a massive budget agreement (1. The spending package will cost about $320 billion over 10 years, according to the Congressional Budget Office. Payments for healthcare substantially increase under the deal. Most praised the agreement. "Congress made the right choice this morning for patients and communities by voting to halt damaging cuts to hospitals that care for low-income working families and others who face financial challenges," said Dr. Bruce Siegel, CEO of America's Essential Hospitals, which represents the nation's safety-net facilities. Marc Goldwein of the Center for a Responsible Federal Budget called the healthcare provisions the one "beacon of light" in what otherwise is an exorbitantly costly budget bill. Goldwein praised its mix of structural reforms with "reasonable policy” and liked that the bill pays for the increased healthcare spending. The bill extends Medicare physician fee cuts ….

Can vouchers make a difference to the use of private primary care services by older people? Experience from the healthcare reform programme in Hong Kong.

Science.gov (United States)

Yam, Carrie H K; Liu, Su; Huang, Olivia H Y; Yeoh, E K; Griffiths, Sian M

2011-10-07

As part of its ongoing healthcare reform, the Hong Kong Government introduced a voucher scheme, intended for encouraging older patients to use primary healthcare services in the private sector, thereby, reducing burden on the overwhelmed public sector. The voucher program is also considered one of the strategies to further develop the public private partnership in healthcare, a policy direction of high political priority as indicated in the Chief Executive Policy Address in 2008-09. This study assessed whether the voucher scheme, as implemented so far, has reached its intended goals, and how it might be further improved in the context of public-private partnership. This was a cross-sectional study using structured questionnaires by face-to-face interviews with older people aged 70 or above in Hong Kong, the target group of the demand-side voucher program. 71.2% of 1,026 older people were aware of the new voucher scheme but only 35.0% had ever used it. The majority of the older people used the vouchers for acute curative services in the private sector (82.4%) and spent less on preventive services. Despite the provision of vouchers valued US$30 per year as an incentive to encourage the use of private primary care services, after 12-months of implementation, 66.2% of all respondents agreed with the statement that "the voucher scheme does not change their health seeking behaviours on seeing public or private healthcare professionals". The most common reasons for no change in their behaviours included "I am used to seeing doctors in the public system" and "The amount of the subsidy is too low". Those who usually used a mix of public and private doctors and those with better self-reported health condition compared to last year were more likely to perceive a change in their own health seeking behaviours. Our study showed that despite a reasonably high awareness of the voucher scheme, its usage was low. The voucher alone was not enough to realize the government's policy of

The role of consent in medical research: breaking or building walls? A call for legislative reform.

Science.gov (United States)

Dangata, Yohanna Yanshiyi

2011-12-01

Research has been integral to the practice of medicine for almost as long as the discipline has existed. Until fairly recently research used to be conducted on human subjects without mandatory requirement for their consent. However, over time medical research became associated with significant cruelty resulting in an outcry for regulation of research actives. This resulted in significant legislation in place for monitoring. Today it is mandatory to obtain consent from subjects before embarking on medical research, and indeed treatment. Its significant regulatory role notwithstanding, the issue of consent at times becomes a hindrance to research. This paper examines the issue of consent in relation to medical research in the context of present legislation. It lays out the background to medical research with respect to purpose, scope, standard protocol and related issues; it then addresses the issue of consent in various scenarios, highlighting problems and the need for legislative reform. It is maintained that while regulatory measures have brought a lot of sanity to medical research and the medical profession, some measures are building walls inhibitory to research activities. Research being integral to the development and growth of healthcare delivery, there is need for reformation of current medical law for balance between patient protectionism and progress in medical research for effective patient care.

The political economy of management knowledge : management texts in English healthcare organizations

OpenAIRE

Ferlie, Ewan; Ledger, Jean; Dopson, Sue; Fischer, Michael D.; Fitzgerald, Louise; McGivern, Gerry; Bennett, Christopher P.

2016-01-01

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoreti...

Progress in reforming chemical engineering education.

Science.gov (United States)

Wankat, Phillip C

2013-01-01

Three successful historical reforms of chemical engineering education were the triumph of chemical engineering over industrial chemistry, the engineering science revolution, and Engineering Criteria 2000. Current attempts to change teaching methods have relied heavily on dissemination of the results of engineering-education research that show superior student learning with active learning methods. Although slow dissemination of education research results is probably a contributing cause to the slowness of reform, two other causes are likely much more significant. First, teaching is the primary interest of only approximately one-half of engineering faculty. Second, the vast majority of engineering faculty have no training in teaching, but trained professors are on average better teachers. Significant progress in reform will occur if organizations with leverage-National Science Foundation, through CAREER grants, and the Engineering Accreditation Commission of ABET-use that leverage to require faculty to be trained in pedagogy.

Regulatory reform in Turkish energy industry: An analysis

International Nuclear Information System (INIS)

Erdogdu, Erkan

2007-01-01

The Republic of Turkey has initiated an ambitious reform program in the most important segments of her energy market; which requires privatization, liberalization as well as a radical restructuring of these industries. However, there is no consensus that the measures introduced are optimal. The present article attempts, first, to evaluate the regulatory framework created by the laws of 2001 in terms of economic efficiency considerations; and second, to determine what still needs to be done to improve the current situation. The paper not only provides an analysis of these reforms but also lists some policy suggestions. The study concludes that despite relatively good legislative framework, in practice, the reforms in Turkey are far from ideal as they are mainly in the form of 'textbook reforms'; and therefore a significant amount of work still lies ahead of Turkey to set up a fully fledged energy market

Negotiating reform at an arm's length from the state: Disease Management Programmes and the introduction of clinical standards in Germany.

Science.gov (United States)

Burau, Viola

2009-07-01

Studies of German health policy often highlight institutional constraints to reform. However, based on a case study of the introduction of clinical standards as part of the Disease Management Programmes for chronic illnesses, this article suggests that negotiating reform at an arm's length from the state can also lead to governance change, although the strengthening of hierarchy is not as prominent as that in some of the countries studied in this special issue. As such, the case of Germany offers interesting insights into the politics of governance change that occur in the shadow, but largely without the direct involvement of the state, which is typical of a corporatist health-care state. In this respect, the analysis identifies three leverages for change. First, the change in medical governance explicitly builds on earlier reforms and gives the reform alliance a competitive edge. Second, the organisations of the joint self-administration, as a more or less open ally of the state, play an influential role throughout the reform process. Importantly and third, this is complemented by the state steering at a distance.

Dry reforming of methane with CO{sub 2} at elevated pressures

Energy Technology Data Exchange (ETDEWEB)

Milanov, A.; Schwab, E.; Wasserschaff, G. [BASF SE, Ludwigshafen (Germany); Schunk, S. [hte AG, Heidelberg (Germany)

2013-11-01

The indirect conversion of natural gas into higher value chemicals and fuels via syngas is superior with regard to efficiency compared to the currently available direct conversion technologies and remains the industrially preferred route. Typically the syngas production route is generally dictated by the H{sub 2}/CO ratio requirements of the downstream synthesis process. Processes such as direct DME synthesis, high-temperature Fischer-Tropsch and acetic acid synthesis require CO rich syngas that is not readily accessible by established technologies like steam methane reforming (SMR) and autothermal reforming of methane (ATR). The CO{sub 2} reforming of methane, also known as dry reforming (DRM), is an attractive alternative technology for the production of CO-rich syngas. This paper gives an overview of the current joint research activities at BASF and hte AG aiming to develop suitable catalysts for CO{sub 2} reforming of methane at elevated pressures with minimized input of process steam. The performance profiles of two newly developed base metal catalysts are presented and discussed. The catalysts exhibit high degrees of methane and CO{sub 2} conversion in combination with an extraordinary coking resistance under high severity process conditions. (orig.)

Analysis on Operating Parameter Design to Steam Methane Reforming in Heat Application RDE

Science.gov (United States)

Dibyo, Sukmanto; Sunaryo, Geni Rina; Bakhri, Syaiful; Zuhair; Irianto, Ign. Djoko

2018-02-01

The high temperature reactor has been developed with various power capacities and can produce electricity and heat application. One of heat application is used for hydrogen production. Most hydrogen production occurs by steam reforming that operated at high temperature. This study aims to analyze the feasibility of heat application design of RDE reactor in the steam methane reforming for hydrogen production using the ChemCAD software. The outlet temperature of cogeneration heat exchanger is analyzed to be applied as a feed of steam reformer. Furthermore, the additional heater and calculating amount of fuel usage are described. Results show that at a low mass flow rate of feed, its can produce a temperature up to 480°C. To achieve the temperature of steam methane reforming of 850°C the additional fired heater was required. By the fired heater, an amount of fuel usage is required depending on the Reformer feed temperature produced from the heat exchanger of the cogeneration system.

Teamed up for reform. As Obama looks to teamed up solve healthcare's problems, Daschle, Lambrew healthcare team makes sense, industry executives say.

Science.gov (United States)

DoBias, Matthew; Galloro, Vince

2008-12-15

The president-elect sent strong signals that he's serious about reform, with some key appointments last week. The move drew applause from industry executives, including one who said the system is now set on a crash course. "There's no guarantee that someone is going to be able to put Humpty Dumpty back together, but we're never going to know until someone starts sorting through the pieces," says William Atkinson, left, of WakeMed.

Reforming Organizational Structures

OpenAIRE

Van de Walle, Steven

2016-01-01

textabstractPublic sectors have undergone major transformations. Public sector reform touches upon the core building blocks of the public sector: organizational structures, people and finances. These are objects of reform. This chapter presents and discusses a set of major transformations with regard to organizational structures. It provides readers a fairly comprehensive overview of the key reforms that have taken place in Western public sectors. Structural reforms in the public sector show ...

Challenges to healthcare reform in China: profit-oriented medical practices, patients' choice of care and guanxi culture in Zhejiang province.

Science.gov (United States)

Wu, Dan; Lam, Tai Pong; Lam, Kwok Fai; Zhou, Xu Dong; Sun, Kai Sing

2017-11-01

Doctors' profit-oriented practices in public institutions were widespread in China. Two major targets of the healthcare reform launched in 2009 were to curb the profit-making practices in public institutions and to encourage the citizens to use primary care. After 6 years, the status of profit-orientation of public institutions remains unknown. Compared with hospitals, there is no trend of increasing use of primary care. Our study aimed to explore the status of profit-orientation of public institutions and patients' utilization preference. The impacts of guanxi (personal relationship) on patients' utilization of healthcare and doctors' practices were also explored. From September 2014 to September 2015, we conducted focus group and individual interviews, followed by a survey with doctors (n = 1111) in Hangzhou, Zhejiang province. Thematic analysis, independent t-test and Fisher's exact test were conducted to analyse the data. This study found that 36.8% of survey respondents needed to consider making profits for their institutions, especially the hospital specialists. A total of 38.5% and 40.7% thought that their practices led to patients' worries of unnecessary drugs and tests, respectively. Doctors attributed their profit-oriented practices to institutions' agenda setting, poor salary and an organizational bonus system. Their awareness of breaching medical ethics created a guilt feeling and frustration. Nearly 65.0% reported patients' preference for hospital-based care even for minor conditions and 76.2% if the patient was a child. Ineffective gate-keeping mechanism, weak primary care and mistrust in community-based care were major reasons. More specialists than primary care practitioners (41.0 vs 21.5%, P < 0.001) said that patients would use guanxi to gain better services and 64.5% of doctors reported better dedication when patients were somehow connected. In conclusion, profit-orientated practice widely exists in public institutions. Patients

Reform of reserve requirements for nuclear decommissioning, dismantling and disposal; Reform der Atomrueckstellungen fuer Stilllegung/Rueckbau und Entsorgung

Energy Technology Data Exchange (ETDEWEB)

Meyer, Bettina [Forum Oekologisch-Soziale Marktwirtschaft e.V. (FOeS), Berlin (Germany); Kuechler, Swantje; Wronski, Rupert [Forum Oekologisch-Soziale Marktwirtschaft e.V. (FOeS), Berlin (Germany). Bereich Energiepolitik

2015-07-15

This article reports on the ongoing intense discussion as to whether the financial reserves of nuclear power plant operators are sufficient. It starts out with an overview of the current scientific and political debate. This is followed by a brief analysis of nuclear financial reserves in 2014 and preceding years. The authors then present the reform concept of the Forum Oekologisch-Soziale Marktwirtschaft (FOes) and go on to compare it with concepts from the political realm.

Russian electricity reform. Emerging challenges and opportunities

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-07-01

The Russian Government is pursuing a strategy of very high economic growth, with the objective of doubling gross domestic product in ten years. It recognises the central role the electricity sector has to play to achieve this target and has embarked on a highly ambitious program of electricity reform. If it is to succeed, the reform program will have to create market structures, market rules and a regulatory framework that will foster competitive wholesale and retail electricity markets. At the same time, it will have to deal with sensitive social issues related to tariff rebalancing and the removal of cross subsidies. Only competitive markets based on transparent prices that reflect costs can deliver the efficient, reliable and internationally competitive performance needed to meet the government's economic targets. Such markets are essential to attract new investment that will be required to ensure security of electricity supply after 2010. This book focuses on key aspects of the proposed reform that could have an important bearing on its success. It also raises concerns as to the pace of reform in related areas, such as the need for complementary reforms in the Russian natural gas sector. The IEA commends the Russian Government on its efforts to embrace this electricity reform - a key element critical to meeting the challenges ahead in terms of its economic growth and energy security. 17 figs., 10 tabs., 3 maps.

[Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico].

Science.gov (United States)

Bautista-Arredondo, Sergio; Serván-Mori, Edson; Colchero, M Arantxa; Ramírez-Rodríguez, Baruch; Sosa-Rubí, Sandra G

2014-01-01

Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

Directory of Open Access Journals (Sweden)

Wang Shiow-Ing

2013-01-01

Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine

Directory of Open Access Journals (Sweden)

Olena Hankivsky

2017-03-01

Full Text Available Background The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH. Methods The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. Results The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine

Ubuntu and the quest for land reform in South Africa

Directory of Open Access Journals (Sweden)

Herman Holtzhausen

2015-06-01

Full Text Available In this article, I ask the question how we can relate ubuntu to South African land reform from a practical-theological point of view. I will look at researchers� efforts to understand ubuntu and how these efforts do and do not integrate into the conversation around land reform.Referring to land reform, I will focus on two private narratives as opposed to dominant public narratives. An in-depth discussion on legislation and research on perspectives of land ownership therefore falls outside of the ambit of this article. In conclusion, I will argue that the relationship between a landowner and his or her dispossessed coworkers can be the fertile soil which ubuntu requires to find sustainable local answers to land reform.

Virtual Communities For Elderly Healthcare: User-Based Requirements Elicitation

NARCIS (Netherlands)

van 't Klooster, J.W.J.R.; van Beijnum, Bernhard J.F.; Pawar, P.; Sikkel, Nicolaas; Meertens, Lucas Onno; Hermens, Hermanus J.

2011-01-01

Virtual communities for elderly healthcare have a potential to improve the community building process and to facilitate care services through support for activities, participation and information needs. This paper expounds on this idea by proposing a mobile virtual community (MVC) platform for

Understanding healthcare innovation systems: the Stockholm region case.

Science.gov (United States)

Larisch, Lisa-Marie; Amer-Wåhlin, Isis; Hidefjäll, Patrik

2016-11-21

Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public

Advances in catalysts for internal reforming in high temperature fuel cells

Science.gov (United States)

Dicks, A. L.

Catalytic steam reforming of natural gas is an attractive method of producing the hydrogen required by the present generation of fuel cells. The molten carbonate (MCFC) and solid oxide (SOFC) fuel cells operate at high enough temperatures for the endothermic steam reforming reaction to be carried out within the stack. For the MCFC, the conventional anodes have insufficient activity to catalyse the steam reforming of natural gas. For these cells, internal reforming can be achieved only with the addition of a separate catalyst, preferably located in close proximity to the anode. However, in the so-called `Direct Internal Reforming' configuration, attack from alkali in the MCFC may severely limit catalyst lifetime. In the case of the state-of-the-art SOFC, natural gas can be reformed directly on the nickel cermet anode. However, in the SOFC, temperature variations in the cell caused by the reforming reaction may limit the amount of internal reforming that can be allowed in practice. In addition, some external pre-reforming may be desirable to remove high molecular weight hydrocarbons from the fuel gas, which would otherwise crack to produce elemental carbon. Degradation of the SOFC anode may also be a problem when internal reforming is carried out. This has prompted several research groups to investigate the use of alternative anode materials.

Reforming petroleum-based fuels for fuel cell vehicles : composition-performance relationships

International Nuclear Information System (INIS)

Kopasz, J. P.; Miller, L. E.; Ahmed, S.; Devlin, P. R.; Pacheco, M.

2001-01-01

Onboard reforming of petroleum-based fuels, such as gasoline, may help ease the introduction of fuel cell vehicles to the marketplace. Although gasoline can be reformed, it is optimized to meet the demands of ICEs. This optimization includes blending to increase the octane number and addition of oxygenates and detergents to control emissions. The requirements for a fuel for onboard reforming to hydrogen are quite different than those for combustion. Factors such as octane number and flame speed are not important; however, factors such as hydrogen density, catalyst-fuel interactions, and possible catalyst poisoning become paramount. In order to identify what factors are important in a hydrocarbon fuel for reforming to hydrogen and what factors are detrimental, we have begun a program to test various components of gasoline and blends of components under autothermal reforming conditions. The results indicate that fuel composition can have a large effect on reforming behavior. Components which may be beneficial for ICEs for their octane enhancing value were detrimental to reforming. Fuels with high aromatic and naphthenic content were more difficult to reform. Aromatics were also found to have an impact on the kinetics for reforming of paraffins. The effects of sulfur impurities were dependent on the catalyst. Sulfur was detrimental for Ni, Co, and Ru catalysts. Sulfur was beneficial for reforming with Pt catalysts, however, the effect was dependent on the sulfur concentration

 Railway Reforms

DEFF Research Database (Denmark)

Asmild, Mette; Holvad, Torben; Hougaard, Jens Leth

This paper considers railway operations in 23 European countries during 1995-2001, where a series of reform initiatives were launched by the European Commission, and analyses whether these reform initiatives improved the operating efficiency of the railways. Efficiency is measured using Multi......-directional Efficiency Analysis, which enables investigation of how railway reforms affect the inefficiencies of specific cost drivers. The main findings are that the reform initiatives generally improve operating efficiency but potentially differently for different cost drivers. Specifically, the paper provides clear...

Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province

Directory of Open Access Journals (Sweden)

Levesque Jean-Frédéric

2012-07-01

Full Text Available Abstract Background Reform of primary healthcare (PHC organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations’ needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. Methods Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. Results Among eligible adults, 18 % reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59 % of cases; unavailability of usual doctor (42 %; impossibility to obtain an appointment (36 %; doctors not accepting new patients (31 %. Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. Conclusion Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.

Challenges facing the finance reform of the health system in Chile.

