An empty toolbox? Changes in health plans' approaches for managing costs and care.
(9/105)
OBJECTIVE: To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care. DATA SOURCES/STUDY SETTING: Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996-1997, 1998-1999, and 2000-2001. STUDY DESIGN: Interviews probed about changes in the design and operation of health insurance products--including provider contracting and network development, benefit packages, and utilization management processes--and about the rationale and perceived impact of these changes. DATA COLLECTION/EXTRACTION METHODS: Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software. PRINCIPAL FINDINGS: Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery. CONCLUSIONS: These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers' financial burdens. (+info)
Legal regulation of the Croatian Medical Journal: model for small academic journals.
(10/105)
During the last few years, the questions of editorial independence and journal governance have come into the focus of scholarly journals. There is little data on the legal regulation of journals outside mainstream science, although they constitute the largest body of biomedical literature. The Croatian Medical Journal functioned for more than 10 years without much legal regulation but with lot of enthusiasm and hard work. This Editorial presents our attempt to make legal provisions for the current status of the Journal and its future work. We defined our owners, main participants in making of the journal, and their responsibilities and benefits. The Agreement will be signed by all four medical schools in Croatia, which will become owners of the Journal. We hope that our experiences and solutions for strengthening the legal status of the Journal will help other editors from small scientific communities to think about their journal and its governance. (+info)
The work covenant: a management strategy for department chairs and program directors.
(11/105)
Learning contracts have been used in adult education to ensure a positive and successful learning process. By means of a learning contract, the instructor can support the learner in a manner that best suits the learner's individual requirements. Like the learning environment, the workplace finds individuals with varying skill sets, areas of interest, and degrees of motivation. Understanding and applying the skills of the worker to appropriate tasks and interests have important ramifications for how workers perceive their jobs and the ultimate effectiveness of the organization. Studies show that the quality of the work environment is critical for the job satisfaction and retention of employees in the public and private sector as well as for the dental academician. Recent literature on faculty development has focused on adapting business-based motivation, mentoring, and performance counseling strategies to the academic setting. By leading and managing faculty development through the use of such strategies, the quality of the work environment can be improved. This article briefly summarizes the commonality between retention strategies and learning contracts within a human resource context and provides a model document that can be used by chairs and program directors to organize and focus their faculty development efforts. (+info)
Biomedical conflicts of interest: a defence of the sequestration thesis-learning from the cases of Nancy Olivieri and David Healy.
(12/105)
No discussion of academic freedom, research integrity, and patient safety could begin with a more disquieting pair of case studies than those of Nancy Olivieri and David Healy. The cumulative impact of the Olivieri and Healy affairs has caused serious self examination within the biomedical research community. The first part of the essay analyses these recent academic scandals. The two case studies are then placed in their historical context-that context being the transformation of the norms of science through increasingly close ties between research universities and the corporate world. After a literature survey of the ways in which corporate sponsorship has biased the results of clinical drug trials, two different strategies to mitigate this problem are identified and assessed: a regulatory approach, which focuses on managing risks associated with industry funding of university research, and a more radical approach, the sequestration thesis, which counsels the outright elimination of corporate sponsorship. The reformist approach is criticised and the radical approach defended. (+info)
Better governance in academic health sciences centres: moving beyond the Olivieri/Apotex Affair in Toronto.
(13/105)
The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair (OAA) regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are. (+info)
Psychosocial factors and work related sickness absence among permanent and non-permanent employees.
(14/105)
STUDY OBJECTIVE: To examine the association between psychosocial work factors and work related sickness absence among permanent and non-permanent employees by sex. DESIGN: A cross sectional survey conducted in 2000 of a representative sample of the European Union total active population, aged 15 years and older. The independent variables were psychological job demands and job control as measures of psychosocial work environment, and work related sickness absence as the main outcome. Poisson regression models were used to compute sickness absence days' rate ratios. SETTING: 15 countries of the European Union. PARTICIPANTS: A sample of permanent (n = 12 875) and non-permanent (n = 1203) workers from the Third European Survey on Working Conditions. RESULTS: High psychological job demands, low job control, and high strain and passive work were associated with higher work related sickness absence. The risks were more pronounced in non-permanent compared with permanent employees and men compared with women. CONCLUSIONS: This work extends previous research on employment contracts and sickness absence, suggesting different effects depending on psychosocial working conditions and sex. (+info)
Management in general practice: the challenge of the new General Medical Services contract.
(15/105)
BACKGROUND: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. AIM: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. DESIGN OF STUDY: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. SETTING: Three general practices in England, chosen using purposeful sampling. METHOD: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. RESULTS: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. CONCLUSION: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. (+info)
Health plan liability and ERISA: the expanding scope of state legislation.
(16/105)
The federal Employee Retirement Income Security Act of 1974 (ERISA) supersedes state laws as they relate to employer-based health care plans. Thus, cases brought under ERISA are heard in federal courts. We examined the intent, scope, and impact of recent laws passed in 10 states attempting to expand the legal rights of health plan enrollees to sue their plans. In June 2004, the US Supreme Court ruled that state-law causes of action brought under the Texas Health Care Liability Act involving coverage decisions by Aetna Health Inc and CIGNA Health Care of Texas were preempted by ERISA. The full implications of this decision are not evident at present. (+info)