Do quality report cards play a role in HMOs' contracting practices? Evidence from New York State.
(33/500)
OBJECTIVE: To answer two related questions: (1) Do managed care organizations (MCOs) in New York State (NYS) consider quality when they choose cardiac surgeons? (2) Do they use information about risk-adjusted mortality rates (RAMR) provided in the New York State Cardiac Surgery Reports? DATA SOURCES: (1) Telephone interviews with and contracting data from the majority of MCOs licensed in NYS; (2) RAMR, quality outlier designation, and procedure volume for all cardiac surgeons, as reported in the Cardiac Surgery Reports. STUDY DESIGN: Interview data were analyzed in conjunction with patterns revealed by contracting data. Null hypotheses that MCOs' contracting choices were random with respect to the information published in the Cardiac Surgery Reports were tested. PRINCIPAL FINDINGS: Sixty percent of MCOs ranked the quality of surgeons as most important in their contracting considerations. Although 64 percent of MCOs indicated some knowledge of the NYS Cardiac Surgery Reports, only 20 percent indicated that the reports were a major factor in their contracting decision. Analyses of actual contracting patterns show that in aggregate, the hypothesis of random choice could be rejected with respect to high-quality outlier status and high procedure volume but not for RAMR or poor-quality outlier status. The panel composition of the majority of MCOs (80.2 percent) was within two standard deviations of the expected mean under the null hypothesis. CONCLUSIONS: Despite a professed preference for high-quality surgeons, the use of publicly available quality reports by MCOs is currently low, and contracting practices for the majority of MCOs do not indicate a systematic selection either for or against surgeons based on their reported mortality scores. This study suggests that policy initiatives to increase the effective use of report cards should be encouraged. (+info)
Public health advocacy: process and product.
(34/500)
OBJECTIVES: In this article the author describes public health advocacy and proposes a conceptual framework for understanding how it works. METHODS: The proposed framework incorporates the image of an assembly line. The public health advocacy assembly line produces changes in societal resource allocation that are necessary for optimizing public health. The framework involves 3 main stages: information, strategy, and action. These stages are conceptually sequential but, in practice, simultaneous. The work at each stage is continually adjusted according to circumstances at the other stages. RESULTS: The framework has practical implications; for example, public health advocacy teams need members with complementary skills in distinct roles. Potential applications are illustrated via two public health advocacy efforts. CONCLUSIONS: The framework may be useful in assessing staffing and funding needs for public health advocacy endeavors, explaining common problems in these endeavors and suggesting solutions, and guiding decisions concerning effort allocation. Application of the framework to a variety of public health advocacy endeavors will clarify its strengths and weaknesses. (+info)
Failure to defend a successful state tobacco control program: policy lessons from Florida.
(35/500)
OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum. (+info)
Rhetoric or reality? The participation of disabled people in NGO planning.
(36/500)
User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected European-based international non-governmental organizations (INGOs) facilitate the participation of disabled people in their planning process? The study was exploratory in nature, using both quantitative and qualitative methods to answer the research question. Data were collected using a self-administered questionnaire with 18 INGOs, which was supported by five semi-structured interviews and 20 'e-mail dialogues' with key informants. The findings indicate that the INGOs involve disabled people's organizations (DPOs) in their planning of services and projects in a variety of ways. Most commonly this is through sharing information with them, but consulting them, including them in decision-making or supporting action initiated by them are other less frequent methods of involvement. INGOs with a specific disability focus involve disabled people in the ways described above more frequently than other INGOs. Although most INGOs regularly provide information and consult DPOs, if there is no assurance that ideas raised will be implemented, then there is no guarantee of DPOs' participation in the planning process of these INGOs. The focus of an INGO and the nature of its projects affect how disabled people are involved in planning, whereas the size of an INGO has little effect. INGOs thus far have failed to match their expressed intentions about participation, but as they help to strengthen DPOs, encourage their formation and move to make disability an issue that cuts across sectoral boundaries, INGOs are changing. There is still a lot of rhetoric about participation, but the participation of disabled people in the planning process of INGOs is a growing reality. (+info)
Re-engineering trust: the adoption and adaption of four models for external quality assurance of health care services in western European health care systems.
(37/500)
Accreditation, ISO, EFQLM and visitatie are, in essence, control mechanisms in health care systems. An analysis is provided of the way the four models have been adopted and adapted in European health care systems over the past decade. After a short discussion of the major reforms in the European health care systems in the direction of regulated markets, deregulation and decentralization, the features of the four models are highlighted and it is explained how each of them can help to fill the 'accountability gap' between health care providers on the one hand and patients, financiers and governments on the other. The quality system perspective of ISO, the quality management development perspective of EFQM, the health care organization perspective of accreditation and the professional perspective of visitatie can each be appropriate given the balance of power between parties in the health care system and the focus and scope of accountability. Although a general convergence between the four models can be observed, actual convergence will depend on their adoption in specific health system contexts. Potential pitfalls for further convergence are the differences in distribution of responsibilities for quality of care among the various European countries, the drift away from clinical decision making, bureaucratic tendencies and too much focus on efficiency and patient empowerment compared with attention to medical effectiveness. (+info)
Methods for external evaluation of health care institutions.
(38/500)
OBJECTIVE: To compare the methods used by external evaluators of health care institutions in Europe. METHODS: A common framework for analysis was designed by the authors and shared among the members of the ExPeRT Project. Each member prepared a description of a model and the results were compared in two workshops. RESULTS: Programmes share similarities in the methods used, but they differ in the focus and purpose of the evaluation. Differences in focus included whether a part or the whole of the institution is analysed and whether the review is patient or system centred. Different purposes of the programmes are reflected in the emphasis and use of the methodological tools: for instance, the appeal system is used only in the programmes that provide a certificate to the institution audited. (+info)
Status of a health care quality review programme in South Africa.
(39/500)
This paper provides an overview of an accreditation programme for health care facilities in South Africa. It traces the origin of COHSASA (The Council for Health Service Accreditation of Southern Africa) which began as a pilot programme in 1992, to its current status as the only accreditation body in the country. There are brief descriptions of its structure, how it is governed, and how standards were developed and organized. The authors sketch a background of the unique sociopolitical context and legal developments within which the programme operates in South Africa and how the programme is contributing towards the new government's intention to provide equitable and quality health care to all its citizens. There is an outline of the principles on which the COHSASA programme is based and the structure and process of the programme. The programme incorporates an integrated, multi-disciplinary, continuous quality improvement approach with special emphasis on capacity building of hospital staff when necessary. The paper refers to groundbreaking research in Kwa-Zulu Natal where the impact of accreditation is being measured in a randomized control trial. It points to the benefits of accreditation being perceived in both public and private sectors of health care in South Africa and outlines some of the results of the program's implementation. (+info)
Trade-offs between location and waiting times in the provision of health care: the case of elective surgery on the Isle of Wight.
(40/500)
BACKGROUND: Recent UK government documents have stated that, within the National Health Service, consumers should be more involved in decision-making. This study considered the technique of discrete choice conjoint analysis (DCCA) for eliciting community views regarding the importance of reducing waiting times. More specifically, the study aimed to establish whether residents living on the Isle of Wight are prepared to travel to the mainland for elective surgery where waiting times are shorter but travel costs may be greater, and, further, if residents are willing to travel, what reduction in waiting time and increase in travel costs would be acceptable. METHODS: A DCCA questionnaire was sent to a random sample of 1,000 individuals living on the Isle of Wight. RESULTS: Seventy-eight per cent of respondents were willing to travel to the mainland for elective surgery. Of these, 48 per cent always chose the mainland and 30 per cent traded between island and mainland, depending on the levels of waiting time and travel costs. Whereas 'traders' preferred the Isle of Wight, they would forgo their preferred location if waiting times were reduced by at least 3.9 months, and they were willing to pay over 12 for a 1 month reduction in waiting time. Different combinations of waiting time reductions and travel cost increases that were acceptable to traders were estimated. CONCLUSIONS: Carrying out elective surgery on the mainland offers the potential to reduce waiting lists for island residents. The majority of respondents would be willing to travel to the mainland. However, one-fifth of respondents were not willing to travel to the mainland for elective surgery. The preferences of this group are important in policy decisions. More generally, the paper demonstrates the potential application of DCCA to public health issues. (+info)