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Australia's Health Workforce 澳大利亚的卫生人力
Pub Date : 2005-12-22 DOI: 10.2139/ssrn.883563
The Productivity Commission's research report into 'Australia's Health Workforce', was released on 19 January 2006. The Commission was asked to undertake a research study to examine issues impacting on the health workforce over the next 10 years. The main finding of the commissioned study's report is that changes are needed if Australia's health workforce is to become more efficient and effective. The Commission recommended an integrated set of national actions which will result in a more sustainable and responsive health workforce. The proposed workforce arrangements are designed to: drive reform to scopes of practice, and job design more broadly, while maintaining safety and quality; deliver a more coordinated and responsive education and training regime for health workers; accredit the courses and institutions and register health professionals in nationally consolidated and coherent frameworks; and; provide the financial incentives to support access to safe and high quality care in a manner that promotes innovation in health workplaces. The proposals would benefit all Australians, including those in rural and remote areas and Indigenous communities where workforce shortages are particularly evident.
生产力委员会关于"澳大利亚卫生人力"的研究报告于2006年1月19日发布。委员会被要求进行一项研究,审查今后10年影响卫生工作人员的问题。委托研究报告的主要发现是,如果澳大利亚的卫生工作者要变得更有效率和更有效,就需要进行改革。委员会建议采取一套综合的国家行动,这将使卫生工作队伍更具可持续性和反应能力。拟议的劳动力安排旨在:推动改革工作范围和更广泛的工作设计,同时保持安全和质量;为卫生工作者提供更加协调和反应迅速的教育和培训制度;认可课程和机构,并在全国统一和一致的框架内注册卫生专业人员;和;提供财政奖励,以促进卫生工作场所创新的方式,支持获得安全和高质量的护理。这些提议将使所有澳大利亚人受益,包括那些劳动力短缺尤其明显的农村和偏远地区以及土著社区的人。
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引用次数: 94
Seven Challenges for the Implementation of Balanced Scorecard in Hospitals 医院实施平衡计分卡的七大挑战
Pub Date : 2005-10-01 DOI: 10.2139/ssrn.899343
Bruno Folly Guimarães e Silva, V. Prochnik
The article presents a literature review on performance measurement in health care institutions. This survey identifies seven main challenges to the implementation of the Balanced Scorecard (BSC). The external environment poses three different challenges: more rigorous regulation processes, increasingly diverse customer needs and stiffer competition. In the internal environment, the main challenges to health care management are: conflicts between management and physicians' interests, conflicts among value proposals for different kinds of customers, lack of performance measurement methods and inefficient information systems. The empirical part of the article discusses the use of performance measurement techniques by a sample of 15 Brazilian hospitals. The article shows that all the seven challenges found in the international literature are also present in the Brazilian healthcare institutions. Among other conclusions, its shows that healthcare institutions in Brazil make use of several performance measures in day-to-day management. However, the information produced by these measures is not linked to the hospitals' strategic planning. In general, the indicators are traditional and well-known and can be applied to any sector of activity. Only some financial and internal process indicators were specific to hospitals' needs and could also be found in the international literature. The indicators were distributed unequally across the four BSC perspectives. Much more accurate indicators were available for the financial and internal process approaches than for the other two approaches (clients and learning and growth). Performance measurement systems can thus be said to be much needed in Brazilian hospitals, and the focal task in implementing them is to link them with the strategic plan design. This article was presented at the 3rd CONFERENCE ON PERFORMANCE MEASUREMENT AND MANAGEMENT CONTROL, Nice, September 22-23, 2005.