Science.gov (United States)

Herrera, Tania

2014-05-28

Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

Improvements of reforming performance of a nuclear heated steam reforming process

International Nuclear Information System (INIS)

Hada, Kazuhiko

1996-10-01

Performance of an energy production process by utilizing high temperature nuclear process heat was not competitive to that by utilizing non-nuclear process heat, especially fossil-fired process heat due to its less favorable chemical reaction conditions. Less favorable conditions are because a temperature of the nuclear generated heat is around 950degC and the heat transferring fluid is the helium gas pressurized at around 4 MPa. Improvements of reforming performance of nuclear heated steam reforming process were proposed in the present report. The steam reforming process, one of hydrogen production processes, has the possibility to be industrialized as a nuclear heated process as early as expected, and technical solutions to resolve issues for coupling an HTGR with the steam reforming system are applicable to other nuclear-heated hydrogen production systems. The improvements are as follows: As for the steam reformer, (1) increase in heat input to process gas by applying a bayonet type of reformer tubes and so on, (2) increase in reforming temperature by enhancing heat transfer rate by the use of combined promoters of orifice baffles, cylindrical thermal radiation pipes and other proposal, and (3) increase in conversion rate of methane to hydrogen by optimizing chemical compositions of feed process gas. Regarding system arrangement, a steam generator and superheater are set in the helium loop as downstream coolers of the steam reformer, so as to effectively utilize the residual nuclear heat for generating feed steam. The improvements are estimated to achieve the hydrogen production rate of approximately 3800 STP-m 3 /h for the heat source of 10 MW and therefore will provide the potential competitiveness to a fossil-fired steam reforming process. Those improvements also provide the compactness of reformer tubes, giving the applicability of seamless tubes. (J.P.N.)

Improving Healthcare through Lean Management

DEFF Research Database (Denmark)

Nielsen, Anders Paarup; Edwards, Kasper

2011-01-01

The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare....... The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy...

Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico.

Directory of Open Access Journals (Sweden)

Sergio Bautista-Arredondo

2014-01-01

Full Text Available Objective. Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Materials and methods. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Results. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Conclusions. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

[Reform of the Law DIN EN ISO 9001:2000. Commentary on the new requirements on quality management systems].

Science.gov (United States)

Eckert, H; Böhmer, K

2000-09-01

Since January this year the German translation of the third draft to the reform of the DIN EN ISO 9000 is available. The draft reveals an approximation to the models of Business Excellence. Most important changes are a far stronger customer orientation, orientation on the processes and resource management. The norms DIN EN ISO 9002 and 9003 have been removed, ISO 8402 has been integrated in the reformed DIN EN ISO 9000. Apart from that the compatibility with other management systems has been improved. It was the aim of the reform to improve the applicability for all types of business, products and services.

[Social medicine and healthcare economics. The framework for future forms of healthcare].

Science.gov (United States)

Rebscher, Herbert

2008-05-01

In the political debate, even in academia, the concepts of "profitability" or "efficiency" are thrown around very robustly and freely with no regard for the players themselves. Economically speaking there can be no efficiency without a definition of targets in terms of outcomes and their level of quality. If even the government's Council of Economic Experts itself finds in its assessment of hospital funding that the "reform's target parameters - improving the profitability of service provision - have developed positively", but adds that "whether this also applies to the quality of services provided or to the realisation of healthcare outcomes remains to be seen due to the lack of evidence" [21], this indicates a one-sided and problematic curtailment of the concept even by highly competent bodies. Economic control of new forms of healthcare by means of prices and fees for clearly defined services is a complex problem that has not been dealt with adequately. All pricing is based on classification models aimed at ensuring cost and benefit clusters that are as homogeneous as possible. Classification models in healthcare as a basis for price control targets need constant adjusting to ensure accuracy of mapping and appropriateness to performance. A prerequisite for the methodology behind price control models of this kind is presupposing a responsible, rule-bound and criteria-based handling of "variance" and "coincidence" by means of risk-adjusted quality and price systems. They will define the character of a wide range of steering tools and have an effect that goes beyond the narrow formal confines of the sector. That is why the regulatory framework will need first and foremost to define a qualitative framework for the political "security infrastructure" by means of deregulated economic processes in which price control becomes accountable and is justified in terms of content.

Land reform in Russia in 1990-2000-ies, or how land reform was "reformed" during the departmental reorganization

Directory of Open Access Journals (Sweden)

Barsukova Svetlana, Yu.

2015-06-01

Full Text Available The paper provides an overview of the land reform in Russia's recent history. Analysis of land reform, which started in 1990, shows what actions and what logic led the land sector in the state in which it was at the finish line of the quarter-century reform marathon. The reform process was not linear, it highlighted the steps differing objectives and strategies to achieve them. Land reform is presented as a struggle of different political forces, which were reflected in the redistribution of functions between agencies in lobbying for appointment to senior positions promoted various commands. The authors conclude about the gradual displacement of state regulation of land relations, the deliberate destruction of the land management as a basis for the development of land resources.

Radiant non-catalytic recuperative reformer

Energy Technology Data Exchange (ETDEWEB)

Khinkis, Mark J.; Kozlov, Aleksandr P.

2017-10-31

A radiant, non-catalytic recuperative reformer has a flue gas flow path for conducting hot exhaust gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is positioned adjacent to the flue gas flow path to permit heat transfer from the hot exhaust gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, a portion of the reforming mixture flow path is positioned outside of flue gas flow path for a relatively large residence time.

Challenges of Data-driven Healthcare Management

DEFF Research Database (Denmark)

Bossen, Claus; Danholt, Peter; Ubbesen, Morten Bonde

This paper describes the new kind of data-work involved in developing data-driven healthcare based on two cases from Denmark: The first case concerns a governance infrastructure based on Diagnose-Related Groups (DRG), which was introduced in Denmark in the 1990s. The DRG-system links healthcare...... activity and financing and relies of extensive data entry, reporting and calculations. This has required the development of new skills, work and work roles. The second case concerns a New Governance project aimed at developing new performance indicators for healthcare delivery as an alternative to DRG....... Here, a core challenge is select indicators and actually being able to acquire data upon them. The two cases point out that data-driven healthcare requires more and new kinds of work for which new skills, functions and work roles have to be developed....

Candidates stick to party guns. In lieu of new healthcare plans, Bush, Gore follow party reform proposals.

Science.gov (United States)

Gardner, J; Hallam, K

2000-07-03

As the Democratic and GOP nominating conventions approach next month, presumptive nominees Al Gore and George W. Bush are offering no new healthcare plans, both preferring to ride the healthcare waves already set in motion by their respective party's leadership. And the really interesting thing is, the plans aren't that different. Call it creeping incrementalism.

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

Science.gov (United States)

Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

2016-07-01

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

Financial Reform, Institutional Interdependency, and Supervisory Failure in the Post-Crisis Korea

OpenAIRE

Hong-Bum Kim; Chung Lee

2005-01-01

In the wake of the economic crisis of 1997-98 South Korea undertook a number of reforms in financial supervision. In spite of these reforms doubts have been raised as to whether Korea has in fact succeeded in creating a system of financial supervision capable of dealing with certain risks and responding to new challenges appropriately. This paper argues that because of institutional interdependency a successful institutional reform requires changing not only the particular institution at issu...

Local Instruction Theories as Means of Support for teachers in Reform Mathematics Education

NARCIS (Netherlands)

Gravemeijer, K.P.E.

2004-01-01

This article focuses on a form of instructional design that is deemed fitting for reform mathematics education. Reform mathematics education requires instruction that helps students in developing their current ways of reasoning into more sophisticated ways of mathematical reasoning. This implies

Enhancing forest tenure reforms through more responsive regulations

Directory of Open Access Journals (Sweden)

Anne M Larson

2012-01-01

Full Text Available Forest tenure reforms have offered new opportunities for communities to obtain formal rights to forests and forest benefits, but at the same time a variety of limitations are placed on livelihood options. This article draws on several case studies of reforms in Africa, Asia and Latin America to analyse the regulations accompanying reforms. It identifies three types of regulations, namely rules that limit areas available to local communities; rules that delineate conservation areas and impose related limits on use; and bureaucratic requirements for permits and management plans, which restrict the commercial use and marketing of valuable forest products. It discusses problems with these regulations, and proposes a simple framework for identifying ways to promote regulations that work for forest conservation but are more responsive to the needs of communities and forests.

Steepest Ascent Tariff Reforms

DEFF Research Database (Denmark)

Raimondos-Møller, Pascalis; Woodland, Alan D.

2006-01-01

a theoretical concept where the focus is upon the size of welfare gains accruing from tariff reforms rather than simply with the direction of welfare effects that has been the concern of theliterature.JEL code: F15.Keywords: Steepest ascent tariff reforms; piecemeal tariff policy; welfare; market access; small......This paper introduces the concept of a steepest ascent tariff reform for a small open economy. By construction, it is locally optimal in that it yields the highest gain in utility of any feasible tariff reform vector of the same length. Accordingly, it provides a convenient benchmark...... for the evaluation of the welfare effectiveness of other well known tariff reform rules, as e.g. the proportional and the concertina rules. We develop the properties of this tariff reform, characterize the sources of the potential welfare gains from tariff reform, use it to establish conditions under which some...

Health system reform.

Science.gov (United States)

Ortolon, Ken

2009-06-01

A vote on reforming the nation's health care system seems likely this summer as President Obama makes good on a campaign pledge. Although the Democratic leadership in Congress appears ready to push through reform legislation before the next election, TMA and AMA leaders say very little is known about what that "reform" likely will look like.

Medical Education and Curriculum Reform: Putting Reform Proposals in Context

Directory of Open Access Journals (Sweden)

Daniel Kam Yin Chan, MD, MB.BS, MHA

2004-01-01

Full Text Available The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.

Brazilian healthcare model for people with mental disorders: a systematic literature review

Directory of Open Access Journals (Sweden)

Marcelo Theophilo Lima

2013-03-01

Full Text Available Objective: To evaluate the process of implementing the Brazilian psychiatric reform, especially regarding its impact on families’ management of healthcare issues. Methods: Interpretative research performed between August 2011 and January 2012, where symbolic interactionism was used as theoretical reference and Grounded Theory was used as the methodological reference. Initially, 49 articles on the subject were selected applying as descriptors mental health, psychiatric reform and psychosocial care, in Scielo, lIlACS and university libraries’ databases. of these, 17 articles were excluded for being published prior to 2008 and 18 for having approaches not comprised in the scope of the study. Results: The power relationships in the treatment method were identified as causal conditions of the de-hospitalization process, which occurs in a context of deficiency in the network intended to replace psychiatric hospitals, therefore requiring the participation of patients’ families in their reintegration at home and treatment. This strategy to deconstruct the psychiatric hospital-based model results in an excessive burden to the families. Conclusion: If, on one hand, the shift from hospitalization to in-home care, with embracement of the disease and of patients’ suffering in their very social relationships, was to propose the recovery of patients’ civil and human rights and their remaining into the society, on the other hand, it creates another series of problems, such as the emotional and logistical burden imposed on patients’ families.

Photocatalytic reforming of biomass for hydrogen production

NARCIS (Netherlands)

Ripken, R.M.; de Boer, V.J.H.W.; Gardeniers, J.G.E.; le Gac, S.

2017-01-01

Here, we describe a novel microfluidic device to determine the required bandgap for the photocatalytic reforming of biomass model substrates (ethylene glycol, glycerol, xylose and xylitol) in water. Furthermore, this device is applied to eventually elucidate the reaction mechanism of aqueous

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

Science.gov (United States)

Laverty, Louise; Harris, Rebecca

2018-06-01

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Education for a New Era: Stakeholders’ Perception of Qatari Education Reform

Directory of Open Access Journals (Sweden)

Maha Ellili-Cherif

2013-11-01

Full Text Available The paper reports the results of a qualitative research study that explores principal, teacher, and parent perceptions with regard to Qatar’s education reform, Education for a New Era (EFNE launched in 2004. The study focuses on the effects of the reform on each group, their perceived advantages and disadvantages of the reform, and the challenges they face in the implementation of EFNE. Data for this study was collected through an open-ended questionnaire. The results point to the positive effects of EFNE on improving instruction, principals' leadership style, and learner attitude to education. These stakeholders believe that the reform is too ambitious and sometimes unrealistic. The three groups also report challenges that revolve around the amount of extra effort and work it requires from them, the continuous reform changes, and the threats to the local culture and language. Discussion and conclusions are provided regarding EFNE.

Effect of Government-Community Healthcare Co-Financing on ...

African Journals Online (AJOL)

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

Patient satisfaction and loyalty among military healthcare beneficiaries enrolled in a managed care program.

Science.gov (United States)

Jennings, B M; Loan, L A

1999-11-01

A study was performed to evaluate military beneficiaries' motivation for choosing to change from a civilian managed care system to the military managed care system. Concerns about healthcare cost, quality, and access underpin major reform in military healthcare. The military health system (MHS) is implementing managed care through an initiative known as TRICARE. Patient choice and satisfaction are highly relevant to all healthcare delivery systems; they are being explored aggressively in the MHS as TRICARE evolves. This descriptive study was conducted using a telephone survey consisting of 63 items derived from four pre-existing instruments as well as five facility-specific questions and demographics. The population of interest targeted military beneficiaries on a TRICARE waiting list who, at the time of enrollment, indicated a desire to receive care at the military facility. Consumers were inclined to return to the military system because of loyalty. Also, this study provided evidence that staff courtesy is important to those who seek healthcare. Good quality and accessibility were verified as essential elements in sustaining a consumer's positive view of and attraction to a particular healthcare system. Cost was proven to be a less substantial factor of consumer decision making. Surveys such as this give healthcare providers more information about aspects of care, such as patient loyalty and interpersonal dynamics, that attract people to their healthcare delivery systems. For healthcare systems to thrive, consumer influence and the power of patient dissatisfaction must be understood.

Reforming Medicare through 'version 2.0' of accountable care.

Science.gov (United States)

Lieberman, Steven M

2013-07-01

Medicare needs fundamental reform to achieve fiscal sustainability, improve value and quality, and preserve beneficiaries' access to physicians. Physician fees will fall by one-quarter in 2014 under current law, and the dire federal budget outlook virtually precludes increasing Medicare spending. There is a growing consensus among policy makers that reforming fee-for-service payment, which has long served as the backbone of Medicare, is unavoidable. Accountable care organizations (ACOs) provide a new payment alternative but currently have limited tools to control cost growth or engage and reward beneficiaries and providers. To fundamentally reform Medicare, this article proposes an enhanced version of ACOs that would eliminate the scheduled physician fee cuts, allow fees to increase with inflation, and enhance ACOs' ability to manage care. In exchange, the proposal would require modest reductions in overall Medicare spending and require ACOs to accept increased accountability and financial risk. It would cause per beneficiary Medicare spending by 2023 to fall 4.2 percent below current Congressional Budget Office projections and help the program achieve fiscal sustainability.

Reform despite politics? The political economy of power sector reform in Fiji, 1996–2013

International Nuclear Information System (INIS)

Dornan, Matthew

2014-01-01

Attempts to reform the electricity sector in developing countries have achieved mixed results, despite the implementation of similar reforms in many developed countries, and concerted effort by donors to transfer reform models. In many cases, political obstacles have prevented full and effective implementation of donor-promoted reforms. This paper examines the political economy of power sector reform in Fiji from 1996 to 2013. Reform has been pursued with political motives in a context of clientelism. Policy inconsistency and reversal is explained by the political instability of ethnic-based politics in Fiji. Modest success has been achieved in recent years despite these challenges, with Fiji now considered a model of power sector reform for other Small Islands Developing States (SIDS) in the Pacific. The experience demonstrates that reform is possible within difficult political environments, but it is challenging, takes time and is not guaranteed. The way in which political motives have driven and shaped reform efforts also highlights the need for studies of power sector reform to direct greater attention toward political drivers behind reform. - Highlights: • This is the first study of power sector reform in Fiji or other Small Island Developing States (SIDS) of the Pacific. • The clientelist nature of politics in Fiji is found to have both driven and shaped reform efforts. • There has been modest success in recent years despite these obstacles, with Fiji now considered a model for other SIDS. • The experience demonstrates that reform is possible within difficult political environments, but it is challenging, takes time and is not guaranteed

The impact of NAFTA and options for tax reform in Mexico

OpenAIRE

Martinez-Vazquez, Jorge; Chen, Duanjie

2001-01-01

The North American Free Trade Agreement (NAFTA) has had a profound impact on Mexico's economy and institutions. Clearly, no consideration of tax reform can ignore its role. The thinking about tax reform in Mexico requires evaluating NAFTA's effect on Mexico's economy, including its tax structure, and the effects of its tax system on trade and capital flows between Mexico and its NAFTA part...

Pension reform in the European periphery: the role of EU reform advocacy

NARCIS (Netherlands)

Stepan, M.; Anderson, K.A.

2014-01-01

SUMMARY: This paper analyzes the impact of international reform advocacy on national pension reforms. We analyze European Union (EU) reform advocacy in two EU member states: Greece and Hungary. Although the EU has articulated a fairly coherent template for sustainable pensions, its use of soft

The reform of the Spanish public administration and the Wellfare State during the economic crisis (2012-2015

Directory of Open Access Journals (Sweden)

Carlos Vidal Prado

2017-05-01

Full Text Available This work analyzes some structural reforms of public administrations implemented from 2012 in Spain, as a result of the economic crisis, and public policies implemented to achieve them, and if truly met the intended objectives (improve the quality and efficiency of services, transparency in public administrations and creating an Open Government. The work part of a brief diagnosis of the causes and consequences of the economic crisis, to tackle after reforms in public administration and in the model of Welfare State, especially in what refers to public employment, education, healthcare and the attention to the dependence. Finally, a brief assessment of the adopted solutions and its real impact on the current situation of the economy and the Spanish Administration is performed.

Arbitration Reform

Directory of Open Access Journals (Sweden)

Svetlana Stepurina

2017-01-01

Full Text Available УДК 347.73:341.63Subject. This informational article highlights recent changes to the Russian legislation on arbitration.Purpose. To highlight the most important aspects of arbitration law reform, and examines the effects they will have on the development of arbitration in RussiaMethodology. The author uses a formal-legal method.Results, scope of application. The author distinguishes the difference between constantly acting arbitration courts and arbitration courts ad hoc. The special status of a number of arbitration institutions (the ICAC and MAC at the Russian Chamber of Commerce and Industry, is contrary to the constitutional principle of equality under the law. A major achievement of the new legislation on arbitration courts is expanding the range arbitrarily disputes.Conclusions. The new legislation more clearly prescribed the interaction of arbitration and state courts, including requiring the latter to promote the arbitrators, acting under the regulations of the permanent arbitration institutions in obtaining evidence.In addition, the reform of the arbitration law have left aside the problem of improving the quality of judicial control over arbitration decisions.The arbitration law will still be able to improve the arbitration, to enhance its credibility and attractiveness for the participants of civil turnover.

Performance management of the public healthcare services in Ireland: a review.

