ISSN:0749-6753    

DOI:10.1002/hpm.4740080402

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe management of public services in the 1990s raises a number of central issues which require to be resolved. On the one hand, efficiency and effectiveness require attention, as in the 1980s or indeed anytime. On the other hand, the distinctive nature of public (and governmental) services needs to be recognized or reasserted. This Keynote Address to the Keele University, Centre for Health Planning and Management MBA (Health Executive) Programme Alumni Association by Howard Davies, Director General of the Confederation of British Industry, sets out some key principles based on the ‘British Debate’ which are nevertheless generalizable in a number of cases to a wholly international audie

ISSN:0749-6753    

DOI:10.1002/hpm.4740080403

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

年代:1993

数据来源: WILEY

摘要:

AbstractHealth policy everywhere is in flux. In marked contrast with the impenetrable orthodoxy and inaction characteristic of past decades, health policy currently is in the midst of large‐scale upheaval. Many of the fundamental assumptions and principles that long guided health‐sector development are in the process of being turned upside downWhether a country is rich or poor, it matters not. Virtually every country either has or is contemplating major reforms in its provisions for the organization and financing of health services. Moreover, the differences in health services structure which divided nations, are becoming smaller—to the point where formerly shunned international exchanges now are considered useful mediums for the exposition of common tensions and the exploration of choices for adapting health care to complex and new economic real

ISSN:0749-6753    

DOI:10.1002/hpm.4740080404

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

年代:1993

数据来源: WILEY

摘要:

AbstractThis article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non‐staff expenditures especially are subjected to reductions. The system still seems to ‘favour’ doctors and nurses, but less than in a system with traditional budgetary institutionsThe behaviour of the top‐management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top‐management team. The declining output makes it easier to departmentsceteris paribusto keep within their budgets. And that makes it easier for the top‐management team to keep the overall hospital budgetThe obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters o

ISSN:0749-6753    

DOI:10.1002/hpm.4740080405

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

年代:1993

数据来源: WILEY

摘要:

AbstractAs part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community‐based services, but said that this would be done in the context of the developing organization of the national health insurance programWith the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the communityWe found that organization theories were helpful for explaining developments in the health service as a whole and the place of community‐based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promot

ISSN:0749-6753    

DOI:10.1002/hpm.4740080406

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

年代:1993

数据来源: WILEY

摘要:

Abstract‘Overuse’ of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or ‘reference centres’, as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital‐based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self‐referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over‐prescribe, particularly antibiotics and sedativesThe study suggests that in Maseru, the perception of ‘overuse’ is due to congestion and that improved patient flow management will reduce the numbers of patients waiting. Quality of care could be strengthened by regular audit of prescribing practices by clinician

ISSN:0749-6753    

DOI:10.1002/hpm.4740080407

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

年代:1993

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740080408

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

年代:1993

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740080401

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

年代:1993

数据来源: WILEY