Home health care: payment and growth.

As institutional health care providers attempt to limit their expenditures on patients in the face of payment restrictions, home health care is becoming an increasingly attractive and heavily utilized alternative to institutional care. Home health care can be cost-effective, yielding results comparable to the less intensive phases of traditional inpatient care. In many cases, the home is a more desirable setting for patients, with the psychological benefits of familiar, nonthreatening surroundings enhancing convalescence.     

Charting a course toward legible medical records. Perfect paperwork can mean financial savings, better patient care.

Short of going fully electronic, there are various ways to clean up your medical record system to make it more efficient and less time-consuming. Check out how some experienced physician executives are dealing with this perennial problem.     

Strategically integrating hospital/home care services for improved profitability

Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for-profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management.     

Toward the library of the future.

Over the past decade libraries have become increasingly aware of the revolutionary impact of developments in information technology on their key function. The new developments challenge the library's traditional role as electronic information products and services open up a previously unimaginable array of options. The author contemplates a vision of the future in which the unpredictability of the human mind interacts with an expanding array of new technologies and libraries strive to develop an information infrastructure to serve teaching and research in universities.     

An EOQ model with partial delayed payment and partial backordering

In many transactions concerning selling and buying, a specified delay of payment is offered or accepted by the seller. This can be regarded as a kind of discount and has potential consequences for the order size. These kinds of effects are not explicitly incorporated in the classical formulas for economic order quantities (EOQ). In this research we consider an EOQ problem under partial delayed payment. A fraction of the purchasing cost must be paid at the beginning of the period and the remaining amount can be paid later. Shortages are permitted and occur as a combination of backorders and lost sales. The aim of this paper is to determine the order and shortage quantities.     

Managed care liability.

Debate is heating up concerning proposals that patients have the right to sue their managed care plans for damages from wrongful denial of benefits or delays in care. Some states have recently passed legislation to address this issue and it is expected to be an area of intense legislative debate during this year. As managed care entities increasingly enter the realm of medical decision-making, the additional burden of this responsibility is taking shape. Whether managed care plans should be treated like providers of care and be held accountable for decisions that impact patient outcomes, or be viewed only as insurers is a policy question of immense proportion.     

Physician payment in Canada, Germany, and the United States

As the debate about reforming the U.S. health care system intensifies, interest has focused on three alternative delivery systems: the predominantly private-sector model in the United States, the provincial-government health insurance model of Canada, and the social insurance model of Germany. The organization of physician payment is an important part of all these health care systems. To maintain an affordable system that delivers high-quality care, payment to physicians must be sufficient to attract and maintain an able group of doctors, while not exceeding an amount that the country can afford. In this article, these three systems will be examined, and an attempt will be made to apply the lessons learned from Germany and Canada to the direction of physician payment reform in the United States.     

Managing health care quality.

Using the cited principles of professional staff credentialing and quality assurance, a department chairman, medical director, or other health care executive will be in an excellent position to assess quality of care against established standards and manage problems in the routine provision of medically appropriate care. He or she will also be able to assure the hospital's board that the hospital and its medical staff are well positioned to meet future challenges to provide effective quality, utilization, and risk management.     

Vector Expected Utility and Attitudes Toward Variation

This paper proposes a model of decision under ambiguity deemed vector expected utility, or VEU. In this model, an uncertain prospect, or Savage act, is assessed according to (a) a baseline expected‐utility evaluation, and (b) an adjustment that reflects the individual's perception of ambiguity and her attitudes toward it. The adjustment is itself a function of the act's exposure to distinct sources of ambiguity, as well as its variability. The key elements of the VEU model are a baseline probability and a collection of random variables, or adjustment factors, which represent acts exposed to distinct ambiguity sources and also reflect complementarities among ambiguous events. The adjustment to the baseline expected‐utility evaluation of an act is a function of the covariance of its utility profile with each adjustment factor, which reflects exposure to the corresponding ambiguity source. A behavioral characterization of the VEU model is provided. Furthermore, an updating rule for VEU preferences is proposed and characterized. The suggested updating rule facilitates the analysis of sophisticated dynamic choice with VEU preferences.     

考虑支付红利的可转债模糊定价模型及其算法

由于金融市场经常受到一些模糊不确定因素的影响,使得可转债定价具有模糊特征.本文研究了具有支付红利以及标的资产为美式期权的可转债模糊定价问题.在Black-Scholes模型的基础上,提出了该类型可转债的模糊定价模型,它推广了传统的具有确定参数值的可转债定价模型.为了方便估计可转债价值,给出了具有三角模糊数形式的可转债定价公式.最后,选取实例分析和检验了该模糊定价方法的实用性.     

Health care trends, Part 2. The new health care team. Panel discussion

In Part 2 of this third annual panel discussion, six experts talk about the growing diversity of health care providers and what it means for consumers and physicians. Americans are getting their wellness and health care services from a wider variety of non-physician practitioners than ever before. The number of allied health and alternative providers with direct patient access is likely to continue growing. This trend is being driven by consumer demand, by the lobbying efforts of non-physician providers, and by federal, state, and private payers who see the potential for reduced health care spending, greater consumer satisfaction, and better outcomes. In practice, this means physicians and non-physician providers, some of whom may not be sanctioned by the medical establishment, are obligated to collaborate as a team. Members of this new provider team will have to communicate effectively (with each other, with consumers, and with payers) and make evidence-based clinical decisions. Physicians may have to share decision-making with other members of this new health care team.     

The emerging health care landscape. The drivers of health care

Other than hold on tight, how does a health care system successfully weather the turbulent conditions facing the industry? This article focuses on key drivers in the three main segments of the health care market: employer-based, commercial/ERISA, and Medicare and Medicaid. Effectively managing the dynamics within these markets will be vital to a delivery system's success and its ability to withstand the forces of change. Given the market changes that are occurring, how does an academic medical center, emerging hospital-sponsored IDS, or a large physician clinic trying to develop a system determine the necessary components and structure? What kind of system will work best? The considerations are numerous and explored in this article.     

Health care reform. Four variables and a theory: an equation for health care

Writings about health care reform currently appearing in all manner of publications often can confuse, rather than clarify, both problems and solutions. One of the strengths of the study of economics is the ability to summarize complex situations in graphic form, and one of the benefits of management theory is to visualize approaches to problems in a broad and well-organized manner. Three recent articles, when combined, suggest a fresh analysis of the problems demanding health care reform in this nation. They are reviewed here and synthesized into a philosophical view that encourages a more positive approach to solutions for the problems. The first article considers an economic theory with striking applications to health care. The second article suggests one management approach for the future for both for-profit and not-for-profit organizations. The third article takes a fresh approach to competition in health care. This review will discuss the economic theory and then apply the management principles to the problem of health care reform confronting the profession and the nation today.     

Resource allocation. The cost of care: two troublesome cases in health care ethics.

With the cost of health care rising rapidly, both physicians and administrators regularly face resource allocation decisions. Under these conditions of relative scarcity, the equitable and appropriate distribution of limited resources becomes an ethical as well as a financial issue. Through ethical analysis, physician executives can assist their physician colleagues and fellow administrators to find rationally defensible answers to questions regarding the distribution of limited resources. Six criteria are frequently "weighted in the balance" by ethicists when analyzing whether justice is served in the distribution of a limited resource: need, equality, contribution, ability to pay, effort, and merit. The authors argue that, from an ethical standpoint, the best single criterion upon which one can base an allocation decision is that of merit, defined as the potential to benefit from the investment of additional resources.     

Organizational effectiveness. Primary care and the congruence model

The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.