Science.gov (United States)

Mesabbah, Mohammed; Arisha, Amr

2016-01-01

Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

Critical Study Regarding the Evolution of Incomes and Expenses of the Romanian Healthcare System in the Context of Budgetary Decentralization

Directory of Open Access Journals (Sweden)

Violeta ISAI

2016-04-01

Full Text Available The healthcare system in Romania is continuously under a reform process, in order to make more efficient the medical care and to allow a wide access for the population to the healthcare services. The incomes of the healthcare system mainly come from the contribution to the social healthcare insurance, but also from other taxes, the system also benefits from subsidies from the state budget. The public healthcare expenses have a relatively low percentage from the total public expenses, being mainly oriented towards hospitals, subsidized drugs and primary medical assistance. The integration of Romania into the EU brought for the healthcare system opportunities as well as threats: the increase of the competence and quality of the medical act, the favourable context of decentralization but also the increase of the costs for medical services, the mobility of the patients and the pronounced migration of the qualified medical staff to other countries of the EU. The paper wants to analyse the incomes and expenses from the healthcare, taking into account all these aspects.

Iliopsoas Tendon Reformation after Psoas Tendon Release

Directory of Open Access Journals (Sweden)

K. Garala

2013-01-01

Full Text Available Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.

Advanced design of fast reactor-membrane reformer (FR-MR)

International Nuclear Information System (INIS)

Tashimo, M.; Hori, I.; Yasuda, I.; Shirasaki, Y.; Kobayashi, K.

2004-01-01

A new plant concept of nuclear-produced hydrogen is being studied using a Fast Reactor-Membrane Reformer (FR-MR). The conventional steam methane reforming (SMR) system is a three-stage process. The first stage includes the reforming, the second contains a shift reaction and the third is the separation process. The reforming process requires high temperatures of 800 ∼ 900 deg C. The shift process generates heat and is performed at around 200 deg C. The membrane reforming has only one process stage under a nonequilibrium condition by removing H2 selectively through a membrane tube. The steam reforming temperature can be decreased from 800 deg C to 550 deg C, which is a remarkable benefit offered by the non-equilibrium condition. With this new technology, the reactor type can be changed from a High Temperature Gas-cooled Reactor (HTGR) to a Fast Reactor (FR). A Fast Reactor-Membrane Reformer (FR-MR) is composed of a nuclear plant and a hydrogen plant. The nuclear plant is a sodium-cooled Fast Reactor with mixed oxide fuel and with a power of 240 MWt. The heat transport system contains two circuits, the primary circuit and the secondary circuit. The membrane reformer units are set in the secondary circuit. The heat, supplied by the sodium, can produce 200 000 Nm 3 /h by 2 units. There are two types of membranes. One is made of Pd another one (advanced) is made of, for example V, or Nb. The technology for the Pd membrane is already established in a small scale. The non-Pd type is expected to improve the performance. (author)

HOW DOES CORRUPTION AFFECTS HEALTHCARE SECTOR IN BULGARIA

Directory of Open Access Journals (Sweden)

Jordan Deliversky

2016-03-01

Full Text Available Corruption in the healthcare sector is a reflection of the structural challenges in the health care system. The problem of corruption in healthcare is of a multidimensional nature. The Bulgarian health care system is based on a regulated regime. On one hand there is the functioning of a state-owned and state-controlled health fund financed through obligatory contributions by all income earners, and on the other, a union of health providers that negotiate a national framework health contract with the fund. Causes of corruption are classified as different factors such as structural factors and government policies factors. The health sector is susceptible to corruption for various reasons, mostly related to its organization. The health sector is a complex sector. In order to be effective, reforms to combat corruption must be informed by theory, guided by evidence and adapted to context. It is necessary to review and develop diagnostic and treatment algorithms as standards of good medical practice, which would help to assess the package of medical and non-medical activities.

Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology.

Science.gov (United States)

Wiens, Jenna; Shenoy, Erica S

2018-01-06

The increasing availability of electronic health data presents a major opportunity in healthcare for both discovery and practical applications to improve healthcare. However, for healthcare epidemiologists to best use these data, computational techniques that can handle large complex datasets are required. Machine learning (ML), the study of tools and methods for identifying patterns in data, can help. The appropriate application of ML to these data promises to transform patient risk stratification broadly in the field of medicine and especially in infectious diseases. This, in turn, could lead to targeted interventions that reduce the spread of healthcare-associated pathogens. In this review, we begin with an introduction to the basics of ML. We then move on to discuss how ML can transform healthcare epidemiology, providing examples of successful applications. Finally, we present special considerations for those healthcare epidemiologists who want to use and apply ML. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Reforming Romanian energy policy

International Nuclear Information System (INIS)

Perkins, S.

1993-01-01

Success in reforming energy sector depends on the implementation of the programme of economic reform agreed in February 1993. The difficulty of the negotiations between the International Monetary Fund and the Romanian government reflects the wider difficulties faced by the economy as a whole. They can be blamed in part on the legacy of uneconomic and inflexible industrial development and in part on opposition from interest groups which stand to lose from reform. Nonetheless, in spite of hesitant approach, the government does appear committed to the economic reform necessary to establish a market-oriented economy. But as the danger of a financial crisis engendered by the inadequately supported short-term borrowing of foreign exchange becomes urgent, the question is whether economic reform can be now implemented fast enough to protect economic enterprises and saving from a debt crisis. The scope for further delay in implementing the 1993 economic reform programme is fast disappearing. Procrastination should not be allowed to threaten the success of the reforms achieved in the energy and other sectors of the economy. 8 refs., 2 figs

A synthesis of welfare reform policy and its impact on substance users.

Science.gov (United States)

Montoya, Isaac D; Atkinson, John S

2002-01-01

The purpose of this study was to provide an overview of welfare reform and its impact on the substance-abusing recipient. The data for this paper were derived from sources including the US Department of Health and Human Services and the National Institute on Drug Abuse. The number of individuals on public assistance has decreased in the years following implementation of welfare reform legislation. Factors relevant to transitioning welfare recipients into the workplace, such as transportation and childcare, have special ramifications for the drug-using population. Additionally, these individuals require treatment for their addictions in order to become employable. The issue of concern is that recipients may be deterred from seeking benefits by various provisions of welfare reform legislation and turn instead to other sources (including illicit activities) for sustenance. Welfare caseloads have been dropping over the past two years. However, the number of substance abusers continues to rise. It is not known in what ways welfare reform will affect substance abusers who are welfare recipients. Important policy issues arise from this nexus; it is argued that these issues will require careful investigation.

Partnering between Government and Industry, and Acquisition Reform Initiative

National Research Council Canada - National Science Library

Jones, Richard

1997-01-01

The diminishing use of technical Military Specifications (Mil-specs) and the increased emphasis on performance based requirements due to acquisition reform has limited technical communication between government and industry...

The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine.

Science.gov (United States)

Hankivsky, Olena; Vorobyova, Anna; Salnykova, Anastasiya; Rouhani, Setareh

2016-08-17

The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. The study concludes that any meaningful reforms of

How do government reforms influence the establishment of private limited companies in Sweden?

OpenAIRE

Patel, Ibrahim; Thörn, Simon

2012-01-01

Background: This study focuses on three reforms which the Swedish government have performed: The abolishment of the audit requirement, the reduction of the legal capital requirement, and the reduction of the employment taxes. What effect have they had on the establishment of private limited companies? Purpose: The purpose of this dissertation is to explain the influence government reforms have on the establishment and re-establishment of private limited companies inSweden. Method: An explanat...

Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

Science.gov (United States)

Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

2016-10-01

This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The A to Z of healthcare data breaches.

Science.gov (United States)

Kobus, Theodore J

2012-01-01

There currently exists a myriad of privacy laws that impact a healthcare entity, including more than 47 notification laws that require notification when a data breach occurs, as well as the breach notification requirements of the Health Information Technology for Economic and Clinical Health Act. Given the plethora of issues a healthcare entity faces, there are certain principles that can be built into an organization's philosophy that will comply with the law and help protect it from reputational harm. © 2012 American Society for Healthcare Risk Management of the American Hospital Association.

Plasma-catalytic reforming of ethanol: influence of air activation rate and reforming temperature

International Nuclear Information System (INIS)

Nedybaliuk, O.A.; Chernyak, V.Ya.; Fedirchuk, I.I.; Demchina, V.P.; Bortyshevsky, V.A.; Korzh, R.V.

2016-01-01

This paper presents the study of the influence that air activation rate and reforming temperature have on the gaseous products composition and conversion efficiency during the plasma-catalytic reforming of ethanol. The analysis of product composition showed that the conversion efficiency of ethanol has a maximum in the studied range of reforming temperatures. Researched system provided high reforming efficiency and high hydrogen energy yield at the lower temperatures than traditional conversion technologies

Verification of Timed Healthcare Workflows Using Component Timed-Arc Petri Nets

DEFF Research Database (Denmark)

Bertolini, Cristiano; Liu, Zhiming; Srba, Jiri

2013-01-01

Workflows in modern healthcare systems are becoming increasingly complex and their execution involves concurrency and sharing of resources. The definition, analysis and management of collaborative healthcare workflows requires abstract model notations with a precisely defined semantics and a supp......Workflows in modern healthcare systems are becoming increasingly complex and their execution involves concurrency and sharing of resources. The definition, analysis and management of collaborative healthcare workflows requires abstract model notations with a precisely defined semantics...

Ethical issues in healthcare financing.

Science.gov (United States)

Maharaj, S R; Paul, T J

2011-07-01

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

China's economic reform and industry sector energy requirement: A forecast to 2015

International Nuclear Information System (INIS)

Gu, A.Y.

1997-01-01

With its GDP growing at an average rate of 9.8% for the last seventeen years, China has the world's fastest growing economy. This rapid pace of growth and industrialization has caused economic strain because fuel production cannot keep pace with demand, If China allows this situation to continue, significant oil imports will be necessary. In 1993, the industrial sector contributed 56% to China's GDP and consumed 61% of the total final energy. The industrial sector will remain the largest energy consumer in China well into the next century. According to China's Ninth Five-Year Plan (1996--2000), China will strengthen its ability to develop new products and will use technological advancement to promote industrial development. The Plan calls for special attention in four major areas: microelectronics technology, digital technology, software technology, and network technology. Given China's emphasis on developing light industries and on improving industrial sector energy efficiency, it is important to study the future energy demand of the industrial sector. Two scenarios for future energy requirements are studied through the year 2015: a Business As Usual (BASU) scenario and an Energy Efficient (EE) scenario. The study evaluates China's current economic reform policies and energy efficiency policies. The results of this evaluation are used to assign appropriate growth rates to industrial GDP and the industrial energy intensity for both scenarios. Results from the two scenarios are compared and analyzed

Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time.

NARCIS (Netherlands)

Hendriks, M.; Spreeuwenberg, P.; Rademakers, J.; Delnoij, D.M.J.

2009-01-01

BACKGROUND: Many countries have introduced elements of managed competition in their healthcare system with the aim to accomplish more efficient and demand-driven health care. Simultaneously, generating and reporting of comparative healthcare information has become an important quality-improvement

[Managing the cold chain in healthcare facilities].

Science.gov (United States)

Royer, Mathilde; Breton Marchand, Justine; Pons, David

2017-11-01

The storage of temperature-sensitive healthcare products requires control of the cold chain. Healthcare facilities must have the appropriate equipment at their disposal and ensure the traceability and monitoring of temperatures. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Use of catalytic reforming to aid natural gas HCCI combustion in engines: experimental and modelling results of open-loop fuel reforming

Energy Technology Data Exchange (ETDEWEB)

Peucheret, S.; Wyszynski, M.L.; Lehrle, R.S. [Future Power Systems Group, Mechanical Engineering, The University of Birmingham, Edgbaston, Birmingham B15 2TT (United Kingdom); Golunski, S. [Johnson Matthey, Technology Centre, Blount' s Court, Sonning Common, Reading RG4 9NH (United Kingdom); Xu, H. [Jaguar Land Rover Research, Jaguar Land Rover W/2/021, Abbey Road, Coventry CV3 4LF (United Kingdom)

2005-12-01

The potential of the homogeneous charge compression ignition (HCCI) combustion process to deliver drastically reduced emissions of NO{sub x} and improved fuel economy from internal combustion engines is well known. The process is, however, difficult to initiate and control, especially when methane or natural gas are used as fuel. To aid the HCCI combustion of natural gas, hydrogen addition has been successfully used in this study. This hydrogen can be obtained from on-line reforming of natural gas. Methane reforming is achieved here by reaction with engine exhaust gas and air in a small scale monolith catalytic reactor. The benchmark quantity of H{sub 2} required to enhance the feasibility and engine load range of HCCI combustion is 10%. For low temperature engine exhaust gas, typical for HCCI engine operating conditions, experiments show that additional air is needed to produce this quantity. Experimental results from an open-loop fuel exhaust gas reforming system are compared with two different models of basic thermodynamic equilibria calculations. At the low reactor inlet temperatures needed for the HCCI application (approx. 400 deg C) the simplified three-reaction thermodynamic equilibrium model is in broad agreement with experimental results, while for medium (550-650 deg C) inlet temperature reforming with extra air added, the high hydrogen yields predicted from the multi-component equilibrium model are difficult to achieve in a practical reformer. (author)

Pension Reforms in Countries with Developed and Transitional Economies

Directory of Open Access Journals (Sweden)

Sergey Anatolyevich Belozyorov

2015-12-01

Full Text Available The subject matter of the research is as follows: pension reforms conducted by some states define the transformation of pension systems. The choice of countries is stipulated by the fact that each of them has different types of pension systems and preconditions for reforms. The purpose is to develop an approach that allows comparing and evaluating changes in disparate systems. The hypothesis is that the ongoing pension reforms, regardless of initial conditions and their type lead to a similar trajectory of pension systems development in all countries. The methodology rests on the comparative analysis that was carried out on the basis of a single algorithm that allows to determine significant modifiable parameters and the overall direction of reform. The novelty is that the authors research the ongoing pension reform from the viewpoint of pension rights formation and distribution of risks. The results are a single trajectory of reforms implementation for the studied countries, which confirms the authors’ hypothesis. The specific features of the Russian pension system do not affect the reform trajectory, which is similar to all countries. The conclusions are the following: the reducing pressure on pension system requires increasing revenues and limiting the number of potential participants. This is achieved by expanding sources of financing, increasing the dependence of pension on an employee’s contributions, transferring the risks of old age into the individual level, and employment motivation during the retirement period. The principle of the intergenerational solidarity loses its value. The obtained results can be used for the pension reform modification in the Russian Federation, the development of voluntary pension insurance based on the experience of other countries and risks faced by the modern Russian pension system.

Current healthcare in Bulgaria: time for predictive diagnostics and preventive medicine.

Science.gov (United States)

Dimitrov, Dimiter V

2010-12-01

Since 1990 Bulgaria gradually moved from monopolistic to market regulated economy and healthcare. In 2007 the country became member of the European Union and started to adopt EU legislations. However, significant gaps between the average European and Bulgarian level of social, health and economic efficiency remain to be narrowed. The major challenge is the demographic situation, where recent trends give alarming signals. Plans for reformation include transition towards out-patient palliative healthcare centers for the aging population as well as reduction of the costs with new electronic system of health insurance. The favorable location of the country at the Black Sea coast gives opportunities for medical tourism, which can provide quality health service for foreign customers. Finally, national platforms on prevention of major non-communicable diseases, such as obesity, cancer and diabetes, must be established as coordinated actions for the health and wellness of next generations.

The Effects of the Saakashvili Era Reforms on Informal Practices in the Republic of Georgia

Directory of Open Access Journals (Sweden)

Huseyn Aliyev

2014-06-01

Full Text Available Since the 2003 Rose Revolution, the Georgian government implemented a number of major institutional reforms which have succeeded in modernising Georgia’s state institutions, reducing corruption and ‘formalising’ the public sector. While the effects of Saakashvili’s reforms on state and institution-building, corruption and the rule of law have been examined by a large and growing body of academic literature, there has been little discussion about the impact of institutional changes on the previously widespread culture of informality in Georgia. This article explores the effects of Georgian institution-building from such aspects of informality as the use of informal networks and connections in exchanges of favours, gift-giving and other types of informal activities. The findings of this study, based on the analysis of recent surveys and in-depth interviews, conclude that the reforms succeeded in undermining the overall importance of informal practices in dealings with state bureaucracy, education system, healthcare, law enforcement, judiciary and some other areas previously dominated by informality. However, the reliance on informality did not disappear, and informal networks are still employed as coping mechanisms and as social safety nets.

Reforming technology for syngas production

International Nuclear Information System (INIS)

Epstein, M.

1997-01-01

Methane forming reactions using either steam or CO 2 have been known to industry for a long time. These endothermic reactions require the investment of a relatively large amount of energy. German researchers, in the 1970's, conceived and developed the idea to use this reaction and the reverse methanation reaction in a closed loop for the transportation and distribution of nuclear heat. The idea was also adopted for use with solar energy as a heat source. Utilizing solar energy as the heat source, the Weismann Institute of Science has fabricated, installed and operated a complete loop capable of the conversion and transportation of over 400 kW of heat. This system can be operated with a wide range of CO 2 /H 2 O/CH 4 feed mixtures. Steam reforming is the common reforming reaction in the ''open loop'' mode for the purpose of synthesis gas production. This is accomplished with a large excess of steam on a nickel catalyst. However, it has only recently been recognized that there is also a substantial market for CO 2 reforming. The CO 2 /CH 4 mixture in various proportions exists in many places and has, so far, not been used efficiently. The sources for this mixture are biogas produced in anaerobic digestion processes and gas resources such as the NATUNA gas field in Indonesia, and many others. Therefore, the system of CO 2 /CH 4 deserves more attention. Commercial catalysts used for steam reforming based on nickel are not suitable for this system. Therefore, other catalysts based on Rhodium and Ruthenium have been developed and some performance data is presented in this paper. Also presented is a conceptual schematic layout of a CO 2 reforming plant and matching methanator. A computer code for a detailed design of the entire loop in a commercial size system has been prepared where optimized operational conditions as well as equipment parameters can be determined. (author). 3 figs, 3 tabs

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

Science.gov (United States)

Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan.

Science.gov (United States)

Hamada, Hironori; Sekimoto, Miho; Imanaka, Yuichi

2012-10-01

In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality. Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service. DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82). This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Data Quality Objectives For Selecting Waste Samples To Test The Fluid Bed Steam Reformer Test

International Nuclear Information System (INIS)

Banning, D.L.

2010-01-01

This document describes the data quality objectives to select archived samples located at the 222-S Laboratory for Fluid Bed Steam Reformer testing. The type, quantity and quality of the data required to select the samples for Fluid Bed Steam Reformer testing are discussed. In order to maximize the efficiency and minimize the time to treat Hanford tank waste in the Waste Treatment and Immobilization Plant, additional treatment processes may be required. One of the potential treatment processes is the fluid bed steam reformer (FBSR). A determination of the adequacy of the FBSR process to treat Hanford tank waste is required. The initial step in determining the adequacy of the FBSR process is to select archived waste samples from the 222-S Laboratory that will be used to test the FBSR process. Analyses of the selected samples will be required to confirm the samples meet the testing criteria.

