An incentive compensation system that rewards individual and corporate productivity.
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INTRODUCTION: An economically mature health care market has led to increased cost competition. Subsequently, a perceived need for productivity-based physician compensation has developed. While some institutions have rewarded individual productivity based on specific facets of academic responsibility, such as teaching, research, and patient care, we chose to develop an incentive compensation system that rewards both individual and group productivity. PROGRAM DEVELOPMENT: We developed a physician incentive compensation system that rewards individual and group productivity by capturing multiple aspects of work activity. Faculty members are given compensation value points for clinical productivity, scholarship activities, teaching activities, service activities, and achievement of the department's goals. The system was implemented in a graduated fashion in the Department of Family Medicine at Indiana University beginning July 1, 2000. PROGRAM EVALUATION: In April 2003, all faculty physicians (n=18) participated in a survey about the compensation system. The majority of faculty view the system as a necessity for the department (72.2%); 35.2% were satisfied with the system overall; 35.3% were neutral; and 27.4% were dissatisfied or not sure of their overall satisfaction. CONCLUSIONS: A comprehensive physician incentive compensation system incorporating department goals can be designed and implemented in an academic setting. (+info)
The impact of the introduction of user fees at a district hospital in Cambodia.
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Proponents of user fees in the health sector in poor countries cite a number of often interrelated rationales, relating inter alia to cost recovery, improved equity and greater efficiency. Opponents argue that dramatic and sustained decreases in service utilization follow the introduction of user fees, highlighting evidence that user fees reduce service utilization when they fail to result in improved quality of care and/or when services are priced higher than those charged by private health care providers. Utilization of public health services in Cambodia is low. Supply-side factors are significant determinants of such low public sector utilization, including low official salaries of service providers (forcing many to seek additional income in the private sector), and operations budgets which are erratic and often insufficient to cover running costs of service delivery outlets. The Cambodia Ministry of Health (MOH) encourages user fee schemes at operational district level. By allowing revenue to be retained at the health facility level, the MOH aims to improve health care delivery--and consequently service utilization--through increased salaries to health facility staff and increases in operations budgets. This case study of the introduction of user fees at a district referral hospital in Kirivong Operational District in Cambodia, using the findings from empirical research, examines the impact of user fees on health-careseeking behaviour, ability to pay and consultation prices at private practitioners. The research showed that consultation fees charged by private providers increased in tandem with price increases introduced at the referral hospital. It further demonstrates--for the first time that we are aware of from the available literature--that the introduction and subsequent increase in user fees created a 'medical poverty trap', which has significant health and livelihood impact (including untreated morbidity and long-term impoverishment). Addressing the medical poverty trap will require two interventions to be implemented immediately: regulation of the private sector, and reimbursing health facilities for services provided to patients who are exempted from paying user fees because of poverty. A third, longer-term initiative is also suggested: the establishment of a social health insurance mechanism. (+info)
Migration of health-care workers from developing countries: strategic approaches to its management.
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Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration. (+info)
Workers' perspectives on mandated employer health insurance.
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There is renewed discussion of using employer mandates as a strategy for decreasing the number of uninsured Americans. California recently passed the Health Insurance Act of 2003, the first state-based "play-or-pay" legislation in nearly a decade. To better understand workers' perceptions, the California HealthCare Foundation commissioned NORC at the University of Chicago to conduct a survey to assess workers' views on mandated employer coverage. We found that the vast majority of workers support such a mandate--regardless of whether they are insured--although there is some variation regarding how extensive the mandate should be. (+info)
Findings from the most recent Medical Library Association salary survey.