本文对医疗机构绩效评估的相关文献进行了综述。这项调查确定了实施平衡计分卡(BSC)的七个主要挑战。外部环境带来了三种不同的挑战:更严格的监管程序、日益多样化的客户需求和更激烈的竞争。在内部环境中,医疗管理面临的主要挑战是:管理层与医生利益冲突,不同类型客户的价值建议冲突,绩效衡量方法缺乏,信息系统效率低下。文章的实证部分讨论了15家巴西医院样本的绩效测量技术的使用。文章表明,在国际文献中发现的所有七个挑战也存在于巴西的医疗机构。在其他结论中,它表明巴西的医疗机构在日常管理中使用了几种绩效指标。然而,这些措施产生的信息与医院的战略规划没有联系。一般来说,这些指标是传统的和众所周知的,可以应用于任何活动部门。只有一些财务和内部流程指标是医院具体需要的,也可以在国际文献中找到。这些指标在四个平衡计分卡视角中分布不均。与其他两种方法(客户、学习和成长)相比,财务和内部过程方法提供了更准确的指标。因此,巴西医院可以说非常需要绩效衡量系统,而实施这些系统的重点任务是将它们与战略计划设计联系起来。本文发表于2005年9月22-23日在尼斯举行的第三届绩效评估与管理控制会议上。
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引用次数: 8
Forget Quality: Do Non-Profits Even Signal Their Status 忘记质量:非营利组织甚至表明他们的地位吗
Pub Date : 2005-09-23 DOI: 10.2139/ssrn.811664
A. Malani, G. David
Why do firms take non-profit status? One of the most popular theories in the law and economics literature is that non-profit status is a signal of quality (Hansmann 1980; Glaeser & Shleifer 2001). This paper offers a simple, empirical test of this theory. If non-profit status signals quality, surely non-profit firms would want to ensure that consumers were aware of their non-profit status. A simple way firms could broadcast such a signal would be to add it to their names, but this sort of signaling is unheard of. Alternatively, firms might indicate their non-profit status on, e.g., their website or in yellow pages listings. Taking this cue, we conduct a survey of over 2800 firms in the hospital, nursing home and childcare industries. Our aim is to determine whether non-profit firms communicate their status to consumers on their websites or yellow pages listings. We conclude that non-profit status may signal quality, but the value of the signal is very poor. We infer this from the fact that firms that have other signals of quality, such as a religious or academic affiliation, are less likely to signal that they are non-profit. Firms only signal non-profit status, however, when it is cheap to do so. The most costly signals we examine are those in yellow pages listings, followed by home pages and then about-us pages on websites. Yet less than 7.5 percent of non-profit firms signal their status in yellow pages listings; only 25 percent do so on their home pages and 30 percent on their about-us pages. Indeed, over 35 percent never signal their non-profit status. Even among firms that have no other indicators of quality, roughly 70 percent of hospitals and 30 percent of nursing homes never signal their status on their websites.
为什么企业采取非营利性地位?法律和经济学文献中最流行的理论之一是非营利状态是质量的信号(Hansmann 1980;Glaeser & Shleifer 2001)。本文对这一理论进行了简单的实证检验。如果非营利性的地位标志着质量,那么非营利性公司肯定会希望确保消费者意识到他们的非营利性地位。公司传播这种信号的一种简单方法是将其添加到公司名称中,但这种信号是闻所未闻的。或者,公司可以在其网站或黄页清单上表明其非营利性地位。以此为线索,我们对医院、养老院和儿童保育行业的2800多家公司进行了调查。我们的目的是确定非营利公司是否在他们的网站或黄页列表上向消费者传达他们的地位。我们得出结论,非营利状态可能是质量的信号,但信号的价值很差。我们从以下事实中推断出这一点:具有其他质量信号的公司,如宗教或学术关系,不太可能表明它们是非营利性的。然而,只有在成本低廉的情况下,公司才会表明自己是非营利性的。我们检查的最昂贵的信号是黄页列表,其次是主页,然后是网站上的“关于我们”页面。然而,只有不到7.5%的非营利公司在黄页列表中标明了自己的地位;只有25%的人在他们的主页上这样做,30%的人在他们的关于我们的页面上这样做。事实上,超过35%的人从不表明他们是非营利组织。即使在没有其他质量指标的公司中,大约70%的医院和30%的养老院也从未在其网站上表明自己的地位。
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引用次数: 2
Technology Diffusion and Market Structure: Evidence from Infertility Treatment Markets 技术扩散与市场结构:来自不孕症治疗市场的证据
Pub Date : 2005-09-01 DOI: 10.2139/ssrn.813826
B. Hamilton, Brian McManus
We study how market structure influenced the diffusion of new treatment technology (ICSI) among U.S. fertility clinics that performed in vitro fertilization (IVF). We find that competitive (i.e., non-monopoly) markets were more likely to have a clinic that offered ICSI than monopoly markets. Our results account for the potential endogeneity of market structure with respect to entry-foreclosing technology adoption and unobserved market characteristics that might increase the return from offering ICSI. We also provide evidence that ICSI diffused faster to competitive markets because the returns from the new technology were greater there. Early-adopting clinics in competitive markets experienced a significant increase in size, while early-adopting monopoly clinics did not. However, monopoly clinics that adopted ICSI soon after its invention were more likely to delay the entry of rival firms than monopolists that adopted ICSI later.