Romanian healthcare system at a glance

Directory of Open Access Journals (Sweden)

Christiana Balan

2013-04-01

Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

Understanding chest radiographic anatomy with MDCT reformations

Energy Technology Data Exchange (ETDEWEB)

Sussmann, A.R. [Department of Radiology, Thoracic Imaging, NYU Langone Medical Center, New York, NY (United States); Ko, J.P., E-mail: jane.ko@nyumc.or [Department of Radiology, Thoracic Imaging, NYU Langone Medical Center, New York, NY (United States)

2010-02-15

Chest radiograph interpretation requires an understanding of the mediastinal reflections and anatomical structures. Computed tomography (CT) improves the learning of three-dimensional (3D) anatomy, and more recently multidetector CT (MDCT) technology has enabled the creation of high-quality reformations in varying projections. Multiplanar reformations (MPRs) of varying thickness in the coronal and sagittal projections can be created for direct correlation with findings on frontal and lateral chest radiographs, respectively. MPRs enable simultaneous visualization of the craniocaudal extent of thoracic structures while providing the anatomic detail that has been previously illustrated using cadaveric specimens. Emphasis will be placed on improving knowledge of mediastinal anatomy and reflections including edges, lines, and stripes that are visible on chest radiographs.

75 FR 51429 - Definitions Contained in Title VII of Dodd-Frank Wall Street Reform and Consumer Protection Act

Science.gov (United States)

2010-08-20

... VII of Dodd-Frank Wall Street Reform and Consumer Protection Act AGENCY: Securities and Exchange... comments. SUMMARY: The Dodd-Frank Wall Street Reform and Consumer Protection Act (the ``Dodd-Frank Act... requirements. \\1\\ Dodd-Frank Wall Street Reform and Consumer Protection Act, Public Law No. 111-203, 124 Stat...

Systems, Stakeholders, and Students: Including Students in School Reform

Science.gov (United States)

Zion, Shelley D.

2009-01-01

The education system in the United States is under pressure from a variety of sources to reform and improve the delivery of educational services to students. Change across a system as complex and dynamic as the educational system requires a systemic approach and requires the participation or buy-in of all participants and stakeholders. This…

It's about Time for Autism Reform Legislation in Utah

Science.gov (United States)

Shiozawa, Brian J.

2015-01-01

On 3 April 2014, Governor Gary Herbert signed into law a health insurance reform bill that requires private insurers to cover autism therapy. Specifically, SB57 requires state-regulated health plans to cover applied behavior analysis (ABA) therapy. While early diagnosis and intervention can reduce the long-term cost of autism, families are finding…

Reform Drivers and Reform Obstacles in Natural Resource Management

DEFF Research Database (Denmark)

Gezelius, Stig S.; Raakjær, Jesper; Hegland, Troels Jacob

2010-01-01

ABSTRACT: The ability to transform historical learning into institutional reform is a key to success in the management of common pool natural resources. Based on a model of institutional inertia and a comparative analysis of Northeast Atlantic fisheries management from 1945 to the present....... Institutional inertia entails that large-scale management reform tends to be crisis driven....

Sharing Elderly Healthcare information on Cloud Computing

OpenAIRE

Lu, Fangjie; Khan, Israr

2012-01-01

Context: Due to rapid increase in the population of elderly people, sharing healthcare information has become an essential requirement for the development of e-health system. By conducting a research in e-health and cloud computing we have explored the advantages and disadvantages of sharing healthcare information for elderly people through cloud computing. Objectives: The main purpose of this research is to investigate the suitability of cloud computing to share healthcare information. The s...

Dynamic modeling of a three-stage low-temperature ethanol reformer for fuel cell application

Energy Technology Data Exchange (ETDEWEB)

Garcia, Vanesa M; Serra, Maria [Institut de Robotica i Informatica Industrial (CSIC-UPC), Llorens i Artigas 4-6, 08028 Barcelona (Spain); Lopez, Eduardo; Llorca, Jordi [Institut de Tecniques Energetiques, Universitat Politecnica de Catalunya, Diagonal 647, ed. ETSEIB, 08028 Barcelona (Spain)

2009-07-01

A low-temperature ethanol reformer based on a cobalt catalyst for the production of hydrogen has been designed aiming the feed of a fuel cell for an autonomous low-scale power production unit. The reformer comprises three stages: ethanol dehydrogenation to acetaldehyde and hydrogen over SnO{sub 2} followed by acetaldehyde steam reforming over Co(Fe)/ZnO catalyst and water gas shift reaction. Kinetic data have been obtained under different experimental conditions and a dynamic model has been developed for a tubular reformer loaded with catalytic monoliths for the production of the hydrogen required to feed a 1 kW PEMFC. (author)

The indonesia’s Police Reform Police in the Reform Era New Institutionalism Perspective

Directory of Open Access Journals (Sweden)

ACHMAD NURMAND

2016-05-01

Full Text Available Since the reformation and democratization movement in 1998, Indonesians have faced a chronic corruption problem. At the beginning of reformation era in 1998 to fight against corruption, the Indonesian government reforms the organization structure of the Indonesia Police to be an independent body separated from the Military organization. The police reforms begun in 1999 and got legal foundation with Act No. 2/2002. However, since fourteen years, the level of police reform has not yet succeed because of low community satisfaction on police service and the intense conflicts always occur whenever ACA investigates the case of corruptions conducted by police leaders. Three conflicts between police institution and ACA have taken placed. By using institutionalism approach, this research focus on the reform in police themselves are major actors on how reforms are organized and managed. This study is interpretative in nature gained only through social constructions such as language, consciousness, shared meanings, documents, tools, and other artefacts’. This finding revealed that this unsuccessful institutionalization process took place in a context of the main task of police for communicty service. Second, the study has demonstrated that three concepts from institutional theory as aforementioned provided vocabularies and insights to explain the phenomenon under study.

Turkish electricity reform

Energy Technology Data Exchange (ETDEWEB)

Bagdadioglu, Necmiddin [Department of Public Finance, Hacettepe University, 06800 Ankara (Turkey); Odyakmaz, Necmi [E.ON Holding, Armada Business Centre, 06520 Ankara (Turkey)

2009-03-15

Turkish electricity reform has progressed slowly due to internal resistance against privatisation, and gained momentum after Electricity Market Law of 2001, prepared in line with EU Energy Acquis and established required institutional and legal framework. Although the eligibility threshold has reached 39% market opening rate, the dominant position of public both as owner and decision-maker is still the major problem in the sector. Currently Turkey is self-sufficient in electricity, but likely to face shortages in 10 years if the growing demand is not met by either speeding the liberalisation process, or joining the South East Europe Electricity Market. (author)

Sensing behaviour in healthcare design

DEFF Research Database (Denmark)

Thorpe, Julia Rosemary; Hysse Forchhammer, Birgitte; Maier, Anja

2017-01-01

We are entering an era of distributed healthcare that should fit and respond to individual needs, behaviour and lifestyles. Designing such systems is a challenging task that requires continuous information about human behaviour on a large scale, for which pervasive sensing (e.g. using smartphones...... specifically on activity and location data that can easily be obtained from smartphones or wearables. We further demonstrate how these are applied in healthcare design using an example from dementia care. Comparing a current and proposed scenario exemplifies how integrating sensor-derived information about...... user behaviour can support the healthcare design goals of personalisation, adaptability and scalability, while emphasising patient quality of life....

Powering Africa: Meeting the financing and reform challenges

International Nuclear Information System (INIS)

Eberhard, Anton; Shkaratan, Maria

2012-01-01

Sub-Saharan Africa faces chronic power problems, including insufficient generation capacity, low connectivity, poor reliability, and high costs, all of which constrain development. The investment requirements to meet Africa's power needs are noted and strategies to address the funding gap are set out. The time for an ideological debate on public versus private investment is over—both are needed. Africa's key challenges are the management of hybrid power markets, the reform of state-owned utilities, cost-reflective pricing, better targeting of subsidies, the nimbler rollout of electrification, and stronger regional integration. - Highlights: ► Africa has insufficient power generation, low connectivity, poor reliability, and high costs. ► Investment requirements to meet Africa's power needs are calculated. ► Key challenges are the management of hybrid power markets and the reform of state-owned utilities. ► Other challenges are cost-reflective pricing, extending access, and stronger regional integration.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

Science.gov (United States)

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Deposit insurance reform; or, deregulation is the cart, not the horse

OpenAIRE

John H. Kareken

1990-01-01

This paper, originally published in the spring 1983 Quarterly Review, explains why flat-rate deposit insurance gives financial intermediaries an incentive to take on too much risk. It also discusses the purposes of deposit insurance and some ways reforms might serve those purposes. Three possible reforms are discussed: abolishing the insurance and requiring depository institutions to either hold safe assets or mark to market, reducing the deposit ceilings for insurance, and risk-adjusting the...

Innovation in healthcare: a concept analysis.

Science.gov (United States)

Weberg, Dan

2009-01-01

Innovation is a frequently used buzzword in healthcare. This article will clarify innovation as a process requiring leadership, among other factors, in order to occur. The concept of innovation will be defined, as well as the precedents and consequences. This exploration will serve as the definition of healthcare innovation and provide a clearer definition for future literature and research in healthcare, especially related to leadership and change. It is the purpose for this article to allow the reader to think about innovation in a critical manner and begin to add substantive meaning related to it.

Health-care reform or labor market reform? A quantitative analysis of the affordable care act

OpenAIRE

Nakajima, Makoto; Tuzemen, Didem

2015-01-01

The Patient Protection and Affordable Care Act (ACA) requires all individuals to have health insurance, and introduces penalties to large firms that do not offer affordable coverage to their employees. While the possible effects of the ACA on the insurance decision of individuals have been studied, what is less studied is how the ACA can affect labor demand. In particular, since the ACA does not require small firms to offer health insurance, and does not require firms to offer health insuranc...

Factors affecting science reform: Bridging the gap between reform initiatives and teaching practices

Science.gov (United States)

Pensak, Karl John

In response to the perceived deficiencies in science education today, and to the expressed need for research into the culture of schools (due primarily to the failure of many science reforms in the past), this study used a broad based approach to study the gap between science education research and science education practice. This study identified 47 factors that may encourage or inhibit science curriculum reform. A survey was conducted to determine which factors were perceived to be important by local and national K-12 classroom teachers, science supervisors/coordinators, and college/university professors. Continual staff development (scheduled as part of teachers' work day/week/month), funding (for long-term staff development, teacher training and support, science laboratory facilities and materials), teacher motivation and "ownership" of the reform, the need for collaborative opportunities for classroom teachers, teachers' college preparation, textbook reform, community support, and reform initiatives that are "in tune" with assessment, are major factors identified as having a substantial affect on the successful adoption, implementation, and institutionalization of science reforms.

Catalytic reforming methods

Science.gov (United States)

Tadd, Andrew R; Schwank, Johannes

2013-05-14

A catalytic reforming method is disclosed herein. The method includes sequentially supplying a plurality of feedstocks of variable compositions to a reformer. The method further includes adding a respective predetermined co-reactant to each of the plurality of feedstocks to obtain a substantially constant output from the reformer for the plurality of feedstocks. The respective predetermined co-reactant is based on a C/H/O atomic composition for a respective one of the plurality of feedstocks and a predetermined C/H/O atomic composition for the substantially constant output.

[PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

Science.gov (United States)

Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

2014-01-01

The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

The Use of Grid Storage Protocols for Healthcare Applications

CERN Document Server

Donno, F; CERN. Geneva. IT Department

2008-01-01

Grid computing has attracted worldwide attention for a variety of domains. Healthcare projects focus on data mining and standardization techniques, the issue of data accessibility and transparency over the storage systems on the Grid has seldom been tackled. In this position paper, we identify the key issues and requirements imposed by Healthcare applications and point out how Grid Storage Technology can be used to satisfy those requirements. The main contribution of this work is the identification of the characteristics and protocols that make Grid Storage technology attractive for building a Healthcare data storage infrastructure.

Understanding the space of nursing practice in Colombia: A critical reflection on the effects of health system reform.

Science.gov (United States)

Camargo Plazas, Pilar

2018-04-11

Worldwide, healthcare has been touched by neoliberal policies to the extent that it has some of its characteristics, such as being asymmetrical, competitive, dehumanized, and profit driven. In Colombia, Law 100/93 was created as an ambitious reform aimed at integrating the social security and public sectors of healthcare in order to create universal access, and at the same time to generate market competence with the objective of improving effectiveness and responsiveness. Instead, however, Colombian health reform has served to generate competition which has aggravated inequalities among people. Within this context, we practice nursing. As nurses, our responsibility is to advocate for our patients. We cannot ignore what is happening worldwide in hospitals and community health settings because our responsibility is to promote health, prevent disease, and care for human beings. So, today, when the world pushes for economical profit and competence on one hand, and, on the other, for moral compromises to care, respect, and advocacy for all human beings, being a nurse in the Colombian health system represents a challenge for us. This challenge is especially significant because harm and benefit, justice and injustice, respect and disrespect are separated by a fine line that is easy to transgress. © 2018 John Wiley & Sons Ltd.

Sex work, reform initiatives and HIV/AIDS in inner-city Johannesburg.

Science.gov (United States)

Richter, Marlise

2008-11-01

The on-going criminalisation of sex work in South Africa, concurrent sexual partnerships, socio-economic vulnerability, migrant status and gender-based violence intensify sex workers' risk of contracting HIV. These factors combine to restrict the skills, ability and resources of sex workers to negotiate safer sex and to access HIV prevention, treatment and healthcare services. The paper situates the living and working conditions of sex workers in Hillbrow, an inner-city area of Johannesburg, within the South African legal context, especially in regard to current law reform initiatives regarding sex work, as well as the increasing anxiety about the influx of (sex) tourists during the 2010 FIFA World Cup. In addition, the paper describes an intervention by the Reproductive Health & HIV Research Unit at the University of the Witwatersrand, Johannesburg, an innovator in providing mobile healthcare services and education to hotel-based sex workers in Hillbrow. The paper contends that a legal-rights-approach to HIV risk and vulnerability, together with powerful public health considerations, render decriminalisation an imperative response to sex workers' material conditions.

Reforming Organizational Structures

NARCIS (Netherlands)

S.G.J. Van de Walle (Steven)

2016-01-01

textabstractPublic sectors have undergone major transformations. Public sector reform touches upon the core building blocks of the public sector: organizational structures, people and finances. These are objects of reform. This chapter presents and discusses a set of major transformations with

Managing healthcare services in the global marketplace.

Science.gov (United States)

Fried, Bruce J; Harris, Dean M

2007-01-01

The world is getting "flatter"; people, information, technology, and ideas are increasingly crossing national borders. U.S. healthcare is not immune from the forces of globalization. Competition from medical tourism and the rapid growth in the number of undocumented aliens requiring care represent just two challenges healthcare organizations face. An international workforce requires leaders to confront the legal, financial, and ethical implications of using foreign-trained personnel. Cross-border institutional arrangements are emerging, drawing players motivated by social responsibility, globalization of competitors, growth opportunities, or an awareness of vulnerability to the forces of globalization. Forward-thinking healthcare leaders will begin to identify global strategies that address global pressures, explore the opportunities, and take practical steps to prepare for a flatter world.

Political Struggle Over The Immigration Reform During G.W.Bush Presidency

Directory of Open Access Journals (Sweden)

Aleksandra Aleksandrovna Filippenko

2014-01-01

Full Text Available By the beginning of the XXI century, the US had about 12 million illegal aliens and the immigration reform was evidently much needed. The Immigration Act of 1990 was significantly outdated and required revision. Additional regulations that passed in the 1990-s had to be systematized. The White House and the president George W. Bush inclined to the comprehensive immigration reform that would include an amnesty for the certain part of the illegal aliens. Some lawmakers were ready to strike a deal, but than happened the 9/11 tragedy. Immigration reform was shelved and turned into a matter of national security. Immigration reform bills were taken into consideration only in conjunction with boarder security bills. Edward Kennedy was very much aware of the issue's complexity and the need for reform; he did all he could to reach a compromise with his fellow Republicans. John McCain became his closest ally in the reform. Democrats made considerable concessions, while moderate Republicans were willing to meet them halfway, but the conservatives would not let the Congress adopt a new legislation, calling any attempt at comprehensive immigration reform an amnesty for the criminals. During the 107-110 Congresses the immigration reform was thoroughly worked through from both sides, but the proposed bills rarely got to the floor and never passed both Houses. Even though the time has passed, suggestions offered and deals reached during the Bush presidency did not lose the edge and any new immigration legislation is going be based on the 2002-2008 bills.

POLITICAL STRUGGLE OVER THE IMMIGRATION REFORM DURING G.W.BUSH PRESIDENCY

Directory of Open Access Journals (Sweden)

Aleksandra Aleksandrovna Filippenko

2014-01-01

Full Text Available By the beginning of the XXI century, the US had about 12 million illegal aliens and the immigration reform was evidently much needed. The Immigration Act of 1990 was significantly outdated and required revision. Additional regulations that passed in the 1990-s had to be systematized. The White House and the president George W. Bush inclined to the comprehensive immigration reform that would include an amnesty for the certain part of the illegal aliens. Some lawmakers were ready to strike a deal, but than happened the 9/11 tragedy. Immigration reform was shelved and turned into a matter of national security. Immigration reform bills were taken into consideration only in conjunction with boarder security bills. Edward Kennedy was very much aware of the issue's complexity and the need for reform; he did all he could to reach a compromise with his fellow Republicans. John McCain became his closest ally in the reform. Democrats made considerable concessions, while moderate Republicans were willing to meet them halfway, but the conservatives would not let the Congress adopt a new legislation, calling any attempt at comprehensive immigration reform an amnesty for the criminals. During the 107-110 Congresses the immigration reform was thoroughly worked through from both sides, but the proposed bills rarely got to the floor and never passed both Houses. Even though the time has passed, suggestions offered and deals reached during the Bush presidency did not lose the edge and any new immigration legislation is going be based on the 2002-2008 bills.

Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Eiring, Øystein; Nielsen, Jesper Bo

Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd Mette Kjer Kaltoft, University of Southern Denmark Øystein Eiring, Norwegian Knowledge Centre for the Health Services Jesper Bo Nielsen, University of Southern Denmark...... requirement in relation to the BEANs only by assuming professionals are able to make up the shortfalls remaining after the peer-reviewed published products of scientific research have been fully exploited. Since the clinical judgement of individual professionals has never been subjected to scientific...... never get near to meeting the needs of practice. What is required is the translation of the wisdom of the clinical crowd through the processing of the beliefs of expert professionals into BEANs. The process must be appropriately analytically rigorous, but this should not be confounded with scientific...

Competencies Required for Healthcare Information Technology to Be an Effective Strategic Business Change Partner

Science.gov (United States)

Davalos, Eugenia

2013-01-01

One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers…

Reforming performance of a plasma-catalyst hybrid converter using low carbon fuels

International Nuclear Information System (INIS)

Horng, R.-F.; Lai, M.-P.; Huang, H.-H.; Chang, Y.-P.

2009-01-01

The reforming performance of a plasma-catalyst hybrid converter using different low carbon fuels was investigated. The methodology was to use arc from spark discharge combined with an appropriate oxygen/carbon molar ratio (O 2 /C) and feeding rate of the supplied mixture. To enhance the mixing and reforming reaction, a gas intake swirl was generated by inducing the mixture tangentially into the reaction chamber. The required energy for fuel processing was provided by heat released through the oxidation of the air-fuel mixture. The reforming temperature as well as the effect of steam addition on the hydrogen production was studied. The results showed that reformate gas temperature had a profound effect on the overall reaction. The H 2 /(CO + CO 2 ) ratio reformed by both methane and propane was shown to increase with temperature and that the optimum ratio was obtained when reforming methane under 650 deg. C. The conversion efficiency of the fuel was also shown to increase with increasing temperature. The best thermal efficiency of 72.01% was obtained near 750 deg. C. The theoretical equilibrium calculations and the experimental results were compared.

