ISSN:0749-6753    

DOI:10.1002/hpm.4740090102

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

年代:1994

数据来源: WILEY

摘要:

AbstractMany governments are trying to invent new types of ‘internal’ healthcare market that will expose health services to competitive pressures to innovate, contain costs, raise service quality, and respond better to consumer demands; but not expose them to ‘market failures’ which prejudice universal access to ‘basic’ health services. Policy debates in this area are muddled and constricted by a failure to differentiate the variants of internal market that are available. This article outlines a taxonomy of the main types of internal market: primary doctor purchasing; managed competition; competitive bidding; social insurance; and compulsory private insurance. It notes their main structural characteristics and differences. Although internal market reforms have been intended to support the commercialization of healthcare, the idea of designing new types of economic structure to avoid market failure in healthcare has wider and more radical implications than most policy‐

ISSN:0749-6753    

DOI:10.1002/hpm.4740090103

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe scarcity of resources in healthcare systems has general causes and country‐specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely onCost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each countr

ISSN:0749-6753    

DOI:10.1002/hpm.4740090104

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

年代:1994

数据来源: WILEY

摘要:

AbstractIn the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and managementThe underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state‐owned medical facilities, make the reform in the Russian health sector more radicalThis paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax‐financed to the health insurance system, is presen

ISSN:0749-6753    

DOI:10.1002/hpm.4740090105

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe Planning Department of the health authority for the Canton of Basel‐Stadt has decided to develop a process of planning and decision‐making to install performance contracts between them and the acute hospitals situated in the cantonIn part I, a short description of the Swiss health system is given, followed by an analysis of the situation in the Canton of Basel‐Stadt. The second and main part describes the process of planning and decision‐making to achieve performance contracts for public and private ho

ISSN:0749-6753    

DOI:10.1002/hpm.4740090106

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

年代:1994

数据来源: WILEY

摘要:

AbstractJapanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment‐based health insurance operating on a nonprofit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 bedsIn this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences—personal and formal skills required of the leadership in the hospitalThere follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective—‘what kind of impact does the Japanese culture have on the health care organization?’ and/or ‘what kind of sub‐culture is developed in the Japanese hospitals’. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies — specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialities—silent agreements bet

ISSN:0749-6753    

DOI:10.1002/hpm.4740090107

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe health care system in Sweden has been undergoing radical change since 1991. The mainly public financed (90%) system with 26 autonomous counties spent 8.5% of its gross domestic product on health care in 1991. The main features of the ‘paradigm shift’ are: separation of production and financing; resource allocation to health districts in relation to the needs of the population; and introduction of public competition between health districts (purchasers) and hospitals (providers). The health district boards are responsible for the health care of the population in their district hospitals financed by their activities (e.g. through diagnosis‐related groups (DRGs)) and quality aspects monitored by central authoritiesA parliamentary committee (HSU 2000) is investigating how Sweden's health care system can be organized and financed in the future. Three models are analyzed: a reformed county council court model, a primary care‐managed model, and a compulsory insurance model. Each model must be consistent with equity and public financingFrom 1992 in the Stockholm county, five surgical specialities were paid for their activities according to DRGs for inpatient care and another system for outpatient care. The number of treated patients during 1992 increased by 8% in inpatient care, 50% in day surgery and by 15% in outpatient care. Taken together, the activities increased by 11%, which is slightly more than the expected 10% increase in productivity. (There was a 10% decrease in DRG prices from 1 January 1992.) The total costs decreased by 1% due to fewer personnel. Nothing has been reported concerning the quality of care, neither before nor after the model was introduced. From 1993, all somatic acute specialities are paid by DRGs and the equivalent outpatient classification systems. The results from 1993 will be presented in the autumn

ISSN:0749-6753    

DOI:10.1002/hpm.4740090108

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

年代:1994

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740090109

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

年代:1994

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740090101

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

年代:1994

数据来源: WILEY