我们研究了市场结构如何影响新治疗技术(ICSI)在美国进行体外受精(IVF)的生育诊所中的传播。我们发现竞争性(即非垄断)市场比垄断市场更有可能有提供ICSI的诊所。我们的研究结果解释了市场结构的潜在内生性,涉及进入限制技术的采用和未观察到的市场特征,这些特征可能会增加提供ICSI的回报。我们还提供证据表明,ICSI更快地扩散到竞争市场,因为新技术的回报更大。竞争市场中早期采用的诊所规模显著增加,而早期采用垄断的诊所则没有。然而,在ICSI发明后不久采用ICSI的垄断诊所比后来采用ICSI的垄断诊所更有可能推迟竞争对手公司的进入。
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引用次数: 28
Doctor Who? Who Gets Admission Offers in UK Medical Schools 医生吗?谁能被英国医学院录取
Pub Date : 2005-09-01 DOI: 10.2139/ssrn.826327
Wiji Arulampalam, R. Naylor, Jeremy P. Smith
In the context of the UK Government’s ambitious programme of medical school expansion, it is important to have an understanding of how the medical school admissions process works, and with what effects. The issue is also relevant for the Schwartz Review (2004) into higher education admissions. Using individual-level data for two entire cohorts of medical student applicants in UK universities and exploiting the panel structure of the applicant-medical school information, we estimate models to analyse the probability that an individual student receives an offer of a place. We find that prior qualifications, school type, gender, age, social class and ethnic background are major influences on whether a student receives an offer from a medical school. We also find that the probability of receiving an offer from a particular medical school is influenced by the identity of other medical schools applied to. Finally, we find evidence that certain groups of applicants are particularly disadvantaged the later they apply within the application process.
在英国政府雄心勃勃的医学院扩张计划的背景下,了解医学院招生过程是如何运作的,以及有什么影响是很重要的。这个问题也与高等教育招生的施瓦茨评论(2004)有关。利用英国大学两组医科学生申请者的个人水平数据,并利用申请人-医学院信息的面板结构,我们估计模型来分析单个学生收到录取通知书的概率。我们发现,先前的学历、学校类型、性别、年龄、社会阶层和种族背景是学生是否获得医学院录取的主要影响因素。我们还发现,收到某一特定医学院录取通知书的概率受到申请的其他医学院身份的影响。最后,我们发现有证据表明,某些群体的申请人在申请过程中的后期申请时尤其处于不利地位。
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引用次数: 17
Feds Order Physicians and Health Care Providers to Provide Free Language Translation Services to Limited English Proficient Patients: Colwell V. United States Department of Health and Human Services 联邦政府命令医生和卫生保健提供者为有限的英语熟练患者提供免费的语言翻译服务:Colwell诉美国卫生和人类服务部
Pub Date : 2005-08-11 DOI: 10.2139/SSRN.782364
Sharon L. Browne
For 2400 years society has been confident that physicians will use their professional judgment in treating their patients. Recently the federal government has intruded into the patient-physician relationship by adopting a requirement that physicians provide free oral and written translation services to limited English proficient patients, without reimbursement, or face possible prosecution for national origin discrimination under Title VI of the Civil Rights Act of 1964. Title VI prohibits discrimination on the grounds of race, color, or national origin. Neither language nor limited English proficiency status are protected classifications. This unprecedented expansion of Title VI is being challenged in Colwell v. United States Department of Health and Human Services. This paper argues that the federal government's intrusion into the patient-physician relationship is invalid. First, although the policy is a legislative rule creating new obligations for physicians, the government gave no prior notice of the policy change in violation of the notice and comment rulemaking requirements of the Administrative Procedures Act. Second, the rule is ulta vires because nothing in Title VI supports equating language with national origin. Third, the rule is overbroad and unconstitutionally vague in violation of the First Amendment.
2400年来,社会一直相信医生在治疗病人时会运用他们的专业判断。最近,根据1964年《民权法案》第六章的规定,联邦政府介入了医患关系,要求医生为英语水平有限的病人提供免费的口头和书面翻译服务,而且没有赔偿,否则可能因国籍歧视而受到起诉。第六章禁止基于种族、肤色或国籍的歧视。语言或有限英语水平都不属于受保护的分类。在Colwell诉美国卫生与公众服务部一案中,第六章这种前所未有的扩张受到了挑战。本文认为联邦政府对医患关系的干预是无效的。首先,虽然该政策是一项立法规则,为医生创造了新的义务,但政府没有事先通知政策变化,这违反了《行政程序法》的通知和评论规则制定要求。其次,该规则是绝对有效的,因为第六章中没有任何内容支持将语言与国籍等同起来。第三,该规定过于宽泛,含糊不清,违反了宪法第一修正案。
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引用次数: 0
Does Health Insurance Impede Trade in Health Care Services? 健康保险会阻碍医疗服务贸易吗?