At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

Directory of Open Access Journals (Sweden)

Haggerty Jeannie

2010-09-01

Full Text Available Abstract Background Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. Methods/Design A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year. The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare. Discussion Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While

Bluetooth: Opening a Blue Sky for Healthcare

Directory of Open Access Journals (Sweden)

X. H. Wang

2006-01-01

Full Text Available Over the last few years, there has been a blossoming of developing mobile healthcare programs. Bluetooth technology, which has the advantages of being low-power and inexpensive, whilst being able to transfer moderate amounts of data over a versatile, robust and secure radio link, has been widely applied in mobile healthcare as a replacement for cables. This paper discussed the applications of Bluetooth technology in healthcare. It started with the brief description of the history of Bluetooth technology, its technical characteristics, and the latest developments. Then the applications of Bluetooth technology in healthcare sector were reviewed. The applications are based on two basic types of links of Bluetooth technology: point-to-point link and point-to-multipoint link. The special requirements from healthcare and the challenges of successful application of Bluetooth in healthcare will be discussed. At last the future development of Bluetooth technology and its impacts on healthcare were envisioned.

Public Administration reforms and results

Directory of Open Access Journals (Sweden)

Gunnar Helgi Kristinsson

2014-12-01

Full Text Available Research on administrative reforms during the past thirty years indicates that reform efforts of countries differ. The Anglo Saxon states were at the forefront of the New Public Management movement while countries on mainland Europe were more hesitant and moved further towards the Neo-Weberian state. Academics have tried to explain different reform efforts within countries by looking at political, historical and cultural issues, values and economic factors to name just a few. Three hypotheses are put forward to explain reform efforts in different states. This research involves analysing the implementation of two different reform trends, New Public Management and the Neo-Weberian tradition. The analysis indicates that countries vary in their commitment to reform rather than in the emphasis on either New Public Management or the Neo-Weberian State. Decentralization, clear objectives and consultation with communities and experts are closely related to national reform efforts. However, Iceland does distinguish itself from Europe and the Nordic countries. The analysis reveals that although decentralization is high in the Icelandic system, autonomy of agencies does not have a strong relation to a varied use of administrative instruments. The second part of the article focuses on the results and achievements of reform programmes. The achievement of reform programmes are examined in relation to theories of bounded rationality, street level bureaucracy (bottom up and consensus decision making. Three hypotheses are presented and tested to explain what causes reforms programmes to be successful in some countries and not in others. The analysis reveals that countries are more likely to succeed if bounded rationality is applied with careful preparation and when stakeholders are consulted.

Lean healthcare from a change management perspective.

Science.gov (United States)

van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk

2016-05-16

Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

Plasma devices for hydrocarbon reformation

KAUST Repository

Cha, Min Suk

2017-02-16

Plasma devices for hydrocarbon reformation are provided. Methods of using the devices for hydrocarbon reformation are also provided. The devices can include a liquid container to receive a hydrocarbon source, and a plasma torch configured to be submerged in the liquid. The plasma plume from the plasma torch can cause reformation of the hydrocarbon. The device can use a variety of plasma torches that can be arranged in a variety of positions in the liquid container. The devices can be used for the reformation of gaseous hydrocarbons and/or liquid hydrocarbons. The reformation can produce methane, lower hydrocarbons, higher hydrocarbons, hydrogen gas, water, carbon dioxide, carbon monoxide, or a combination thereof.

Healthcare waste management in Asia

International Nuclear Information System (INIS)

Prem Ananth, A.; Prashanthini, V.; Visvanathan, C.

2010-01-01

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Healthcare waste management in Asia.

Science.gov (United States)

Ananth, A Prem; Prashanthini, V; Visvanathan, C

2010-01-01

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review.

Science.gov (United States)

Siddiqi, Ahmed; White, Peter B; Mistry, Jaydev B; Gwam, Chukwuweike U; Nace, James; Mont, Michael A; Delanois, Ronald E

2017-08-01

In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models. A literature search was performed using PubMed and the CMMSIC to explore different APMs and clinical results after implementation. All studies that were not in English or unrelated to the topic were excluded. Preliminary results of bundled payment models have shown reduced costs in total joint arthroplasty largely by reducing hospital length of stay, decreasing readmission rates, as well as reducing the number of patients sent to in-patient rehabilitation facilities. In order to refine episode of care bundles, CMMSIC has also developed other initiatives such as the Comprehensive Care for Joint Replacement (CJR) pathway and Surgical Hip and Femur Fracture (SHFFT). Despite the unknown future of the Affordable Care Act, BPCI, and CJR, preliminary results of alternative models have shown promise to reduce costs and improve quality of care. Moving into the future, surgeon control of the BPCI and CJR bundle should be investigated to further improve patient care and maximize financial compensation. Copyright © 2017 Elsevier Inc. All rights reserved.

Architecture Capabilities to Improve Healthcare Environments

Science.gov (United States)

Ebrahimi, Ali; Mardomi, Karim; Hassanpour Rahimabad, Kasra

2013-01-01

Background The physical environment of healthcare buildings has great importance in issues such as patient safety, functional efficiency, user satisfaction, healthcare outcomes, and energy and resources consumption. Objectives The present study assesses physical environments of Iranian healthcare buildings. Materials and Methods This study was performed using a descriptive-analytical method. Data collection was carried out via a written questionnaire. Results Based on the findings of this study, "functional efficiency", "user satisfaction", "environmental issues", "patient safety”, “accountability in incidents and disasters", and "flexibility" are regarded as the most issues in the country's hospitals. Also, none of the parameters is "without any problem" and has a "desirable status". Conclusions According to the responses, all of the healthcare buildings in this research had flaws in their physical environment, which require attention. Thus, it is necessary to review and pay more attention to the architecture of the country's healthcare buildings. PMID:24350145

School Performance, Accountability and Waiver Reforms: Evidence from Louisiana. CEPA Working Paper No. 17-06

Science.gov (United States)

Dee, Thomas; Dizon-Ross, Elise

2017-01-01

States that received federal waivers to the No Child Left Behind (NCLB) Act were required to implement reforms in designated "Focus Schools" that contribute to achievement gaps. In this study, we examine the performance effects of such "differentiated accountability" reforms in the state of Louisiana. The Focus School reforms…

Strategies for navigating the healthcare credit market.

Science.gov (United States)

Wareham, T L

2001-04-01

Not-for-profit healthcare organizations are experiencing a tightened credit market due to financial stresses on the healthcare industry such as declining payments, effects of the Balanced Budget Act of 1997, and the shift to outpatient care. In the future, healthcare organizations wanting to access the capital market will be expected to preserve cash as an "insurance policy," offer greater security and stricter covenants, and report financial information on a quarterly basis. To meet these requirements and navigate today's tighter credit market, healthcare financial managers will need to focus on the organization's most reliably profitable areas of business, link strategic and financial issues, and carefully monitor the balance sheet.

Application of flexible micro temperature sensor in oxidative steam reforming by a methanol micro reformer.

Science.gov (United States)

Lee, Chi-Yuan; Lee, Shuo-Jen; Shen, Chia-Chieh; Yeh, Chuin-Tih; Chang, Chi-Chung; Lo, Yi-Man

2011-01-01

Advances in fuel cell applications reflect the ability of reformers to produce hydrogen. This work presents a flexible micro temperature sensor that is fabricated based on micro-electro-mechanical systems (MEMS) technology and integrated into a flat micro methanol reformer to observe the conditions inside that reformer. The micro temperature sensor has higher accuracy and sensitivity than a conventionally adopted thermocouple. Despite various micro temperature sensor applications, integrated micro reformers are still relatively new. This work proposes a novel method for integrating micro methanol reformers and micro temperature sensors, subsequently increasing the methanol conversion rate and the hydrogen production rate by varying the fuel supply rate and the water/methanol ratio. Importantly, the proposed micro temperature sensor adequately controls the interior temperature during oxidative steam reforming of methanol (OSRM), with the relevant parameters optimized as well.

Application of Flexible Micro Temperature Sensor in Oxidative Steam Reforming by a Methanol Micro Reformer

Directory of Open Access Journals (Sweden)

Yi-Man Lo

2011-02-01

Full Text Available Advances in fuel cell applications reflect the ability of reformers to produce hydrogen. This work presents a flexible micro temperature sensor that is fabricated based on micro-electro-mechanical systems (MEMS technology and integrated into a flat micro methanol reformer to observe the conditions inside that reformer. The micro temperature sensor has higher accuracy and sensitivity than a conventionally adopted thermocouple. Despite various micro temperature sensor applications, integrated micro reformers are still relatively new. This work proposes a novel method for integrating micro methanol reformers and micro temperature sensors, subsequently increasing the methanol conversion rate and the hydrogen production rate by varying the fuel supply rate and the water/methanol ratio. Importantly, the proposed micro temperature sensor adequately controls the interior temperature during oxidative steam reforming of methanol (OSRM, with the relevant parameters optimized as well.

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

Directory of Open Access Journals (Sweden)

AlBuhairan FS

2014-09-01

specific health-care needs that are different than children or adults (82.3% and 84.0%, respectively. With respect to health services, the majority (85.8% believed that adolescents should be hospitalized in adolescent-specific wards. Only 26.7% of health-care providers believed that patients should be transferred from child to adult health-care services at 12–13 years of age, as is currently practiced in the country. Conclusion: A gap exists between the training, knowledge and skills of health-care providers, and the needs to address health-care issues of adolescents in Saudi Arabia. This coupled with the fact that health-care providers are interested in gaining more knowledge and skills and are supportive of changes in the health-care system provides an opportunity for building local capacity and instituting medical and nursing education and health-care reform that can better serve the needs of the country's young population. Keywords: medical education, young population, knowledge transfer

Implications of organizational ethics to healthcare.

Science.gov (United States)

Ells, Carolyn; MacDonald, Chris

2002-01-01

Organizational ethics is an emerging field concerned with the study and practice of the ethical behaviour of organizations. For effective application to healthcare settings, we argue that organizational ethics requires attention to organizations' special characteristics combined with tools borrowed from the fields of business ethics and bioethics. We identify and discuss several implications of this burgeoning field to healthcare organizations, showing how organizational ethics can facilitate policy making, accountability, self-evaluation, and patient and business perspectives. In our conclusion, we suggest an action plan for healthcare organizations to help them respond appropriately to their ethical responsibilities.

The telecom reform process in Europe and the upcoming challenges

DEFF Research Database (Denmark)

Henten, Anders

2013-01-01

of the whole information communications technology (ICT) area requiring new policy and regulatory answers. Originality/value – The paper provides a brief introduction to the European telecommunication reform process, its achievements, present challenges, and the policy responses of the European Union......Purpose – The purpose of this paper is to provide a brief introduction to the telecommunication reform process in Europe, its status, and upcoming policy issues. Furthermore, it also aims to provide an overview of the papers in this special issue. Design/methodology/approach – The paper provides...

The role of independent agents in the success of health insurance market reforms.

Science.gov (United States)

Hall, M A

2000-01-01

The impact of reforms on the health insurance markets cannot be understood without more information about the role played by insurance agents and a closer analysis of their contribution. An in-depth, qualitative study of insurance-market reforms in seven illustrative states forms the basis for this report on how agents help to shape the efficiency and fairness of insurance markets. Different types of agents relate to insurers in their own ways and are compensated differently. This study shows agents to be almost uniformly enthusiastic about guaranteed-issue requirements and other components of market reforms. Although insurers devise strategies for manipulating agents in order to avoid undesirable business, these opportunities are limited and do not appear to be seriously undermining the effectiveness of market reforms. Despite the layer of cost that agents add to the system, they play an important role in making market reforms work, and they fill essential information and service functions for which many purchasers have no ready substitute.

Process Management Practices In Healthcare Institutions

OpenAIRE

Şükrü Kılıç; Cumhur Aydınlı

2015-01-01

Healthcare institutions differ from other service businesses by their “matrix organizational structure” and “error-free output” requirement. However, the processes stay the same for all organizational activities at different levels. One of the post-modern management approach is to focus on basis of necessary processes and fundamental organizational changes. This case study aims to initially explain the characteristics of healthcare institutions and the ba...

The voluntary fulfillment of the taxes payment as reformative institution of Venezuelan tax system

Directory of Open Access Journals (Sweden)

Jose Guillermo Garcia

2007-07-01

Full Text Available A consensus between the reformers of the public administration exists on a matter that changes are not decreed, but that these require, for their effective fulfillment of certain conditions, like stimulation of actors affected by the reforms, to recognize the new scenario like favorable and therefore, to act in its name. Under this premise, this paper analyzes the voluntary fulfillment of the taxes payment as reformative institution of the Venezuelan tax system, which has implied the development of a formal incentives structure promoting the initiative of conscious tax payment.

A method for defining value in healthcare using cancer care as a model.

Science.gov (United States)

Feeley, Thomas W; Fly, Helen Shafer; Albright, Heidi; Walters, Ronald; Burke, Thomas W

2010-01-01

Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the US healthcare delivery system. Defining and applying the principles of value-based competition in healthcare delivery models will permit future evaluation of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. In this article, we describe an approach for assessing the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center. We describe the analysis of a multidisciplinary care center that treats head and neck cancers, and we attempt to examine how this center integrates with Porter and Teisberg's (2006) concept of value-based competition based on the results analysis. Using the relationship between outcomes and costs as the definition of value, we developed a methodology to analyze proposed outcomes for a population of patients treated using a multidisciplinary approach, and we matched those outcomes to the costs of the care provided. We present this work as a model for defining value for a subset of patients undergoing active treatment. The method can be applied not only to head and neck treatments, but to other modalities as well. Public reporting of this type of data for a variety of conditions can lead to improved competition in the healthcare marketplace and, as a result, improve outcomes and decrease health expenditures.

Constitutional reform as process

OpenAIRE

Schultze, Rainer-Olaf (Prof.)

2000-01-01

Constitutional reform as process. - In: The politics of constitutional reform in North America / Rainer-Olaf Schultze ... (eds.). - Opladen : Leske + Budrich, 2000. - S. 11-31. - (Politikwissenschaftliche paperbacks ; 30)

Reforming Technical and Technological Education.

Science.gov (United States)

Wilson, David N.

1993-01-01

Review of technical and technological educational reform in Brazil, Canada, Germany, Great Britain, Indonesia, Malaysia, Singapore, and Sweden shows that reform takes time to complete effectively, long-term approaches are needed, and reform is linked to industrial development, regional cooperation, and decentralized decision making. (SK)

Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare.

Science.gov (United States)

Phillips, Andrew B; Merrill, Jacqueline A

2015-12-01

Healthcare is in a period significant transformational activity through the accelerated adoption of healthcare technologies, new reimbursement systems that emphasize shared savings and care coordination, and the common place use of mobile technologies by patients, providers, and others. The complexity of healthcare creates barriers to transformational activity and has the potential to inhibit the desired paths toward change envisioned by policymakers. Methods for understanding how change is occurring within this complex environment are important to the evaluation of delivery system reform and the role of technology in healthcare transformation. This study examines the use on an integrative review methodology to evaluate the healthcare literature for evidence of technology transformation in healthcare. The methodology integrates the evaluation of a broad set of literature with an established evaluative framework to develop a more complete understanding of a particular topic. We applied this methodology and the framework of punctuated equilibrium (PEq) to the analysis of the healthcare literature from 2004 to 2012 for evidence of technology transformation, a time during which technology was at the forefront of healthcare policy. The analysis demonstrated that the established PEq framework applied to the literature showed considerable potential for evaluating the progress of policies that encourage healthcare transformation. Significant inhibitors to change were identified through the integrative review and categorized into ten themes that describe the resistant structure of healthcare delivery: variations in the environment; market complexity; regulations; flawed risks and rewards; change theories; barriers; ethical considerations; competition and sustainability; environmental elements, and internal elements. We hypothesize that the resistant nature of the healthcare system described by this study creates barriers to the direct consumer involvement and engagement

The Value That Infectious Diseases Physicians Bring to the Healthcare System.

Science.gov (United States)

McQuillen, Daniel P; MacIntyre, Ann T

2017-09-15

While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee-sponsored study of ID physicians' positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach-better health, better care, and lower per capita cost-that is the principle tenet of healthcare system reform. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Improving healthcare practice behaviors: an exploratory study identifying effective and ineffective behaviors in healthcare.

Science.gov (United States)

Van Fleet, David D; Peterson, Tim O

2016-01-01

The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients. The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups. The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities. The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997). With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers. The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider. Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as

Tailor-made finance versus tailor-made service : Can the state improve consumer choice in healthcare by reforming the financial structure?

NARCIS (Netherlands)

K.J. Grit (Kor); A.A. de Bont (Antoinette)

2010-01-01

textabstractABSTRACT Background: Policy instruments based on the working of markets have been introduced to empower consumers of healthcare, however it is not easy to become a critical consumer in healthcare. Objectives: The aim of this study is to analyze the possibilities of the state to

Self-employed nurses as change agents in healthcare: strategies, consequences, and possibilities.

Science.gov (United States)

Wall, Sarah

2014-01-01

The purpose of this paper is to report on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare. Focussed ethnography was used to explore self-employed nurses' work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system. These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice. Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing's professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform.

Behavioral Reference Model for Pervasive Healthcare Systems.

Science.gov (United States)

Tahmasbi, Arezoo; Adabi, Sahar; Rezaee, Ali

2016-12-01

The emergence of mobile healthcare systems is an important outcome of application of pervasive computing concepts for medical care purposes. These systems provide the facilities and infrastructure required for automatic and ubiquitous sharing of medical information. Healthcare systems have a dynamic structure and configuration, therefore having an architecture is essential for future development of these systems. The need for increased response rate, problem limited storage, accelerated processing and etc. the tendency toward creating a new generation of healthcare system architecture highlight the need for further focus on cloud-based solutions for transfer data and data processing challenges. Integrity and reliability of healthcare systems are of critical importance, as even the slightest error may put the patients' lives in danger; therefore acquiring a behavioral model for these systems and developing the tools required to model their behaviors are of significant importance. The high-level designs may contain some flaws, therefor the system must be fully examined for different scenarios and conditions. This paper presents a software architecture for development of healthcare systems based on pervasive computing concepts, and then models the behavior of described system. A set of solutions are then proposed to improve the design's qualitative characteristics including, availability, interoperability and performance.

Patient Protection and Affordable Care Act of 2010: reforming the health care reform for the new decade.

