Health services management research : an official journal of the Association of University Programs in Health Administration
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Health Serv Manage Res · Feb 2011
Assessing the effects of drug price reduction policies on older people in Taiwan.
This study investigates the initial effects of the government's prescription drug price reduction policies on outpatient hypertension treatment for the elderly in Taiwan. The National Health Insurance scheme has taken a number of steps in recent years to reduce drug prices. The data used in the study comprises the medical records of approximately 137,000 hypertension patients aged 65 and above. ⋯ In addition, we found that physicians do substitute full-price drugs for reduced-price drugs. However, they appear to be reluctant to reduce the use of essential drugs, even when facing rate reductions. The evidence suggests that physicians consider the profit they can derive by prescribing certain drugs; hence, health policy officials should monitor the effects of possible drug substitutions when they design policies for their own countries.
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Health Serv Manage Res · Aug 2010
Accounting for health-care outcomes: implications for intensive care unit practice and performance.
The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. ⋯ These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.
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Health Serv Manage Res · Feb 2010
Major incident planning in primary care trusts in north-west England: a cross-sectional survey.
The Civil Contingencies Act (2004) requires UK primary care trusts (PCTs) to plan and respond to major health incidents. We carried out a cross-sectional survey of all PCTs in the north-west region of England using a telephone interview with a structured questionnaire. We assessed: (1) staff members responsible for emergency planning; (2) risk assessment; (3) training and exercises; and (4) the planned response to a major incident. ⋯ Fifteen had discussed major incident preparations with their local acute trust but none could quantify the support they would be able to provide in terms of accelerated discharges. We have revealed potentially serious deficiencies in the emergency preparedness of many PCTs. PCTs are expected to play a vital role in coordinating the National Health Service (NHS) response to a major incident and these results have important implications for the ability of the NHS as a whole to effective respond to such incidents.
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Health Serv Manage Res · Nov 2007
A research model of health-care competition and customer satisfaction.
In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. ⋯ The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.
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Health Serv Manage Res · Nov 2007
The use and perceptions of routine health data: a qualitative study of four cancer network teams in England.
Health service managers have been criticized for placing more emphasis on the collection of data than on their use for the improvement of care. The present study examined how routine aggregate data on cancer services are perceived by management teams and how such data are used to inform strategic decision-making and planning. Semi-structured interviews were conducted with 19 members of four cancer network teams in England. ⋯ Limited use of aggregate data appeared to relate to problems of accessibility, lack of resources to turn the data into meaningful information and service improving action, and poor data quality and relevance. These factors apparently lead to inability or reluctance to use routine data to monitor and improve cancer services at the network level. Data-user concerns should be addressed to facilitate greater use of available routine data.