Pub Date : 2005-07-01 DOI: 10.1596/1813-9450-3667
A. Mattoo, Randeep Rathindran
There is limited trade in health services despite big differences in the price of health care across countries. Whether patients travel abroad for health care depends on the coverage of treatments by their health insurance plan. Under existing health insurance contracts, the gains from trade are not fully internalized by the consumer. The result is a strong"local-market bias"in the consumption of health care. A simple modification of existing insurance products can create sufficient incentives for consumers to travel. For just 15 highly tradable, low-risk treatments, the annual savings to the United States would be $1.4 billion even if only one in 10 patients who need these treatments went abroad. Half of these annual savings would accrue to the Medicare program alone. The authors examine how measures by destination countries to improve and credibly signal the quality of health care can enhance the scope for trade.
尽管各国医疗保健价格差异很大,但卫生服务贸易有限。患者是否出国就医取决于其医疗保险计划对治疗的覆盖范围。根据现有的健康保险合同,贸易的收益并没有被消费者完全内化。其结果是在医疗保健消费中存在强烈的“本地市场偏见”。对现有的保险产品进行简单的修改就可以为消费者创造足够的旅游激励。仅就15种高度可交易、低风险的治疗方法而言,即使需要这些治疗的患者中只有十分之一去了国外,美国每年也将节省14亿美元。每年节省下来的费用中,有一半将用于医疗保险计划。作者研究了目的地国家为改善和可靠地表明卫生保健质量而采取的措施如何能够扩大贸易范围。
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引用次数: 50
Value Creation Potential of Intellectual Capital in Biotechnology - Empirical Evidence from Finland 生物技术中智力资本的价值创造潜力——来自芬兰的经验证据
Pub Date : 2005-03-01 DOI: 10.1111/J.1467-9310.2005.00381.X
R. Hermans, I. Kauranen
The objective of the study was to empirically verify impacts of intellectual capital (IC) to the anticipated future sales of small- and medium-sized companies within the biotechnology industry. The study creates and develops tools for the valuation of companies by relating the existing intangibles and the expected value creation of the companies in that industry displaying high growth prospects but long and insecure product development phases. Theoretically, IC is divided into the following three categories: human capital (HC), structural capital (SC), and relational capital (RC). In the empirical setting, survey data of small- and medium-sized Finnish biotechnology companies are used. In the econometric analyses, the interactions, or empirical co-variation, between the three categories of IC explain two-thirds of the variance in the anticipated future sales of the sample companies. Thus, it seems that a well-balanced combination of HC, SC, and RC implies value creation potential and high anticipated future sales.
本研究的目的是实证验证智力资本(IC)对生物技术产业中小企业预期未来销售额的影响。该研究通过将现有的无形资产与该行业中显示高增长前景但产品开发阶段长且不安全的公司的预期价值创造相关联,创建并开发了公司估值工具。从理论上讲,企业资本分为以下三类:人力资本(HC)、结构资本(SC)和关系资本(RC)。在实证设置中,使用芬兰中小型生物技术公司的调查数据。在计量经济学分析中,三类IC之间的相互作用或经验共变解释了样本公司预期未来销售额差异的三分之二。因此,HC, SC和RC的良好平衡组合似乎意味着价值创造潜力和高预期的未来销售。
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引用次数: 114
Aids Policy and Pharmaceutical Patents: Brazil's Strategy to Safeguard Public Health 艾滋病政策和药品专利:巴西保障公众健康的战略
Pub Date : 2005-02-01 DOI: 10.1111/J.1467-9701.2005.00668.X
J. C. Cohen, Kristina M.L. Acri née Lybecker
Developing nations are challenged to strike a balance between their patent obligations as members of the World Trade Organisation (WTO) and their drug pricing strategies. The Brazilian approach to pharmaceutical price negotiations has been strikingly effective. Describing the context of the Brazilian pharmaceutical sector, their public health system and the Brazilian AIDS policy, this paper examines the Brazilian strategy vis-a-vis the international pharmaceutical manufacturers to explore why their tactics were successful and the potential for wider application by other developing countries.
发展中国家面临的挑战是在它们作为世界贸易组织(WTO)成员的专利义务和它们的药品定价策略之间取得平衡。巴西在药品价格谈判中的做法非常有效。本文描述了巴西制药部门的背景,他们的公共卫生系统和巴西艾滋病政策,研究了巴西相对于国际制药商的战略,以探索为什么他们的策略是成功的,以及其他发展中国家更广泛应用的潜力。
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引用次数: 17
Teaching without harming the living: performing minimally invasive procedures on the newly dead. 不伤害生者的教学:对刚死去的人进行微创手术。
Pub Date : 2005-01-01
Kenneth V Iserson
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引用次数: 0
期刊
Journal of health care law & policy
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