Science.gov (United States)

Manchikanti, Laxmaiah; Caraway, David L; Parr, Allan T; Fellows, Bert; Hirsch, Joshua A

2011-01-01

The Patient Protection and Affordable Care Act (the ACA, for short) became law with President Obama's signature on March 23, 2010. It represents the most significant transformation of the American health care system since Medicare and Medicaid. It is argued that it will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care. The length and complexity of the legislation and divisive and heated debates have led to massive confusion about the impact of ACA. It also became one of the centerpieces of 2010 congressional campaigns. Essentials of ACA include: 1) a mandate for individuals and businesses requiring as a matter of law that nearly every American have an approved level of health insurance or pay a penalty; 2) a system of federal subsidies to completely or partially pay for the now required health insurance for about 34 million Americans who are currently uninsured - subsidized through Medicaid and exchanges; 3) extensive new requirements on the health insurance industry; and 4) numerous regulations on the practice of medicine. The act is divided into 10 titles. It contains provisions that went into effect starting on June 21, 2010, with the majority of provisions going into effect in 2014 and later. The perceived major impact on practicing physicians in the ACA is related to growing regulatory authority with the Independent Payment Advisory Board (IPAB) and the Patient Centered Outcomes Research Institute (PCORI). In addition to these specifics is a growth of the regulatory regime in association with further discounts in physician reimbursement. With regards to cost controls and projections, many believe that the ACA does not fix the finances of our health care system - neither public nor private. It has been suggested that the Congressional Budget Office (CBO) and the administration have used creative accounting to arrive at an alleged deficit reduction; however, if everything is included appropriately and

Bible reading in Africa: the shaping of a reformed perspective

Directory of Open Access Journals (Sweden)

B. Wielenga

2010-07-01

Full Text Available In this article I try to develop a reformed perspective on Bible reading in Africa by ordinary readers. I explore the concept of ordinary readers in the context of recent hermeneutical discus-sions, and of the differences between their mode of reading and that of biblical scholars against the background ofthe reality of the oral or semi-literate cultures of Africa. A reformed perspec-tive, with its emphasis on the church as locus for Bible reading under the operation of the Holy Spirit, opens up a way forward out of the dilemma between ordinary and professional Bible reading. A reformed perspective can also clear the way for a gender-sensitive reading of the Bible in a continent where most Bible readers are women. This requires from those who read the Bible together an attitude of humility.

Reforming the Tax Mix in Canada

Directory of Open Access Journals (Sweden)

Bev Dahlby

2012-04-01

Full Text Available Periodically, tax systems need major reforms to remove the “barnacles” that accumulate under the short-term pressures of political expediency and to adapt to the long-term forces of technological and economic change. The current fiscal and economic problems that confront the provinces require an assessment of much-needed reforms. Raising tax revenue imposes large costs on our society, not only because of the administration and compliance costs of collecting taxes, but because taxes distort economic decisions in the private sector. This is especially true of provincial corporate income taxes. Taxing highly mobile corporate capital and corporate profits encourages firms to shift their investments and profits across provincial and international boundaries. The provinces would enjoy significant boosts to economic growth and efficiency gains by enacting a revenue-neutral switch from corporate to sales or personal income taxes. For Alberta, such a shift would yield up to $40 per dollar of tax revenue shifted from corporate to personal income taxes; for fiscal year 2011-12, this would amount to a percapita welfare gain of roughly $19,000. Other options for tax reform are also discussed in this paper, including the adoption of a penny tax to the GST to fund infrastructure spending by municipalities. However, we think this would saddle the private sector with significant compliance costs and create major economic distortions between neighbouring municipalities by creating an incentive to shop where the penny tax proposal was not adopted. In surveying the most pressing tax reform issues facing Canada, we offer policymakers a firm basis for coming to grips with them, so they can treat tax dollars with the care and foresight Canadians expect.

Energy efficiency of a direct-injection internal combustion engine with high-pressure methanol steam reforming

International Nuclear Information System (INIS)

Poran, Arnon; Tartakovsky, Leonid

2015-01-01

This article discusses the concept of a direct-injection ICE (internal combustion engine) with thermo-chemical recuperation realized through SRM (steam reforming of methanol). It is shown that the energy required to compress the reformate gas prior to its injection into the cylinder is substantial and has to be accounted for. Results of the analysis prove that the method of reformate direct-injection is unviable when the reforming is carried-out under atmospheric pressure. To reduce the energy penalty resulted from the gas compression, it is suggested to implement a high-pressure reforming process. Effects of the injection timing and the injector's flow area on the ICE-SRM system's fuel conversion efficiency are studied. The significance of cooling the reforming products prior to their injection into the engine-cylinder is demonstrated. We show that a direct-injection ICE with high-pressure SRM is feasible and provides a potential for significant efficiency improvement. Development of injectors with greater flow area shall contribute to further efficiency improvements. - Highlights: • Energy needed to compress the reformate is substantial and has to be accounted for. • Reformate direct-injection is unviable if reforming is done at atmospheric pressure. • Direct-injection engine with high-pressure methanol reforming is feasible. • Efficiency improvement by 12–14% compared with a gasoline-fed engine was shown

Theoretical Aspects of Developing the Ideological Platform for Reforming the Economy of Regions of Ukraine

Directory of Open Access Journals (Sweden)

Bielikova Nadiya V.

2016-01-01

Full Text Available The article is concerned with developing the ideological platform for reforming the economy of regions of Ukraine on the basis of theories, conceptions, approaches and methods of research of regularities in the economic development of countries and their regions. The article substantiates both theoretical basis and methodological support for developing a economic reforming mechanism; expediency of use as to certain economic theories as well as quantitative and qualitative research methods as to reforming the economy of country and its regions. Requirements for development of the ideological platform of reforming the economy of the country's regions have been defined. The article considers achievements of philosophical disciplines that form the basis for developing of the ideological platform of economic reforming: philosophical anthropology (existentialism as doctrine about the human nature (essence; social theory and the institutional theory, developed on the basis of the latter; philosophy of economics; conceptions and ideas of the philosophy of history. The theoretical basis of studying the economic reforming in Ukraine and its regions has been substantiated, which consists of the following components: reforming the model of country's economy as a whole; reforming the model of a particular region's economy; reforming the model of region's economy as a component of the national economy; reforming the model of economy of country and its regions.

Pervasive mobile healthcare systems for chronic disease monitoring.

Science.gov (United States)

Huzooree, Geshwaree; Kumar Khedo, Kavi; Joonas, Noorjehan

2017-05-01

Pervasive mobile healthcare system has the potential to improve healthcare and the quality of life of chronic disease patients through continuous monitoring. Recently, many articles related to pervasive mobile healthcare system focusing on health monitoring using wireless technologies have been published. The main aim of this review is to evaluate the state-of-the-art pervasive mobile healthcare systems to identify major technical requirements and design challenges associated with the realization of a pervasive mobile healthcare system. A systematic literature review was conducted over IEEE Xplore Digital Library to evaluate 20 pervasive mobile healthcare systems out of 683 articles from 2011 to 2016. The classification of the pervasive mobile healthcare systems and other important factors are discussed. Potential opportunities and challenges are pointed out for the further deployment of effective pervasive mobile healthcare systems. This article helps researchers in health informatics to have a holistic view toward understanding pervasive mobile healthcare systems and points out new technological trends and design challenges that researchers have to consider when designing such systems for better adoption, usability, and seamless integration.

Financial Reform and Financial Development in Nigeria: A ...

African Journals Online (AJOL)

User

2011-05-20

May 20, 2011 ... An International Multi-Disciplinary Journal, Ethiopia. Vol. 5 (3), Serial No. ... reform in Nigeria on some financial sector and real sector variables. The ... quantitative restrictions on lending, high reserve requirement as the causes of negative and ... graphical analysis of the outcome of the two era. In section ...

Dutch virtual integration of healthcare information.

Science.gov (United States)

de Graaf, J C; Vlug, A E; van Boven, G J

2007-01-01

As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

Budget reform in Ukraine and the OECD countries

Directory of Open Access Journals (Sweden)

Puchko Anna

2016-09-01

Full Text Available The article analyzes the fiscal reforms in Ukraine and the OECD countries. It has been proved that the main areas which should undergo changes are the tax reform, regulatory reform and restructuring policies to encourage entrepreneurship, reform of social protection and social security, reform of social sphere constituents, administrative reform, reform of the army and law enforcement, administrative and territorial reform. According to the analysis results, there has been drawn the conclusion about the need to introduce in Ukraine the successful experience of the OECD countries in implementing budget reforms.

Transforming healthcare with information technology in Japan: a review of policy, people, and progress.

Science.gov (United States)

Abraham, Chon; Nishihara, Eitaro; Akiyama, Miki

2011-03-01

Healthcare reform as part of the economic recovery plan in Japan is placing emphasis on the use of healthcare information technology (HIT). This research mainly focuses on the HIT efforts in Japan with reference to the US for context. The purpose is to: (a) provide detail on governmental policy impacting promotion of HIT adoption to provide services to the people of Japan, (b) describe the outcomes of past and present policy impacting progress based on a case study of HIT use in the Kyoto Yamashina area, and (c) discuss issues for refinement of current policy. The method is case study, and data collection techniques include: (a) interviews of people involved in policy making for HIT in Japan (Japanese healthcare professionals, government officials, and academics involved in HIT research in Japan) and use in the medical community of HIT in the Kyoto Yamashina area, (b) archived document analysis of reports regarding government policy for HIT policy and user assessment for HIT mainly in the case study site, and (c) the literature review about HIT progression and effectiveness assessments to explore and describe issues concerning the transformation with HIT in Japan. This study reveals the aspects of governmental policy that have been effective in promoting successful HIT initiatives as well as some that have been detriments in Japan to help solve pressing social issues regarding healthcare delivery. For example, Japan has stipulated some standardized protocols and formats for HIT but does not mandate exactly how to engage in inter-organizational or intra-organizational health information exchange. This provides some desired autonomy for healthcare organizations and or governments in medical communities and allows for more advanced organizations to leverage current resources while providing a basis for lesser equipped organizations to use in planning the initiative. The insights gained from the Kyoto Yamashina area initiative reflect the success of past governmental

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care.

Science.gov (United States)

Rajaram, Ravi; Saadat, Lily; Chung, Jeanette; Dahlke, Allison; Yang, Anthony D; Odell, David D; Bilimoria, Karl Y

2016-12-01

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience. Hospital Consumer Assessment of Healthcare Providers and Systems survey data and process-of-care scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare website for 1 year prior to (1 July 2010 to 30 June 2011) and 1 year after (1 July 2011 to 30 June 2012) duty hour reform implementation. Using a difference-in-differences model, non-teaching and teaching hospitals were compared before and after the 2011 reform to test the association of this policy with changes in process-of-care and patient experience measure scores. Duty hour reform was not associated with a change in the five patient experience measures evaluated, including patients rating a hospital 9 or 10 (coefficient -0.003, 95% CI -0.79 to 0.79) or stating they would 'definitely recommend' a hospital (coefficient -0.28, 95% CI -1.01 to 0.44). For all 10 process-of-care measures examined, such as antibiotic timing (coefficient -0.462, 95% CI -1.502 to 0.579) and discontinuation (0.188, 95% CI -0.529 to 0.904), duty hour reform was not associated with a change in scores. The 2011 ACGME duty hour reform was not associated with improvements in process-of-care and patient experience measures. These data should be considered when considering reform of resident duty hour policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Mobile health clinics in the era of reform.

Science.gov (United States)

Hill, Caterina F; Powers, Brian W; Jain, Sachin H; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

2014-03-01

Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage. A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics. Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review. Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs. Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.

Working on reform. How workers' compensation medical care is affected by health care reform.

Science.gov (United States)

Himmelstein, J; Rest, K

1996-01-01

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Administrative Reform

DEFF Research Database (Denmark)

Plum, Maja

Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...

Health care reforms.

Science.gov (United States)

Marušič, Dorjan; Prevolnik Rupel, Valentina

2016-09-01

In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

Survey of Attitudes towards Curriculum Reforms among Medical Teachersin Different Socio-economic and Cultural Environments

DEFF Research Database (Denmark)

Dahl, Mads Ronald

2007-01-01

Curriculum reforms in medical schools require cultural and conceptual changes from the faculty. We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical...... schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each). Teaching staff from medical schools in Bosnia and Herzegovina...... had more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (Pattitudes...

Addressing the Complexities of Big Data Analytics in Healthcare: The Diabetes Screening Case

Directory of Open Access Journals (Sweden)

Daswin De Silva

2015-09-01

Full Text Available The healthcare industry generates a high throughput of medical, clinical and omics data of varying complexity and features. Clinical decision-support is gaining widespread attention as medical institutions and governing bodies turn towards better management of this data for effective and efficient healthcare delivery and quality assured outcomes. Amass of data across all stages, from disease diagnosis to palliative care, is further indication of the opportunities and challenges to effective data management, analysis, prediction and optimization techniques as parts of knowledge management in clinical environments. Big Data analytics (BDA presents the potential to advance this industry with reforms in clinical decision-support and translational research. However, adoption of big data analytics has been slow due to complexities posed by the nature of healthcare data. The success of these systems is hard to predict, so further research is needed to provide a robust framework to ensure investment in BDA is justified. In this paper we investigate these complexities from the perspective of updated Information Systems (IS participation theory. We present a case study on a large diabetes screening project to integrate, converge and derive expedient insights from such an accumulation of data and make recommendations for a successful BDA implementation grounded in a participatory framework and the specificities of big data in healthcare context.

Leading for Urban School Reform and Community Development

Science.gov (United States)

Green, Terrance L.

2015-01-01

Purpose: Improving urban schools of color and the communities where they are located requires leadership that spans school and community boundaries. The purpose of this study is to understand how principal and community leader actions support urban school reform along with community development at two community schools in the urban Midwest and…

Serious reform starts with a systemic risk tax

NARCIS (Netherlands)

Perotti, E.

2010-01-01

The recent IMF report to the G20 states that fiscal reforms are essential to recover the costs of the crisis, as well as to contain future risk creation. This column argues that progress on controlling future risk requires a direct tax on systemic risk. This would restore confidence in the ability

What works and what doesn't work well in the US healthcare system.

Science.gov (United States)

Luft, Harold S

2006-12-01

Most observers agree that the US healthcare system is expensive, provides variable quality and leaves many without coverage. The policy challenge is that there is little consensus on how to approach reform. Many proposals assume that systems appearing to work in one nation can be transferred in toto to another or, alternatively, that only minor tweaking of an existing system is possible. The former approach ignores fundamental social, political and legal realities, and the latter ignores the potential for increased benefits. Additionally, many proposals are ideologically driven, focusing on how to finance expanded coverage. Broadening the discussion to examine other components of the system that do not work well may identify sufficient benefits for various stakeholders to engage them in finding more comprehensive solutions that address a range of problems. This paper examines areas in which the US healthcare system performs worse than one would like and areas in which it appears to work well. In the first category is the high proportion of people without coverage, the inefficient and inequitable incentives for the purchase and provision of insurance, the problems in deciding what should be covered, the ineffective payment incentives, administrative costs and complexities, the variable quality and lack of responsiveness to patient preferences, the less than optimal safety, under-valued primary care, provider de-professionalisation, and the costs that appear to be on auto-pilot. In the second category is the rapid and wide-reaching technological innovation, the ready access to care for the insured, and clinical and patient autonomy. Among the things taken as given is our constitutional (rather than parliamentary) political system and underlying public values about the roles of individuals and government. Current players will be active in any debate about reform, so their interests must be addressed. Likewise, certain underlying economic and social drivers of

The Missing Link in Housing Sector Reforms in Nigeria

Directory of Open Access Journals (Sweden)

Akintunde Otubu

2012-09-01

Full Text Available Housing is a fundamental product for every human being irrespective of financial standing. World acclaimed American psychologist, Abraham Maslow ranked shelter as second only to food in his hierarchy of human needs. Despite the importance of housing to the socio-economic development of man and the nation, housing problems have remained endemic throughout the world. In today’s world, some 100 million persons are homeless and more than a billion are inadequately housed. In 2002 housing deficit in Nigeria was put at about 8 million units. Latest statistics indicate that Nigeria requires a whopping 700,000 housing units annually for the next 15 years. The question is why this state of affairs? Why the perennial and unending problems of housing shortages, forced evictions and slum development? The paper examined these issues in Nigeria in order to advance the future prospect of the sector. The paper identified that whilst reforms were been made to all other subsector of the housing industry, land reform necessary to fast track the process was left unattended to by the government. The paper thus advocated for a robust reform of the current land management system in order to impact positively on the housing reform agenda in Nigeria.

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes.

Science.gov (United States)

Huang, Feng; Gan, Li

2017-02-01

At the end of 1998, China launched a government-run mandatory insurance program, the urban employee basic medical insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identifies variations in patient cost sharing that were imposed by the UEBMI reform and examines their effects on the demand for healthcare services. Using data from the 1991-2006 waves of the China Health and Nutrition Survey, we find that increased cost sharing is associated with decreased outpatient medical care utilization and expenditures but not with decreased inpatient care utilization and expenditures. Patients from low-income and middle-income households or with less severe medical conditions are more sensitive to prices. We observe little impact on patient's health, as measured by self-reported health status. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

Science.gov (United States)

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

Hydrogen from methanol for fuel cells in mobile systems: development of a compact reformer

Energy Technology Data Exchange (ETDEWEB)

Hoehlein, B [Forschungszentrum Juelich GmbH (Germany); Boe, M [H. Topsoee A/S, Lyngby (Denmark); Boegild-Hansen, J [H. Topsoee A/S, Lyngby (Denmark); Broeckerhoff, P [Forschungszentrum Juelich GmbH (Germany); Colsman, G [Forschungszentrum Juelich GmbH (Germany); Emonts, B [Forschungszentrum Juelich GmbH (Germany); Menzer, R [Forschungszentrum Juelich GmbH (Germany); Riedel, E

1996-07-01

On-board generation of hydrogen from methanol with a reformer in connection with the use of a proton-exchange membrane fuel cell (PEMFC) is an attractive option for a passenger car drive. Special considerations are required to obtain low weight and volume. Furthermore, the PEMFC of today cannot tolerate more than 10 ppm of carbon monoxide in the fuel. Therefore a gas conditioning step is needed after the methanol reformer. Our main research activities focus on the conceptual design of a drive system for a passenger car with methanol reformer and PEMFC: Engineering studies with regard to different aspects of this design including reformer, catalytic burner, gas conditioning, balances of the fuel cycles and basic design of a compact methanol reformer. The work described here was carried out within the framework of a JOULE II project of the European Union (1993-1995). Extensive experimental studies have been carried out at the Forschungszentrum Juelich GmbH (KFA) in Germany and at Haldor Topsoee A/S in Denmark. (orig.)

Impact of reform and privatization on consumers: A case study of power sector reform in Orissa, India

International Nuclear Information System (INIS)

Kundu, Goutam Kumar; Mishra, Bidhu Bhusan

2011-01-01

Orissa is the first state in India to have undergone reform in the power sector, with the government withdrawing its control. The model of this reform is known as the WB-Orissa model. The goal of this paper is to examine the impact of this reform on consumers of electricity, which has been measured using multiple regression models. The variables represent the parameters that consumers are most interested in, and the regression coefficients represent the weights of the corresponding variables. The data were collected using a survey methodology. The impact of reform was found to be mixed. Some groups of consumers saw benefits, while others felt a negative impact. A focus group study was conducted to identify the variables of interest to consumers of electricity. The model was used to estimate consumer benefit and was validated using primary data and structural equation modeling. The study revealed beneficial aspects of reform and areas with no benefits. - Highlights: → Linear regression model with seven variables explains consumer benefit. → Governance issue exists after power sector reform of Orissa. → Reform benefited most consumers with a few exceptions. → Reform affected agricultural consumers.

Harmony in health sector: a requirement for effective healthcare delivery in Nigeria.

Science.gov (United States)

Osaro, Erhabor; Charles, Adias Teddy

2014-09-01

Harmony is defined as the pleasing combination of elements of a system to form an all-inclusive, all involving and more productive team. The aim of this present review was to investigate the factors militating against harmony among healthcare professional in the Nigerian healthcare delivery system. This review was carried out by searching through literature on the topic that bother on harmony among health professions in the health sector. Literature search and reports from previous studies indicates that harmony among health workers is pivotal to improving the health indices. However, available evidence suggests that unlike in the developed world, health care professionals do not collaborate well together in Nigeria because of the claim of superiority of a particular health professional over others. This has often resulted in inter-professional conflict which is threatening to tear the health sector apart to the detriment of the patients. The Nigeria health system should be based on team work. Health professionals from a variety of disciplines should work together to deliver the best possible healthcare services to all Nigerians. All members of the team are equally valuable and essential to the smooth running of hospitals. Hospitals should ideally be headed by health administrators or by a qualified member of any of the professions in the health sector. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Health systems reforms in Singapore: A qualitative study of key stakeholders.

Science.gov (United States)

Ong, Suan Ee; Tyagi, Shilpa; Lim, Jane Mingjie; Chia, Kee Seng; Legido-Quigley, Helena

2018-02-19

In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS. The RHS was described as an opportunity to holistically care for a person across the care continuum, address social determinants of health, develop new models of care, and work with social and community partners. Challenges to RHS implementation included difficulties aligning the goals, values, and priorities of multiple actors, the need for better integration across clusters, differing care capabilities and capacities across partners, healthcare financing structures that may not reflect RHS goals, scalability and evaluation of pilot programmes, and disease-centricity, provider-centricity, and medicalisation in health and healthcare. Suggested ways forward included building relationships between actors to facilitate integration; exploring innovative new models of care; clear long-term/scale-up plans for successful pilots; healthcare financing reforms to meet changing patient and population needs; and developing evaluation systems reflective of RHS principles and priorities. Copyright © 2018 Elsevier B.V. All rights reserved.

Device Data Protection in Mobile Healthcare Applications

Science.gov (United States)

Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin

The rapid growth in mobile technology makes the delivery of healthcare data and services on mobile phones a reality. However, the healthcare data is very sensitive and has to be protected against unauthorized access. While most of the development work on security of mobile healthcare today focuses on the data encryption and secure authentication in remote servers, protection of data on the mobile device itself has gained very little attention. This paper analyses the requirements and the architecture for a secure mobile capsule, specially designed to protect the data that is already on the device. The capsule is a downloadable software agent with additional functionalities to enable secure external communication with healthcare service providers, network operators and other relevant communication parties.

Healthcare professionals' perspectives on environmental sustainability.

Science.gov (United States)

Dunphy, Jillian L

2014-06-01

shift to environmentally responsible practice without support from institutions and professional associations. Professional development is required to support this endeavour. The poor transference of pro-ecological behaviour from one setting to another is likely to have international implications for healthcare practice. © The Author(s) 2013.

Costing Practices in Healthcare

DEFF Research Database (Denmark)

Chapman, Christopher; Kern, Anja; Laguecir, Aziza

2014-01-01

.e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.......The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i...

Health care reforms

Directory of Open Access Journals (Sweden)

Marušič Dorjan

2016-09-01

Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

Reform and Backlash to Reform

DEFF Research Database (Denmark)

Hougaard Jensen, Svend E.; Hagen Jørgensen, Ole

Using a stochastic general equilibrium model with overlapping generations, this paper studies (i) the effects on both extensive and intensive labor supply responses to changes in fertility rates, and (ii) the potential of a retirement reform to mitigate the effects of fertility changes on labor s...

Organizational excellence in healthcare

NARCIS (Netherlands)

Does, R.J.M.M.; van den Heuvel, J.; Foley, K.J.; Hermel, P.

2008-01-01

Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this paper, we outline a methodology and present how principles of two improvement programs, i.e., Lean Thinking and Six Sigma, can be combined to provide an

INSTITUTIONAL THEORY OF ECONOMIC REFORMS: BASIC IMPERATIVES

Directory of Open Access Journals (Sweden)

Oleg Sergeevich SUKHAREV

2015-07-01

Full Text Available The ability of institutional economic theory to explain various kinds of economic reforms (changes on the basis of theoretical ideas about the dysfunction of institutions and systems are investigated. A number of classifications of reforms and dysfunctions is introduced and kinds of institutional efficiency of economic systems are defined. Qualitative regularities of various reforms of the twentieth century in different countries are generalized. A number of criteria of effective institutional reforms, capable to lower the depth and the scale of dysfunctions of the functioning economic subsystems is formed. System approach to the analysis of economic systems reforming with underlining the importance of reform “management” factor which defines productivity of economic development is elaborated. Life cycle of institution and economic system in the process of its reforming is presented and correction of J. Hellmann’s model, describing the reforming logic of economy is made.

Analysis of the economic impact of environmental biosafety works projects in healthcare centres in extremadura (spain)

OpenAIRE

García Sanz-Calcedo, Justo; Monzón-González, Pedro

2014-01-01

The aim of this paper is to analyze the results obtained in the methodological application of techniques aimed at the maintenance of environmental biosafety in works of reform and expansion of healthcare centres in Extremadura, Spain during 2004-2010, assessing the costs of its implementation and contrasting if the use of a BSA project in phase of works affects the probability of nosocomial infection and the conditions of health and safety. The average investment accounted for a cost of 5.5 €...

Healthcare financing: approaches and trends in India.

Science.gov (United States)

Bajpai, Vikas; Saraya, Anoop

2010-01-01

Despite the importance of healthcare for the well-being of society, there is little public debate in India on issues relating to it. The 'human capital approach' to finance healthcare largely relies on private investment in health, while the 'human development approach' envisages the State as the guarantorof preventive as well as curative care to achieve universalization of healthcare. The prevailing health indices of India and challenges in the field of public health require a human developmentapproach to healthcare. On the eve of independence, India adopted the human development approach, with the report of the Bhore Committee emphasizing the role of the State in the development and provision of healthcare. However, more recently, successive governments have moved towards the human capital approach. Instead of increasing state spending on health and expanding the public health infrastructure, the government has been relying more and more on the private sector. The public-private partnership has been touted as the new-age panacea for the ills of the Indian healthcare system. This approach has led to a stagnation of public health indices and a decrease in the access of the poor to healthcare.

Conservation and aid: designing more effective investments in natural resource governance reform.

Science.gov (United States)

Nelson, Fred

2009-10-01

Biodiversity conservation outcomes are closely related to the rules and institutions governing resource use. Creating local incentives for conservation through more secure resource tenure is central to conservation outcomes on private and communal lands, where the preponderance of biodiversity occurs. Conservation efforts in sub-Saharan Africa are therefore centrally concerned with governance dynamics and institutional reform processes, such as the decentralization of property rights, and how best to achieve such reforms. Traditional mechanisms for financing conservation efforts in Africa rely heavily on funds channeled through multilateral and bilateral aid agencies. The history of development aid highlights a range of constraints these aid agencies face in terms of working toward more effective resource governance arrangements and promoting reforms. Government aid agencies possess incentives for promoting large-scale and short-term projects that maximize expenditure volumes and tend to define issues in technical rather than political terms. The history of development aid suggests that these and other characteristics of aid agencies impedes their ability to influence governance reform processes and that aid funding may discourage the adoption of reforms. Greater emphasis in African conservation financing needs to be placed on flexible, small-scale investments aligned to local interests and constituencies that prioritize innovation, learning, and experimentation. Additionally, more research is required that explores the linkages between conservation funding, donor decision-making processes, and governance reforms.

Process Management Practices In Healthcare Institutions

Directory of Open Access Journals (Sweden)

Şükrü Kılıç

2015-09-01

Full Text Available Healthcare institutions differ from other service businesses by their “matrix organizational structure” and “error-free output” requirement. However, the processes stay the same for all organizational activities at different levels. One of the post-modern management approach is to focus on basis of necessary processes and fundamental organizational changes. This case study aims to initially explain the characteristics of healthcare institutions and the basic conceptual properties of process and process management. Then the effect of the “management throughprocesses approach” over organization will be discussed. Finally; process management at healthcare institutions, scope of health care and examples of the other post-modern approaches will be examined with their outputs

Political Parties, Clientelism, and Bureaucratic Reform

OpenAIRE

Cruz, Cesi; Keefer, Philip

2015-01-01

The challenge of public administration reform is well-known: politicians often have little interest in the efficient implementation of government policy. Using new data from 439 World Bank public sector reform loans in 109 countries, we demonstrate that such reforms are significantly less likely to succeed in the presence of non-programmatic political parties. Earlier research uses evidence from a small group of countries to conclude that clientelistic politicians resist reforms that restrict...

Education Reform in Hong Kong

Directory of Open Access Journals (Sweden)

Chris Dowson

2000-05-01

Full Text Available Since the early 1990s, the pace of educational reform in Hong Kong has accelerated and broadened to incorporate almost all areas of schooling. The reforms introduced during this period can be subsumed under what has generally been labelled the quality movement. In this paper, we review and comment on a number of policy reform initiatives in the four areas of "Quality Education," English Language Benchmarking, Initial Teacher Training and the Integration of Pupils with Special Needs into Ordinary Classrooms. Following a brief description of each policy initiative, the reforms are discussed in terms of their consistency, coherence and cultural fit.

Steam reformer with catalytic combustor

Science.gov (United States)

Voecks, Gerald E. (Inventor)

1990-01-01

A steam reformer is disclosed having an annular steam reforming catalyst bed formed by concentric cylinders and having a catalytic combustor located at the center of the innermost cylinder. Fuel is fed into the interior of the catalytic combustor and air is directed at the top of the combustor, creating a catalytic reaction which provides sufficient heat so as to maintain the catalytic reaction in the steam reforming catalyst bed. Alternatively, air is fed into the interior of the catalytic combustor and a fuel mixture is directed at the top. The catalytic combustor provides enhanced radiant and convective heat transfer to the reformer catalyst bed.

An "All-American" health reform proposal.

Science.gov (United States)

Reinhardt, U E

1993-01-01

Reforming the U.S. health care system is frequently thought of in absolutist terms: managed competition versus rate regulation; federal versus state administration; and business mandates versus individual insurance purchases. While these choices must be resolved over the long run, the transition to a new health care system will take several years and require more flexible solutions. The "All-American" Deal offers just that. It requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents.

The representation of healthcare end users' perspectives by surrogates in healthcare decisions: a literature review.

Science.gov (United States)

Shah, Syed Ghulam Sarwar; Farrow, Alexandra; Robinson, Ian

2009-12-01

The representation of end users' perspectives in healthcare decisions requires involvement of their surrogates when the end users, i.e. certain patients, elderly people, children and people with disabilities, are unable to present their views. To review critical issues, and the advantages and disadvantages of involving surrogates in representing end users' perspectives in healthcare decisions. A systematic review of literature published in peer-reviewed journals from 1990 to 2005. Findings show that surrogates are used widely in health care and that they are necessary to represent end users' perspectives in healthcare decisions when the latter are unable to do so themselves. Critical issues in using surrogates include key ethical, social, cultural, legal and medico-technological factors; ascertaining the best interest of end users; potential conflict of interest; possible biased decisions and the burden on surrogates. The key advantage of surrogate involvement in healthcare decisions is their ability to represent end users' needs, values and wishes. The main disadvantages include potential discrepancies between the decisions and conclusions of surrogates and end users; the failure of surrogates to predict end users' preferences accurately and the lack of certainty that useful information will be obtained through the surrogacy process. This systematic review has revealed that the involvement of surrogates is an additional vital way to represent end users' perspectives in healthcare decisions where for a range of reasons their opinions are unable to be effectively ascertained. However, because of the heterogeneity of surrogates and end users, the selection of appropriate surrogates and deploying surrogate decisions require particularly careful consideration of their value in individual cases; thus, subsequent decision-making must be reviewed on a case-to-case basis to seek to ensure that the best interests, needs and wishes of the end user are fully and accurately

The impact of tax reforms designed to encourage healthier grain consumption

DEFF Research Database (Denmark)

Nordström, Leif Jonas; Thunström, Linda

2009-01-01

In this paper, we simulate the effects of tax reforms aimed at encouraging healthier grain consumption. We use a rich data set on household grain consumption in 2003 from the market research institute GfK Sweden, combined with information on the nutritional content of the consumption.We estimate...... behavioral parameters, which are used to simulate the impact on the average household of tax reforms entailing either a subsidy on commodities particularly rich in fiber or a subsidy of the fiber density in grain products. Our results suggest that to direct the fiber intake towards nutritional...... recommendations, reforms with a substantial impact on consumer prices are required. Regardless of the type of subsidy implemented, the increase in the intake of fiber is accompanied by unwanted increases in nutrients that are often overconsumed: fat, salt and sugar. Funding the subsidies by taxing these nutrients...

The impact of tax reforms designed to encourage healthier grain consumption

DEFF Research Database (Denmark)

Nordström, Leif Jonas; Thunström, Linda

2009-01-01

In this paper, we simulate the effects of tax reforms aimed at encouraging healthier grain consumption. We use a rich data set on household grain consumption in 2003 from the market research institute GfK Sweden, combined with information on the nutritional content of the consumption. We estimate...... behavioral parameters, which are used to simulate the impact on the average household of tax reforms entailing either a subsidy on commodities particularly rich in fiber or a subsidy of the fiber density in grain products. Our results suggest that to direct the fiber intake towards nutritional...... recommendations, reforms with a substantial impact on consumer prices are required. Regardless of the type of subsidy implemented, the increase in the intake of fiber is accompanied by unwanted increases in nutrients that are often overconsumed: fat, salt and sugar. Funding the subsidies by taxing these nutrients...

Social conscience and healthcare professionals: Where does one ...

African Journals Online (AJOL)

2013-06-07

Jun 7, 2013 ... Where does one draw the line in bearing the responsibility of acting on their social conscience and what level of engagement is appropriate or enough? Are healthcare professionals required to have a social conscience, and if so must they take action regarding the failures of the healthcare system and its ...

Career patterns of healthcare executives.

Science.gov (United States)

Fahey, D F; Myrtle, R C

2001-02-01

This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.

Integrated Environment for Ubiquitous Healthcare and Mobile IPv6 Networks

Science.gov (United States)

Cagalaban, Giovanni; Kim, Seoksoo

The development of Internet technologies based on the IPv6 protocol will allow real-time monitoring of people with health deficiencies and improve the independence of elderly people. This paper proposed a ubiquitous healthcare system for the personalized healthcare services with the support of mobile IPv6 networks. Specifically, this paper discusses the integration of ubiquitous healthcare and wireless networks and its functional requirements. This allow an integrated environment where heterogeneous devices such a mobile devices and body sensors can continuously monitor patient status and communicate remotely with healthcare servers, physicians, and family members to effectively deliver healthcare services.

Right to refuse treatment in Turkey: a diagnosis and a slightly less than modest proposal for reform.

Science.gov (United States)

Irmak, Nurbay

2016-07-01

This paper examines the current state of right to refuse medical treatment in Turkey. Even though there are only a few studies carried out with Turkish physicians on their attitude towards the right to refuse treatment, I argue that recent studies on physicians' views on informed consent and honest disclosure show that Turkish physicians do not tend to recognise their patients' right to decline treatment. This is because the refusal of treatment crucially requires that patients be properly informed and asked for their consent before the treatment. Turkish physicians and healthcare providers' tendency to ignore the right to decline medical treatment cannot be separated from their paternalistic approach to patients and their rights. I argue that part of the problem is the legal framework, which, in essence, is still paternalistic. More specifically, the frequent appearance of the phrase 'medical necessity' in the relevant legislation is conveniently used to justify medical intervention against a patient's will. I conclude the paper by proposing reforms in the legal documents defining and regulating patient rights, including the Constitution of the Turkish Republic, and I will argue that these reforms will help enhance patient rights in Turkey. Turkey has been discussing a new Constitution for the past several years, so my proposal should best be understood as contributing to public discussion of the new Constitution by initiating debate about medical paternalism and patient autonomy in Turkish medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

75 FR 4310 - Credit Reforms in Organized Wholesale Electric Markets

Science.gov (United States)

2010-01-27

... energy markets, in which regional transmission organizations (RTOs) and independent system operators... require RTOs and ISOs to adopt tariff revisions reflecting these proposed credit reforms. The Commission... is in the organized wholesale electric markets.\\5\\ Individual RTOs and ISOs developed their own...

Requirements Identification Towards a Design of Adaptive ICTs for Supporting Bipolar Disorder Treatment in Different Healthcare Contexts

Directory of Open Access Journals (Sweden)

Emanuele Torri

2015-10-01

Full Text Available This paper presents patient and caregiver perspective on ICTs supporting bipolar disorder management in multinational healthcare provisioning contexts. The envisioned mHealth solutions should adopt general requirements that could be instantiated into different clinical settings. Engagement of users in designing new technologies for mental health is crucial to ensure empowerment and patient-centeredness of services. We performed focus groups to understand user needs, attitudes and experiences towards the supportive ICTs in two target regions where the expected solutions will operate. The survey offered valuable inputs for the construction of the clinical requirements used to produce a trans-national call for tender on mobile health solutions aimed at supporting bipolar disorders treatment among public purchasers in different European countries. The study was part of the NYMHPA-MD (Next Generation Mobile Platform for Health in Mental Disorders project, co-funded by the European Commission.

The Choice of Comprehensive Reform Path of Business Administration Majors

Directory of Open Access Journals (Sweden)

Chen Yijun

2015-01-01

Full Text Available Looking back on the development history of business administration majors in colleges of China, the author conducts an analysis on the distribution of colleges offering business administration majors and market demands for these graduates, according to the results of market survey. It finds that there is a large gap between market’s requirements on business administration graduates and their real abilities. Based on the principle of system dynamics, it is necessary to construct a path choosing model of comprehensive reform of busness administration majors, emphasize normal and scientific research and prediction on employers’ requirements, explore advantages and characteristics of colleges, find the orientation professionally and accurately, define the objective of cultivating undergraduates of business administration majors, reform and optimize the talent training system of business administration majors, improve the structure of teachers team, integrate experimental and training resources in colleges, and cultivate students’ abilities in practice and employment.

Security Sector Reform in Albania

OpenAIRE

Abazi, Enika; Bumci, Aldo; Hide, Enri; Rakipi, Albert

2009-01-01

International audience; This paper analyses security sector reform (SSR) in Albania. In all its enterprises in reforming the security sector,Albania is assisted by different initiatives and projects that provide expertise and financial support. To assesswhether reforms improved the overall security environment (national and human) of the country, it is necessaryto measure the effectiveness of the various initiatives and projects. This is gauged by how well the initiatives andprojects achieved...

