Health informatics: linking investment to value.
(33/1312)
Informatics and information technology do not appear to be valued by the health industry to the degree that they are in other industries. The agenda for health informatics should be presented so that value to the health system is linked directly to required investment. The agenda should acknowledge the foundation provided by the current health system and the role of financial issues, system impediments, policy, and knowledge in effecting change. The desired outcomes should be compelling, such as improved public health, improved quality as perceived by consumers, and lower costs. Strategies to achieve these outcomes should derive from the differentia of health, opportunities to leverage other efforts, and lessons from successes inside and outside the health industry. Examples might include using logistics to improve quality, mass customization to adapt to individual values, and system thinking to change the game to one that can be won. The justification for the informatics infrastructure of a virtual health care data bank, a national health care knowledge base, and a personal clinical health record flows naturally from these strategies. (+info)
Clinical care and the factory floor.
(34/1312)
The purpose of this article is to provide the author's perspective on whether it is likely or feasible that those working in the health care domain will adapt and use lessons learned by those in the industrial domain. This article provides some historical perspective on the changes brought about in the industrial domain through the introduction of new technologies, including information technologies. The author discusses how industrialization catalyzed changes in health care delivery that paralleled but lagged behind those of the broader U.S. economy. The article concludes that there is ample reason for those interested in improving the quality and effectiveness of health informatics to systematically evaluate information technology strategies used in the industrial domain. Finally, it outlines some challenges for health informaticians and a number of factors that should be considered in adapting lessons from industry to the health care domain. (+info)
The business value of health care information technology.
(35/1312)
The American health care system is one of the world's largest and most complex industries. The Health Care Financing Administration reports that 1997 expenditures for health care exceeded one trillion dollars, or 13.5 percent of the gross domestic product. Despite these expenditures, over 16 percent of the U.S. population remains uninsured, and a large percentage of patients express dissatisfaction with the health care system. Managed care, effective in its ability to attenuate the rate of cost increase, is associated with a concomitant degree of administrative overhead that is often perceived by providers and patients alike as a major source of cost and inconvenience. Both providers and patients sense a great degree of inconvenience and an excessive amount of paperwork associated with both the process of seeking medical care and the subsequent process of paying for medical services. (+info)
Effect of declining mental health service use on employees of a large corporation.
(36/1312)
This study examines concurrent changes in use of mental and general health services and in annual sick days among 20,814 employees of a large corporation. From 1993 to 1995 mental health service use and costs declined by more than one-third, more than three times as much as the decline in non-mental health service use. However, employees who used mental health services showed a 37 percent increase in use of non-mental health services and significantly increased sick days, whereas other employees showed no such increases. Savings in mental health services were fully offset by increased use of other services and lost workdays. (+info)
Why not private health insurance? 2. Actuarial principles meet provider dreams.
(37/1312)
What do insurers and employers feel about proposals to expand Canadian health care financing through private insurance, in either a parallel stream or a supplementary tier? The authors conducted 10 semistructured, open-ended interviews in the autumn and early winter of 1996 with representatives of the insurance industry and benefits managers working with large employers; respondents were identified using a snowball sampling technique. The respondents felt that proposals for parallel private plans within a competitive market are incompatible with insurance principles, as long as a well-functioning and relatively comprehensive public system continues to exist; the maintenance of a strong public system was both socially and economically desirable. With the exception of serving the niche market for the private management of return-to-work strategies, respondents showed little interest in providing parallel coverage. They were receptive to a larger role for supplementary insurance but cautioned that they are not willing to cover all delisted services. As business executives they stated that they are willing to insure only services and clients that will be profitable. (+info)
Receptivity of a worksite breast cancer screening education program.
(38/1312)
A breast cancer screening education program was offered to 97 major worksites in Forsyth County, North Carolina. Worksites could design a program by choosing components that consisted of (1) brochures, (2) breast cancer education classes taught by program staff or (3) sending company nurses to be trained by program staff to then teach employees at the worksite. A total of 63 out of the original 97 companies (65%) accepted and offered a program to their employees. Worksites that chose to sponsor a program were more likely to have already sponsored breast cancer education programs at their worksites (P = 0.027) or to have a medical department (P = 0.006). The type of component selected was significantly associated with a history of sponsoring other health education programs (P < 0.001). Fourteen worksites chose the more intensive component, the training of a company nurse. More than half of the worksites that had never sponsored and had no plans to sponsor worksite breast education programs were receptive to our program (43 of 73, 59%). The majority of these sites (67%) chose the brochure. These results indicate that worksites are receptive to offering breast cancer educational programs if varying types of components can be selected. (+info)
Prevalence and incidence of herpes simplex virus type 2 infection among male Zimbabwean factory workers.
(39/1312)
Stored sera from a cohort of 2397 male factory workers in Harare, Zimbabwe, were screened for herpes simplex virus type 2 (HSV-2)-specific antibodies, to estimate the prevalence and incidence of genital herpes infection and to assess the relation between HSV-2 and human immunodeficiency virus (HIV) acquisition. The prevalence of HSV-2 at enrollment was 39.8%. Correlates of HSV-2 seropositivity were HIV seropositivity, marital status, history of sexually transmitted disease (STD), older age, and higher income. The incidence of HSV-2 seroconversion during follow-up was 6.2/100 person-years. Correlates of HSV-2 seroconversion were enrollment while HIV-positive or seroconversion during follow-up, reported genital ulcer, history of STD, and number of sex partners. No evidence was found that HSV-2 infection was more likely to precede HIV or vice versa. HSV-2 and HIV seropositivity are strong markers for high-risk sexual behavior. Improved interventions targeted to populations in which the incidence of either viral infection is high are needed. (+info)
Use of performance standards in behavioral health carve-out contracts among Fortune 500 firms.
(40/1312)
OBJECTIVE: To determine the prevalence and nature of performance standards in specialty managed behavioral healthcare contracts among Fortune 500 companies. STUDY DESIGN: This was a cross-sectional survey of all companies listed on the Fortune 500 during 1994, 1995, or both. METHODS: From April 1997 to May 1998 we conducted a mailed survey with phone follow-up. Of the 68% of firms that responded, over one third reported carve-out contracts. The survey focused on whether companies had behavioral health carve-out contracts with specialty vendors and characteristics of these contracts, including the use of performance standards. RESULTS: More than three quarters of the Fortune 500 companies reporting specialty behavioral healthcare contracts used at least one performance standard. Most common were administrative standards (70.2%) and customer service standards (69.4%). About half of the companies used quality standards, whereas only a third used provider-related standards. Most (58.8%) companies using performance standards also specified financial consequences. Larger Fortune 500 firms were significantly more likely to use performance standards. Risk contracts and contracts that included all covered employees were also more likely to include some categories of standards. CONCLUSIONS: Administrative and customer service standards may be most common because companies find it easier to specify those standards, especially compared with clinical quality measures. To the extent that employers want to obtain the most value from their behavioral healthcare purchasing, we expect that more will begin to adopt quality standards in their contracts, especially as performance measures become more refined. Reliance on accreditation, however, is an alternative approach for employers. (+info)