Health services management research : an official journal of the Association of University Programs in Health Administration
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Health Serv Manage Res · Nov 2001
Does the availability of hospital beds affect utilization patterns? The case of end-of-life care.
Hospital downsizing in Canada during the 1990s raised public concern over the availability of hospital care, in addition to heightening administrative interest in improving or maximizing hospital utilization. One ongoing concern about hospital utilization is that a disproportionately large share of hospital resources is used by terminally ill and dying people. A research study using 1992/1993-1996/1997 in-patient abstracts data for the province of Alberta, Canada, was undertaken to explore and describe hospital utilization by dying in-patients. ⋯ Most in-patients were admitted for nursing care; in 51.3% of all cases, no diagnostic or therapeutic procedures were performed prior to death. These findings indicate hospital bed availability influences admission to hospital and length of stay, but not treatment decisions affecting seriously ill and dying patients. In addition, reduced length of stay appears to have been a widespread response to hospital downsizing, with this change substantially preserving individual access to hospitals.
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Health Serv Manage Res · Feb 1999
Cost and price in the NHS: the importance of monetary value in the decision-making framework--the case of purchasing renal replacement therapy.
This paper examines the role of cost, price and health economic evaluation in the National Health Service as demonstrated by reference to renal replacement therapy for patients with end-stage renal failure. In particular, it aims to highlight the problems with monetary value and to illustrate how it may be manipulated by legitimate techniques to produce varying outcome values which may be misleading and thereby distort the healthcare decision-making process. The paper argues for standardization of costing methods and health economic evaluation to enable meaningful intra- and inter-hospital comparisons to be made.
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Inpatient care from hospitals operated by the Department of Veterans Affairs (VA) is offered free of charge to many eligible veterans. Others must make nominal co-payments. As a result, in contrast to the private sector, money prices do not serve as an allocation mechanism for inpatient care. ⋯ The results suggest that willingness to wait depends on the expected benefits of waiting before treatment can be received. The impact of the monetary and non-monetary costs imposed by waiting is small. As VA waiting lists continue to grow, social workers discharge planners and other providers should investigate the tolerance for waiting and incorporate this information into plans for service provision.
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Health Serv Manage Res · Aug 1998
Further flexing? Issues of employment contract flexibility in the UK nursing workforce.
This paper, based on research commissioned by the Royal College of Nursing (Buchan, 1995), reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. ⋯ The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.
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Health Serv Manage Res · Nov 1997
ReviewProgramme budgeting revisited: special reference to people with learning disabilities.
The recent reorganization of community care in the UK removed many of the perverse incentives identified in the previous system. However, the organization of care for many people is still divided across several agencies in the public and independent sectors. ⋯ The principles and practice of programme budgeting provide important lessons for planning and monitoring expenditure. This paper rehearses such principles in the specialized area of policies for people with learning disabilities and draws on the experience of mapping expenditure on relevant services in a survey over 10 local authorities in England.