ISSN:0749-6753    

DOI:10.1002/hpm.4740050202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractAll district health authorities are obliged to use resources most efficiently. One approach to increasing efficiency is to identify measures which allow service levels, in terms of patients treated and standards of care, to be maintained at a lower cost. This could be achieved by maintaining service levels with fewer hospital beds. Reducing lengths of stay by removing organizational delays and expansions of day‐case care, are policies which can increase patient caseload per bed.This paper puts forward an approach for estimating the resources released by such policies and assesses the savings achieved by realizing efficiency gains identified in a previous study by Beechet al.(1987). That study identified significant potential for maintaining services with fewer beds, with the expansion of day‐case care being a key mechanism. However this paper concludes that when services are maintained with fewer beds, the vast majority of hospital costs remain fixed. It also reaches the alarming conclusion that as a vehicle for reducing costs, day‐case care is much less effective than previous studies have implied.However, increasing hospital throughput per bed does release capacity to treat more patients. The proposed reforms of the NHS (Secretaries of State, 1989) envisage an internal market for health care, allowing hospitals to enter into contracts with purchasers of health care. The approach to costing described in this paper is applicable to assessing the increased costs associated with such developments. These extra costs can then be compared with expected i

ISSN:0749-6753    

DOI:10.1002/hpm.4740050203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractEarlier presentations of the theoretical framework for public competition (Saltman and von Otter, 1987) and of the comparative advantage of public competition as against a mixed market model (Saltman and von Otter, 1989a) suggest the importance of concrete arrangements to introduce a public competition approach at the operating level. This paper explores the administrative infra‐structure required to implement public competition within the Swedish county‐council‐based health care s

ISSN:0749-6753    

DOI:10.1002/hpm.4740050204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe post of health planner is a relative newcomer to the health ministries in the Pacific. The small size of most Pacific Island States necessitates activities for the planner that may be slightly different from those of health planners elsewhere. This paper argues that these activities include the following:The promotion of communications both within the Ministry of Health and between it and other government departments.Liaison with donors.Monitoring activities/expenditures.Policy development.

ISSN:0749-6753    

DOI:10.1002/hpm.4740050205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractPerformance priorities for high quality care, multiprofessional team care and deinstitu‐tionalization of patients among mental health services in England and West Germany were found to be significantly influenced by management practices fostering goal congruence, peer review and staff participation in decision makin

ISSN:0749-6753    

DOI:10.1002/hpm.4740050206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractA postal questionnaire was sent to a stratified random sample of 33.6% (556 out of 1655) of health workers representing five occupational groups in the Ratnapura Health Region, Sri Lanka, to discover their intensity of job satisfaction.The overall response rate was 60.3% (335 out of 556), being highest among the nurses (P<0.01) and lowest among the medical practitioners (P<0.001).Of the respondents, 70.0% (237 out of 335) were generally satisfied with the occupational environment. For 14.8% (26 out of 175) of the minor employees it was ‘excellent most of the time’ and for 19.6% (11 out of 56) of midwives it was extremely uncongenial. The immediate supervisor was described as ‘fair at all times’ by 50.4% (169 out of 335); being 61.7% (108 out of 175) among the minor employees and 21.4% (8 out of 37) among the nurses.Community relationships were described as ‘satisfactory’ by 46.5% (156 out of 335); this being 26.3% (88 out of 175) among the minor employees and 56.2% (18 out of 32) among the middle technical officers. The fellow workers were described as co‐operative by 34.1% (114 out of 335) and as ‘all right’ by 34.9% (117 out of 335).Thirty seven per cent (124 out of 335) declared that their personal problems were not affecting their work and 20% (67 out of 335) gave the reply as ‘absolutely no’. The latter reply was highest among the medical practitioners (28.6% or 10 out of 35) and nurses (27.0% or 10 out of 37) respectively.About the factors affecting work, more medical practitioners (57.1% or 20 out of 35) and nurses (67.6% or 25 out of 37) were concerned about staff shortages; more middle technical officers (40.6% or 13 out of 32) and minor employees (37.7% or 66 out of 175) were worried about inadequate incentives and more midwives (50.0% or 28 out of 56) and minor employees (34.8% or 61 out of 175) were not happy with their poor pay. The health department was described as ‘decidedly the best of all government departments’ by 43.3% (76 out of 175) of the minor employees and as ‘better than most other government departments’ by 56.8% (21 out of 37) of the nurses, while 54.4% (19 out of 35) of the medical practitioners failed to find any differences between the health sector and other government sectors.The majority (62.1%) have expressed job satisfaction. Respondents' views on occupational environment, immediate supervisor, community relationships, personal problems and key factors affecting work performance were very significantly diverse among the dif

ISSN:0749-6753    

DOI:10.1002/hpm.4740050207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050208

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050201

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY