ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00430.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In response to ageing populations there are similar patterns of change in the organisation of community care for elderly people in many different countries. These changes may be characterised as firstly, a move away from institutional provision, secondly, the strengthening of home based care and thirdly, coordination and case management. Within care providing organisations issues of cost and allocation of service according to need have traditionally tended to be separate concerns. The development of case management with devolved budgets in community care offers one way in which the resolution of the tension between scarcity and choice, need and costs may be achieved. On the basis of previous studies of this approach some of the factors associated with more or less effective resolution of this tension within service organisations are considered.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00431.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The market in residential care for the elderly is in a state of flux. Key factors are the increasing proportion of elderly (particularly the 85+ age group) and central governments new community care agenda. The mixed economy of public, private and voluntary residential provision will continue but community care policy changes will entail (a) the new role of case managers in the local authorities and (b) an anticipation that the private sector will play a more significant role than hitherto not only in meeting the demand for residential care but also in leading the way by diversifying into new types of care provision. These issues are addressed by (1) examining and commenting on government policy towards the care of the elderly and (2) examining, in detail, the profitability and financial viability of a random sample of private residential homes for the elderly. This financial analysis suggests that, at present, the ability of the private sector to innovate and expand into new forms of service provision is constrained by the number of homes which operate at the margins of viability. The implications of this are that (a) government policy may be founded on an optimistic view of the ability of private sector provision to respond as expected to the new community care agenda and (b) case managers in local authorities may have to exercise considerable financial expertise in identifying financial vulnerability, as well as social work skills, in the deployment of available funds for residential care for the elderly.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00432.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This paper reports on an interpretive study of organisational control in a developing, community based, psychogeriatric service. The service was characterised by its complexity comprising a diversity of interest groups and a multiplicity of agencies. There were distinct differences in performance as perceived by the various interest, or stakeholder, groups; resulting in multiple control systems. Performance as measured by the management control system was found to be, at best, only partial. It was, therefore, of limited use in controlling existing service provision and developing new services. A case is made for recognition of these complexities when designing organisational control systems in such environments.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00433.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Recently General Medical Practice has been inundated with a range of financial and accountability changes. These imposed changes have been welcomed with considerable resentment by General Practitioners (GPs hereafter). This paper explores some of the key historical and contextual reasons for this resentment. The conclusion is that it is traceable to firstly, the nature of these reforms, which are seen as irrelevant at best or, at worst, run counter to the values and concerns of GPs, and secondly, and related to this, to the perceived inappropriate intrusion into medical autonomy by a Government whose forbears were previously enabling such freedom.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00434.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This paper considers the progress to date of those GP practices which have decided to become fundholding practices. We note that already, within the first year of operation, both GP fundholders and District Health Authorities have developed a number of budget ploys. As part of our work we report on the findings of a pilot survey of GP budget holders in the Kent Family Health Service. We conclude that if budget holding becomes the normal pattern of general practice, there will need to be a considerable development of the financial skills and managerial capabilities of the practices and it may be time for the new GP practice manager to come of age.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1992.tb00435.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY