Who is enrolled in for-profit vs. nonprofit Medicare HMOs?
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We compare the characteristics of enrollees in for-profit and nonprofit Medicare health plans using nationwide data from the 1996 Medicare Current Beneficiary Survey. We find few differences in overall health status, limitations in activities of daily living (ADLs), or history of chronic disease. However, older Americans enrolled in for-profit plans are substantially poorer and less educated than those enrolled in nonprofit plans, are more likely to have joined their plan recently, and are more likely to have joined a plan with the expectation of reducing their out-of-pocket health care costs. (+info)
A critical review of 'a critical review': the methodology of the 1993 World Development Report, 'Investing in Health'.
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Since its publication in 1993, the World Bank's World Development Report, Investing in Health, has been subjected to much criticism, particularly over the way it proposes to measure the health losses summarized in the concept of the 'burden of disease', and to establish priorities for health interventions according to the reduction in mortality and disability they could produce and what they would cost. Some of these criticisms are justified, and are recognized by the WDR; others arise from misunderstanding or misapplication of the concepts. Sifting these criticisms to arrive at a better understanding requires looking at what kind of analysis is involved, how the subjective elements of the exercise were determined, and how they can be used to choose which interventions deserve priority when a country cannot meet all its citizens' health needs. (+info)
Caring relationships: an investment in health?
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Although the US has created the most expensive, technologically advanced medical system in the world, health outcomes are not commensurate with investment. The author argues that providers and policy makers have neglected the effect of human relationships on health, citing research showing that better relationships lead to better health. The author concludes with recommendations for improving public health by supporting society's investments in social capital. (+info)
Stakeholder analysis: a review.
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The growing popularity of stakeholder analysis reflects an increasing recognition of how the characteristics of stakeholders--individuals, groups and organizations--influence decision-making processes. This paper reviews the origins and uses of stakeholder analysis, as described in the policy, health care management and development literature. Its roots are in the political and policy sciences, and in management theory where it has evolved into a systematic tool with clearly defined steps and applications for scanning the current and future organizational environment. Stakeholder analysis can be used to generate knowledge about the relevant actors so as to understand their behaviour, intentions, interrelations, agendas, interests, and the influence or resources they have brought--or could bring--to bear on decision-making processes. This information can then be used to develop strategies for managing these stakeholders, to facilitate the implementation of specific decisions or organizational objectives, or to understand the policy context and assess the feasibility of future policy directions. Policy development is a complex process which frequently takes place in an unstable and rapidly changing context, subject to unpredictable internal and external factors. As a cross-sectional view of an evolving picture, the utility of stakeholder analysis for predicting and managing the future is time-limited and it should be complemented by other policy analysis approaches. (+info)
A stakeholder analysis.
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This paper provides guidance on how to do a stakeholder analysis, whether the aim is to conduct a policy analysis, predict policy development, implement a specific policy or project, or obtain an organizational advantage in one's dealings with other stakeholders. Using lessons learned from an analysis of alcohol policy development in Hungary, it outlines issues to be considered before undertaking the stakeholder analysis concerning the purpose and time dimensions of interest, the time-frame and the context in which the analysis will be conducted. It outlines advantages and disadvantages of an individual or team approach, and of the use of insiders and outsiders for the analysis. It describes how to identify and approach stakeholders and considers the use of qualitative or quantitative data collection methods for estimating stakeholder positions, levels of interest and influence around an issue. A key message is that the process of data collection and analysis needs to be iterative; the analyst needs to revise and deepen earlier levels of the analysis, as new data are obtained. Different examples of ways of analyzing, presenting and illustrating the information are provided. Stakeholder analysis is a useful tool for managing stakeholders and identifying opportunities to mobilize their support for a particular goal. However, various biases and uncertainties necessitate a cautious approach in using it and applying its results. (+info)
Financing the health care Internet.
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Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms. (+info)
Building a consensus for expanding health coverage.
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Despite a flourishing economy and recent growth in employment-based health coverage, forty-three million Americans remain uninsured. Extending coverage to the uninsured is not an intractable public policy problem but could be addressed if the various health care stakeholders could only find common ground. We argue that to win broad-based support from across the ideological and political spectra, a meaningful proposal should achieve a balance between public- and private-sector approaches, focus attention on those who are most in need of assistance (low-income workers), and build on systems that work today. With the aim of pulling together a political coalition, we present a proposal specific enough to attract support but whose details will arise later, in the context of the legislative process. (+info)
A satisfaction and return-on-investment study of a nurse triage service.
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OBJECTIVE: To assess patient satisfaction and a health plan's return on investment associated with a telephone-based triage service. STUDY DESIGN: A pre-post study design, with medical claims data, to assess changes in medical service utilization and health plan expenditures associated with members' use of the triage service. PATIENTS AND METHODS: This study is based on data on 60,000 members of a health plan. A telephone survey was conducted to assess member satisfaction and outcomes with the triage service. The plan's medical claims and encounter data were used to calculate medical utilization rates and plan expenditures for those services. The health plan's return-on-investment was evaluated using a pre/post study design to assess changes in medical service utilization between the baseline (December 1995 through November 1996) and program (December 1996 through November 1997) periods. RESULTS: The average nurse response time to a call was just less than 50 seconds, which indicates the service provided ready access to medical advice 24 hours per day, 7 days per week. More than 90% of users were satisfied, and utilization of hospital emergency department (ED) and physician office services decreased significantly after the service was implemented. The changes in medical service utilization resulted in reductions in health plan expenditures that exceeded the plan's costs of providing the service. The plan's estimated return for every dollar invested in the nurse triage service was approximately $1.70. CONCLUSIONS: The telephone-based nurse triage service appears to be a cost-effective intervention that improves access to medical advice, thereby encouraging appropriate use of medical services. The service is associated with reductions in utilization of hospital ED and physician office services and with high levels of member satisfaction. (+info)