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OBJECTIVE: The objective is to provide information on basic issues in library management identified by the Medical Library Association's (MLA's) seventh triennial salary survey. METHODS: The survey was a Web-based questionnaire. A nonrandom sample of persons was obtained by posting messages to MLA's membership and to the MEDLIB-L e-mail discussion list. Employed MLA members and nonmembers employed in medical library settings filled out a Web-based form designed using common gateway interface (CGI) programming. RESULTS: Six hundred forty-five usable responses were analyzed by the Hay Group and presented in the MLA publication, Hay Group/MLA 2001 Compensation and Benefits Survey. Results from the 2001 survey in this article focus on pay and job satisfaction. Salary survey results since 1983 were analyzed to review trends in seniority, diversity, and pay equity. CONCLUSIONS: Given the age progression of respondents from 1983 to 2001, it is clear that succession planning is a core issue for medical libraries. Although efforts to create more diversity in medical libraries in member organizations have started to yield results, pay for white respondents has increased at a higher rate than for other racial categories. The authors found that the pay-for-performance system in the organizations of approximately two-thirds of the respondents is suboptimized and that most of the reasons medical librarians cite for leaving their organization can be addressed and potentially changed by management. Results from the eighth salary survey, slated to be conducted in the fall of 2004, will further track these trends and issues. (+info)
Cost efficiency analysis of modern cytocentrifugation methods versus liquid based (Cytyc Thinprep) processing of urinary samples.
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BACKGROUND/AIMS: Liquid based cytology (LBC) was developed as a replacement for cytocentrifugation in the treatment of cell suspensions. Because accurate data comparing the quality and total cost of modern cytocentrifugation methods versus LBC in non-gynaecological samples are not available, this study was designed to investigate these issues. METHODS: The study comprised 224 urine samples treated with the Thermo Shandon Cytospin 4 using reusable TPX chambers, disposable Cytofunnels for samples up to 0.5 ml, and disposable Megafunnels for samples up to 6 ml. Each method was compared with the Cytyc Thinprep processing of a paired sample. Quality was assessed by scoring cellularity, fixation, red blood cells, leucocytes, abnormalities of urothelial cells, and suitability for molecular studies. Wage costs, investment, and consumables allowed a "total cost" to be calculated on the basis of 200 specimens/month. Total cost and quality combined were used to calculate an index of total quality (ITQ). RESULTS: Cytocentrifugation with disposable chambers resulted in a global quality superior to that of Cytyc Thinprep LBC. Preparation and screening times were 2.25 and 1.33-2 times greater when using LBC compared with cytocentrifugation. The total cost each month reached 1960.23 $ to 2833.43 $ for cytocentrifugation methods and 5464.95 $ for Cytyc Thinprep LBC (92.8-178.8% increased cost). ITQ of cytocentrifugation with disposable chambers surpassed that of Cytyc Thinprep LBC (37.25/32.08 and 9.98, respectively). CONCLUSION: Cytyc Thinprep LBC and cytocentrifugation are both appropriate methods for cytology based molecular studies, but cytocentrifugation remains the quality standard for current treatment of urinary samples because of its lower cost. (+info)
New signs of a strengthening U.S. nurse labor market?
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Wage increases, relatively high national unemployment, and widespread private-sector initiatives aimed at increasing the number of people who become nurses has resulted in a second straight year of strong employment growth among registered nurses (RNs). In 2003, older women and, to a lesser extent, foreign-born RNs accounted for a large share of employment growth. We also observe unusually large employment growth from two new demographic groups: younger people, particularly women in their early thirties, and men. Yet, despite the increase in employment of nearly 185,000 hospital RNs since 2001, the evidence suggests that the current nurse shortage has not been eliminated. (+info)
Conflicts between employee preferences and ergonomic recommendations in shift scheduling: regulation based on consent is not sufficient.
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OBJECTIVE: Contribution to the discussion of the role of participation/consent of employees in working hours regulation. METHODS: Exploratory analysis of conflicts between preferences of employees and ergonomic recommendations in shift scheduling by analysing a large number of participative shift scheduling projects. RESULTS: The analysis showed that very often the pursuit of higher income played the major role in the decision making process of employees and employees preferred working hours in conflict with health and safety principles. CONCLUSIONS: First, the consent of employees or the works council alone does not ensure ergonomically sound schedules. Besides consent, risk assessment procedures seem to be a promising but difficult approach. Secondly, more research is necessary to check the applicability of recommendations under various settings, to support the risk assessment processes and to improve regulatory approaches to working hours. (+info)