China struggles to reform giants

International Nuclear Information System (INIS)

McDonald, Paul

1999-01-01

This article examines the struggle to reform the Chinese oil industry. Topics discussed include the defending of state monopolies, the capital injections required by the three main national oil companies, the bidding of the China National Petroleum Corporation (CNPC) for oilfields in Kazakhstan resulting in the need for large investment, and CNPC's failure to meet its spending commitments in the Middle East. Expenditure on exploration, the funding of gas development, and the plans of the China Petroleum Corporation (Sinopec) to raise funds overseas are discussed, and competition problems are considered. (UK)

Aspects of financial history in Romania. Reform and reformers. The financial tax reform accomplished BY Nicolae Titulescu

Directory of Open Access Journals (Sweden)

Ciobanu, R.

2012-01-01

Full Text Available This paper presents a brief history of the financial reform designed by Nicolae Titulescu at the beginning of the 1920’s. His tax reform law was formulated after thorough research of other European tax systems. He tried to implement it while he was Minister of Finance. Even though the law was adopted, it was never enacted. It met a certain amount of controversy in the Assembly of Deputies. The analysis made also tries to explain the cedular tax system.

Lean Six Sigma in Healthcare

NARCIS (Netherlands)

de Koning, H.; Verver, J.P.S.; van den Heuvel, J.; Bisgaard, S.; Does, R.J.M.M.

2006-01-01

Keywords: Cost reduction; efficiency; innovation; quality improvement; service management. Abstract Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this article, we outline a methodology and present examples

Welfare implication of reforming energy consumption subsidies

International Nuclear Information System (INIS)

Breton, Michèle; Mirzapour, Hossein

2016-01-01

Reforming energy consumption subsidies, in particular for fossil fuels, has been frequently referred to as a quick-win policy to enhance environmental mitigation. In addition, the removal of such subsidies may release a sizeable portion of a country's national budget for use on more productive targets. One of the most recognized challenges of such reform is “selling” the new energy prices to citizens, particularly those with a more fragile purchasing power. Several empirical and technical studies have prescribed that the reform might be supported by a direct compensation mechanism in order to ensure feasibility. This is what was done during the recent energy subsidy reform in Iran. However, the compensation mechanism implemented in Iran's reform was successful at the beginning, but did not proceed as expected. This has raised questions about the feasibility and sustainability of the direct compensation mechanism, and even of the reform policy itself. In this paper, we consider a stylized model where direct compensation is the instrument proposed to restore consumers’ utility against increased energy prices. We find that, when prices of Other Goods are affected by the announced reform policy, the feasibility of a subsidy reform critically depends on the value of certain parameters: the initial subsidization rate, the share of energy in the consumers’ bundle, and the energy portion of price of Other Goods. - Highlights: • A model of energy subsidy reform with direct compensation is proposed. • Feasibility of the reform is related to three key parameters. • An illustrative example using data from the recent Iranian reform is discussed.

Healthcare leadership's diversity paradox.

Science.gov (United States)

Silver, Reginald

2017-02-06

color in leadership roles that guide healthcare policy and access. This study connects contemporary literature to perspectives of executives in the field and offers practical solutions to improving the representation of people of color in executive healthcare leadership roles. Social implications The recommendations offered as a result of this research effort serve to create awareness of the challenges that people of color face in career attainment. Although the process of increasing the representation of people of color in executive healthcare leadership will be a complex task that will involve a number of players over the course of several years, this study serves to provide a practical roadmap with actionable tactics that can be deployed. Originality/value This paper is an extension of the work that was done by the author during the course of completing the program requirements for the author's doctoral program. The findings were previously discussed in the author's dissertation. The value of these findings is significant because they validate some of the topics in contemporary literature with the perspectives of practicing healthcare executives. This study is also unique from other studies in that it offers a long-term plan to increase the representation of people of color in executive roles by creating an early disposition toward executive level roles and identifies a number of practical steps toward that end.

Mexico's "ley de narcomenudeo" drug policy reform and the international drug control regime.

Science.gov (United States)

Mackey, Tim K; Werb, Daniel; Beletsky, Leo; Rangel, Gudelia; Arredondo, Jaime; Strathdee, Steffanie A

2014-11-14

It has been over half a century since the landmark Single Convention on Narcotic Drugs was adopted, for the first time unifying international drug policy under a single treaty aimed at limiting use, manufacture, trade, possession, and trafficking of opiates, cannabis, and other narcotics. Since then, other international drug policy measures have been adopted, largely emphasizing enforcement-based approaches to reducing drug supply and use. Recently, in response to concerns that the historic focus on criminalization and enforcement has had limited effectiveness, international drug policies have begun to undergo a paradigm shift as countries seek to enact their own reforms to partially depenalize or deregulate personal drug use and possession. This includes Mexico, which in 2009 enacted national drug policy reform partially decriminalizing possession of small quantities of narcotics for personal consumption while also requiring drug treatment for repeat offenders. As countries move forward with their own reform models, critical assessment of their legal compatibility and effectiveness is necessary. In this commentary we conduct a critical assessment of the compatibility of Mexico's reform policy to the international drug policy regime and describe its role in the current evolving drug policy environment. We argue that Mexico's reform is consistent with flexibilities allowed under international drug treaty instruments and related commentaries. We also advocate that drug policy reforms and future governance efforts should be based on empirical evidence, emphasize harm reduction practices, and integrate evidence-based evaluation and implementation of drug reform measures.

Lithuanian way of reforms to electricity market

International Nuclear Information System (INIS)

Bacauskas, A.

2002-01-01

Lithuania has inherited a structure of the energy industry, which originally has been developed not for the country, as an independent state, but according to the provisions of the former USSR energy policy, covering energy demand of whole region, including the Baltic countries, Belarus and the Kaliningrad region of Russia. The Lithuanian power system is interconnected by high voltage power lines and operates in parallel with Latvian, Estonian, Russian and Belarus power systems. During twelve years of independence the power sector passed significant changes from a vertically integrated monopoly to some separate power companies and meets EU requirements to an internal electricity market. The main issues of reforms: transparency of costs, commercial relations in power sector, fulfilment of the Electricity Directive 96/92/EU. The Lithuanian electricity market is small and inefficient. Current reforms of a power sector are directed to create the common Baltic electricity market. (author)

Bio-oil steam reforming, partial oxidation or oxidative steam reforming coupled with bio-oil dry reforming to eliminate CO{sub 2} emission

Energy Technology Data Exchange (ETDEWEB)

Hu, Xun [State Key Laboratory for Oxo Synthesis and Selective Oxidation, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou 730000 (China); Graduate School of Chinese Academy of Sciences, Beijing 100039 (China); Lu, Gongxuan [State Key Laboratory for Oxo Synthesis and Selective Oxidation, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou 730000 (China)

2010-07-15

Biomass is carbon-neutral and utilization of biomass as hydrogen resource shows no impact on atmospheric CO{sub 2} level. Nevertheless, a significant amount of CO{sub 2} is always produced in biomass gasification processes. If the CO{sub 2} produced can further react with biomass, then the biomass gasification coupled with CO{sub 2} reforming of biomass will result in a net decrease of CO{sub 2} level in atmosphere and produce the chemical raw material, syngas. To achieve this concept, a ''Y'' type reactor is developed and applied in bio-oil steam reforming, partial oxidation, or oxidative steam reforming coupled with CO{sub 2} reforming of bio-oil to eliminate the emission of CO{sub 2}. The experimental results show that the reaction systems can efficiently suppress the emission of CO{sub 2} from various reforming processes. The different coupled reaction systems generate the syngas with different molar ratio of CO/H{sub 2}. In addition, coke deposition is encountered in the different reforming processes. Both catalysts and experimental parameters significantly affect the coke deposition. Ni/La{sub 2}O{sub 3} catalyst shows much higher resistivity toward coke deposition than Ni/Al{sub 2}O{sub 3} catalyst, while employing high reaction temperature is vital for elimination of coke deposition. Although the different coupled reaction systems show different characteristic in terms of product distribution and coke deposition, which all can serve as methods for storage of the carbon from fossil fuels or air. (author)

Economic Reforms and Constitutional Transition

OpenAIRE

Jeffrey D. Sachs; Wing Thye Woo; Xiaokai Yang

2000-01-01

This paper investigates the relationship between economic reforms and constitutional transition, which has been neglected by many transition economists. It is argued that assessment of reform performance might be very misleading if it is not recognized that economic reforms are just a small part of large scale of constitutional transition. Rivalry and competition between states and between political forces within each country are the driving forces for constitutional transition. We use Russia...

Impact of reform and privatisation on employees a case study of power sector reform in Orissa, India

International Nuclear Information System (INIS)

Kundu, Goutam Kumar; Mishra, Bidhu Bhusan

2012-01-01

Orissa is the first state in India to have undergone reform in the power sector with the Government withdrawing its control. The state government owned integrated Electricity Board which was responsible for generation, transmission and distribution of electricity was unbundled into separate generating, transmitting, distributing and trading companies. The structure and ownership changed. The purpose of this paper is to examine the impact of the reform and privatization on employees. The impact of reform on employees was measured with the help of multiple regression models. The variables represent the parameters that employees are most interested in, and the regression coefficients represent the weights of the corresponding variables. The data were collected using a survey methodology. The impact of reform was observed to be mixed one. Some employees felt benefits while others mentioned negative impact. The study revealed beneficial aspects of reform and areas with no benefits. - Highlights: ► Employee benefit is a linear function of 11 variables. ► Eleven variables predict 95.8% of employees benefit. ► Money received by the employees increased after reform. ► Employees benefit due to reform is a mixed one.

The effectiveness of the Spanish banking reform application of Altman’s Z-Score

Directory of Open Access Journals (Sweden)

Ntoung A. T. Lious

2016-10-01

Full Text Available The recent financial crisis which causes bankruptcy around the world, Spain was placed at the top list because of the crucial state of its banking. This lead to a call to ensure adequate bank capitalization and reduce uncertainty regarding the strength of their balance sheets. In the light of recent event, the important of knowing the financial position of banks is imperative to shareholders. Thus, the aim of this study is to affirm the validity of Altman Z”-Score model as a predictors of the uncertainty regarding financial sector in Spain. This study takes into consideration two periods: before the banking reform and after the banking reform. It requires 30 financial institutions in Spain both big as well as small. Ratio analysis was carried out on the 30 banks before and after the reforms for five years prior to their bankruptcy or nationalisation as the Z” Score model has predictive power of up to five years before the reforms

Negotiating science and engineering: an exploratory case study of a reform-minded science teacher

Science.gov (United States)

Guzey, S. Selcen; Ring-Whalen, Elizabeth A.

2018-05-01

Engineering has been slowly integrated into K-12 science classrooms in the United States as the result of recent science education reforms. Such changes in science teaching require that a science teacher is confident with and committed to content, practices, language, and cultures related to both science and engineering. However, from the perspective of the science teacher, this would require not only the development of knowledge and pedagogies associated with engineering, but also the construction of new identities operating within the reforms and within the context of their school. In this study, a middle school science teacher was observed and interviewed over a period of nine months to explore his experiences as he adopted new values, discourses, and practices and constructed his identity as a reform-minded science teacher. Our findings revealed that, as the teacher attempted to become a reform-minded science teacher, he constantly negotiated his professional identities - a dynamic process that created conflicts in his classroom practices. Several differences were observed between the teacher's science and engineering instruction: hands-on activities, depth and detail of content, language use, and the way the teacher positioned himself and his students with respect to science and engineering. Implications for science teacher professional development are discussed.

Developing a Security Metrics Scorecard for Healthcare Organizations.

Science.gov (United States)

Elrefaey, Heba; Borycki, Elizabeth; Kushniruk, Andrea

2015-01-01

In healthcare, information security is a key aspect of protecting a patient's privacy and ensuring systems availability to support patient care. Security managers need to measure the performance of security systems and this can be achieved by using evidence-based metrics. In this paper, we describe the development of an evidence-based security metrics scorecard specific to healthcare organizations. Study participants were asked to comment on the usability and usefulness of a prototype of a security metrics scorecard that was developed based on current research in the area of general security metrics. Study findings revealed that scorecards need to be customized for the healthcare setting in order for the security information to be useful and usable in healthcare organizations. The study findings resulted in the development of a security metrics scorecard that matches the healthcare security experts' information requirements.

Tax Reform Act of 1986: implications and trends.

Science.gov (United States)

Harris, R F

1988-10-01

The Tax Reform Act of 1986 contains several changes that substantially reduce economic flexibility for not-for-profit hospitals and healthcare systems. These changes, involving limited partnerships, investment tax credit, depreciation, and income deferral plans, among other items, carry several implications. Tax-motivated joint ventures will no longer be attractive to physician investors, donations to hospitals are expected to decline by up to 15 percent, and flexibility in attracting and retaining high-caliber employees is reduced. Efforts to reduce the federal budget deficit and renewed scrutiny of unrelated business income further jeopardize economic flexibility. Another threat is intensified Internal Revenue Service scrutiny of Form 990, which is filed by all not-for-profit organizations with $25,000 or more in annual gross receipts, and Form 990T, which is used to report unrelated business income. Measures to protect facilities' economic flexibility include careful return preparation, alternative recruitment tactics, objective opinions, refusal of high-risk deals, and outside appraisals.

Four methodologies to improve healthcare demand forecasting.

Science.gov (United States)

Côté, M J; Tucker, S L

2001-05-01

Forecasting demand for health services is an important step in managerial decision making for all healthcare organizations. This task, which often is assumed by financial managers, first requires the compilation and examination of historical information. Although many quantitative forecasting methods exist, four common methods of forecasting are percent adjustment, 12-month moving average, trendline, and seasonalized forecast. These four methods are all based upon the organization's recent historical demand. Healthcare financial managers who want to project demand for healthcare services in their facility should understand the advantages and disadvantages of each method and then select the method that will best meet the organization's needs.

49 CFR 260.13 - Credit reform.

Science.gov (United States)

2010-10-01

... appropriations, direct payment of a Credit Risk Premium by the Applicant or a non-Federal infrastructure partner... 49 Transportation 4 2010-10-01 2010-10-01 false Credit reform. 260.13 Section 260.13... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.13 Credit reform. The Federal Credit Reform Act...

Financial and clinical risk in health care reform: a view from below.

Science.gov (United States)

Smith, Pam; Mackintosh, Maureen; Ross, Fiona; Clayton, Julie; Price, Linnie; Christian, Sara; Byng, Richard; Allan, Helen

2012-04-01

This paper examines how the interaction between financial and clinical risk at two critical phases of health care reform in England has been experienced by frontline staff caring for vulnerable patients with long term conditions. The paper draws on contracting theory and two interdisciplinary and in-depth qualitative research studies undertaken in 1995 and 2007. Methods common to both studies included documentary analysis and interviews with managers and front line professionals. The 1995 study employed action-based research and included observation of community care; the 2007 study used realistic evaluation and included engagement with service user groups. In both reform processes, financial risk was increasingly devolved to frontline practitioners and smaller organizational units such as GP commissioning groups, with payment by unit of activity, aimed at changing professionals' behaviour. This financing increased perceived clinical risk and fragmented the delivery of health and social care services requiring staff efforts to improve collaboration and integration, and created some perverse incentives and staff demoralisation. Health services reform should only shift financial risk to frontline professionals to the extent that it can be efficiently borne. Where team work is required, contracts should reward collaborative multi-professional activity.

PARTICIPATORY GOVERNANCE IN THE PUBLIC HEALTHCARE SYSTEMS OF THE SCANDINAVIAN AND BALTIC COUNTRIES

Directory of Open Access Journals (Sweden)

Stefanescu Aurelia

2011-12-01

Full Text Available The diminished trust of citizens in the public sector, the increased complexity of policy issues and the reforms in accordance with the new public management principles generate the need of focusing more extensively on participatory governance. Participatory governance can be defined as the genuine engagement of citizens and other organizations in the formulation of policies and strategies, in the decision-making process from the public sector and in the implementation of the decisions. The present paper's objectives are to define the concept of participatory governance, to argue in favor of implementing it in the public sector and to find to what extent public healthcare institutions from Scandinavian and Baltic countries publish information on participatory governance and how they perceive community engagement. The research findings are that the information on participatory governance disclosed on the websites of relevant institutions from within the Scandinavian and Baltic public healthcare systems is scarce. The countries with the greatest concern for community engagement are Denmark and Sweden. It is argued that there should be a shift in focus within the public sector in general and within the healthcare system in particular, so that citizens are genuinely involved in the relevant processes and their satisfaction is indeed at an adequate level.

The ambiguity of contents and results in the Norwegian internal control of safety, health and environment reform

Energy Technology Data Exchange (ETDEWEB)

Hovden, Jan

1998-05-01

The results of introducing a mandatory public reform in Norway with regard to the requirements on enterprises' management of safety, health and environment (SHE) systems are reviewed and discussed. The reform, named internal control (IC), implies a delegation of the direct control of SHE conditions to the enterprises, and introduces system auditing as the main tool for the regulatory bodies. A mixture of successes and failures in implementing the reform, including some perspectives for further adaptation and development of the IC concept are discussed.

Security issues in healthcare applications using wireless medical sensor networks: a survey.

Science.gov (United States)

Kumar, Pardeep; Lee, Hoon-Jae

2012-01-01

Healthcare applications are considered as promising fields for wireless sensor networks, where patients can be monitored using wireless medical sensor networks (WMSNs). Current WMSN healthcare research trends focus on patient reliable communication, patient mobility, and energy-efficient routing, as a few examples. However, deploying new technologies in healthcare applications without considering security makes patient privacy vulnerable. Moreover, the physiological data of an individual are highly sensitive. Therefore, security is a paramount requirement of healthcare applications, especially in the case of patient privacy, if the patient has an embarrassing disease. This paper discusses the security and privacy issues in healthcare application using WMSNs. We highlight some popular healthcare projects using wireless medical sensor networks, and discuss their security. Our aim is to instigate discussion on these critical issues since the success of healthcare application depends directly on patient security and privacy, for ethic as well as legal reasons. In addition, we discuss the issues with existing security mechanisms, and sketch out the important security requirements for such applications. In addition, the paper reviews existing schemes that have been recently proposed to provide security solutions in wireless healthcare scenarios. Finally, the paper ends up with a summary of open security research issues that need to be explored for future healthcare applications using WMSNs.

Security Issues in Healthcare Applications Using Wireless Medical Sensor Networks: A Survey

Directory of Open Access Journals (Sweden)

Hoon-Jae Lee

2011-12-01

Full Text Available Healthcare applications are considered as promising fields for wireless sensor networks, where patients can be monitored using wireless medical sensor networks (WMSNs. Current WMSN healthcare research trends focus on patient reliable communication, patient mobility, and energy-efficient routing, as a few examples. However, deploying new technologies in healthcare applications without considering security makes patient privacy vulnerable. Moreover, the physiological data of an individual are highly sensitive. Therefore, security is a paramount requirement of healthcare applications, especially in the case of patient privacy, if the patient has an embarrassing disease. This paper discusses the security and privacy issues in healthcare application using WMSNs. We highlight some popular healthcare projects using wireless medical sensor networks, and discuss their security. Our aim is to instigate discussion on these critical issues since the success of healthcare application depends directly on patient security and privacy, for ethic as well as legal reasons. In addition, we discuss the issues with existing security mechanisms, and sketch out the important security requirements for such applications. In addition, the paper reviews existing schemes that have been recently proposed to provide security solutions in wireless healthcare scenarios. Finally, the paper ends up with a summary of open security research issues that need to be explored for future healthcare applications using WMSNs.