Maximizing use of a surgical clinic for referrals of patients having back problems.
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OBJECTIVE: To determine ways to improve the delivery of service in a surgical clinic, based on the outcome of surgical consultations for back pain. DESIGN: A prospective outcome study. SETTING: A university teaching hospital providing secondary and tertiary care. PATIENTS: One hundred and forty-two consecutive patients who presented to surgical clinics for assessment of a back problem between Apr. 14 and May 30, 1996. INTERVENTIONS: Surgeons determined the diagnosis and visit outcome; data were tabulated objectively by a third-party researcher. OUTCOME MEASURES: Waiting time for consultation, presence of referral letter, third-party interests, diagnosis and visit outcome. RESULTS: Twenty-five percent of patients had chronic pain not amenable to surgery, 19% of patients were surgical candidates and were offered an operation, 13% were symptomatically improved to the point of not wanting an operation, 11% wanted a second opinion only, 10% had mechanical back pain appropriate for referral to physiotherapy, 9% had not undergone an adequate trial of nonoperative treatment when seen in the clinic and were given follow-up appointments, 5% were "no shows," 3.5% were seen for a medicolegal assessment, 3.5% wanted confirmation from a specialist that they did not need surgery and 1% had symptoms due to a vascular rather than a spinal cause and were referred to a vascular surgeon. CONCLUSION: Delivery of service could be improved by more rigorous screening to reassign appointment times of patients who have not had an adequate trial of nonoperative treatment, are improved or do not intend to keep their appointment. (+info)
Interventions to improve the delivery of preventive services in primary care.
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OBJECTIVES: This review was conducted to determine the effectiveness of different interventions to improve the delivery of preventive services in primary care. METHODS: MEDLINE searches and manual searches of 21 scientific journals and the Cochrane Effective Professional and Organization of Care of trials were used to identify relevant studies. Randomized controlled trials and controlled before-and-after studies were included if they focused on interventions designed to improve preventive activities by primary care clinicians. Two researchers independently assessed the quality of the studies and extracted data for use in constructing descriptive overviews. RESULTS: The 58 studies included comprised 86 comparisons between intervention and control groups. Postintervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not effective in other studies. CONCLUSIONS: Effective interventions to increase preventive activities in primary care are available. Detailed studies are needed to identify factors that influence the effectiveness of different interventions. (+info)
Health sector reform in the Republic of Macedonia.
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AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund. (+info)
Slovenian experience on health care reform.
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The health care system in Slovenia has undergone significant changes since 1992. The objectives were primarily economic and not medical, since the level of medical services rendered has been fairly high and there were limited needs for improvements. Many changes, such as privatization, have not yet achieved their main objective - improved efficiency and quality. We have, however, observed many positive results, such as the awareness of medical staff that the quality of the national health care system should not be taken as granted but should be based and developed on extremely careful planning. Health care reform packages are being designed primarily to address one important problem: cost containment. An important part of the reform was moving the major part of the health care budget outside of the state budget to make it more transparent and controllable and its use more subject to its primary intention. (+info)
Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.
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This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined. (+info)
Health reform and hospital financing in Georgia.
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AIM: To analyze hospital financing and delivery of inpatient services, financial requirements of the hospitals, and their ability to meet these requirements were determined. METHODS: Data on financial performance of 41 hospitals were collected using a standardized questionnaire. Patient survey, group discussions with hospital administrators, and interviews with policy-makers were also used. RESULTS: Thirty-three hospitals were unable to recover full costs, and 29 were unable to recover full costs excluding capital consumption cost. Cost recovery rate (CRR) of full costs for 14 hospitals was less than 70% and CRR of full costs minus capital consumption costs was less than 70% for 8 hospitals. Collected actual revenues comprised 75.2% of hospitals' full costs. Mean CRR for the sample was 78.6+25.2%. General and long-term hospitals recover 64.8% of their costs, but pediatric and specialized hospitals collected revenues to cover full costs excluding the capital consumption costs. Medium-sized hospitals recovered only 63. 5% of full costs. The hospitals operated with low efficiency, low occupancy rates (31%), and excessive staffing (1.5 physicians per occupied bed). They employed salary equalization policies, which increased the share of fixed costs, perpetuated the oversupply of medical personnel, and yielded low pays. Hospitals charged in excess of their officially accounted costs but, and due to the low collection rates, cost recovery rates were below the officially accounted costs (87.6%). CONCLUSIONS: Low official reimbursement rates and patient unawareness of official hospital costs creates conducive environment for shifting major turnover of the real hospital costs to the patients, resulting in illegal patients charging. (+info)
Cross-border alliances in health care: international co-operation between health insurers and providers in the Euregio Meuse-Rhine.
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On behalf of the European Commission, a Cross-Border Health Care Project was undertaken to explore how citizens living in the Euregio Meuse-Rhine can obtain improved access to health services in the Member States concerned: Belgium, Germany, and The Netherlands. Main attention of the project is focused on practical issues of cross-border health care. The first results have shown that the new cross-border health alliances resulted in improved possibilities for patients to access more health care facilities than before. The creation of health care alliances could also be an example for future collaboration between the countries in Western, Central, and Eastern Europe. This paper also analyses the rights of patients on cross-border care in the Euregion. (+info)
United States health care delivery system, reform, and transition to managed care.
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The US health care delivery system, faced with an exponential increase in expenditures during the second part of the 20th century, was forced to explore ways to reduce costs and, at the same time, maintain a high quality of care. Managed care emerged as one of the answers and quickly became one of the predominant health care delivery models. While the cost of health care did go down, it remains unclear what the future holds. Currently, managed care is growing rapidly in publicly funded programs and the changes which are currently underway may be defining those programs in the time to come. (+info)