The psychology of organizational structure in integrated health systems

Examine a social learning theory model as a framework to guide health system leaders as they consider the psychology of organizational design as it pertains to the successful integration.     

Making integrated health care work

This article summarizes the authors' thinking on value added in health care, and offers examples of the major strategies being implemented by integrated systems across the United States to increase their value and improve their competitive positioning. The research results are based on a review of published literature on 150 health care organizations in various stages of integration, and 20 in-depth case studies of integrating systems.     

医改路何方,领导一句话

最近,去了安徽省的马鞍山市和芜湖市考察公立医院改革的情况,可以说,受益匪浅。凑巧,媒体也报道了北大李玲教授对芜湖整体医疗改革的看法。     

Super doc and real health reform

A large array of social, economic, and professional issues will have to be confronted and resolved before primary care physicians can take their logical place as leaders in the health care delivery system. Linkages will have to be forged between primary care physicians and specialists and between primary care physicians and nonphysician providers of primary care. Key to successful resolution of the current dilemma is ensuring that primary care physicians are compensated at a fair level for their skills. It is the disparity in physician incomes that lies at the heart of the problem, according to the author.     

A proposal for health care reform

A radical overhaul of the health care system is proposed by one doctor who's fed up with the current system. His ideas include competing systems sponsored by the government and the private sector.     

Quality improvement in the era of health reform

More and more scrutiny is certain for the health care field. The intense interest in medical quality management that has been a factor in the field for many years is certain to increase under any reform that the system undergoes. This is a unique opportunity for physician executives to play a leading role in the future course of health care delivery. The alternative of their involvement will be almost total control of the issue by regulators.     

A model for integrated production-packaging systems

The problem of determining the economic packaging frequency of jointly replenished items has received a lot of attention from researchers. This problem is usually encountered while packaging the products after completing manufacture. Nevertheless, production batch quantities certainly influence the manufacturing cycle time of products and hence the economic packaging quantities for jointly replenished items. Therefore, realizing the importance of the relationship between production batch quantities and packaging quantities     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

In search morally intelligent health care reform

The health care policy debate is bitterly divisive because so much money is involved. Politicians want to keep the passionate debate going instead of acting. Why commit political suicide by opposing insurance and drug companies instead of prospering by hooking up with them?     

Primary care: the driver in health care reform

The changes occurring in the health care industry have resulted in a cost-quality competition that has not been present in the past. Because of this competition, managed care is a growing way of financing and providing health care to the people of the United States. Managed care depends heavily on competent primary care physicians. Because primary care physicians are in short supply, the status and financial rewards of primary care practice are increasing. The primary care physician will be the dominant force in medical practice in the immediate future. He or she is capable in a managed setting of resolving the perceived problems of the health care industry in responding to the drivers of health care reform. Costs are reduced while quality is maintained. Access to health care is improved, and fragmentation of health care is significantly lessened.     

集成物流管理系统中定位—运输路线安排问题的研究

综述集成物流管理系统中设施定位—运输车辆行程路线安排问题的主要研究进展 ,分析提出有关求解问题的算法的特点 ,最后提出该研究领域应该关注的几个重要发展方向 .     

Modular design of integrated databases in production management systems

Abstract

Complexity is a serious problem with respect to the application of information technology in the field of production management. This paper presents an overview of the more fundamental problems encountered and proposes a solution for some of those problems in the form of modular decomposition of the conceptual database structure. It is argued that the complexity of information systems is closely connected to the complexity of the organization. Therefore a condition for the realization of integrated information systems for production management is a simplification of the organizational structure by way of defunctionalization and the forming of autonomous units.     

Seeing systems in health care organizations

"Systems" in health care organizations are difficult to visualize and understand by people across the organization. Systems exist as behaviors that have reasons and consequences rather than strict, linear cause and effect relationships. Learn how to sketch and see the systems at work in health care, and how to change them to help end the blame game.     

Efforts to implement national health reform in the United States

Beginning in this issue and carrying forth during the year, the author will trace the history of the development of a national health policy in the United States. In beginning this new feature, Physician Executive recognizes the potential impact of national health reform on physician executives and the need to contribute to informed discussion on the current national health reform debate. In this first article, the authors sets the stage for the series, establishing the historical precedents for national health care reform and some of the groundrules for the articles to follow.     

A guide to the upcoming health reform debate

AT the 1992 ACPE National Institute, several hundred physician executives actively participated in a debate on three competing visions for the health care system in the United States. This new column in the journal attempts to further this process by providing information on policy positions of relevance to College members. While the College does not advocate a particular position, the College encourages individual members to contact the interest group of their choice and get involved in the health policy debate. In this first column, one of the proposals currently being discussed is summarized.     

寄希望于安徽

今次医改,安徽再挑重担,勇立潮头,以“吃螃蟹”的精神为全国探路,意义非比寻常。     

National health reform advocates retrench and prepare for Medicare

With the failure of President Truman's efforts to pass compulsory health insurance for all, national health reform (NHR) advocates began to redirect their political attention to a politically powerful group of Americans who were simultaneously vulnerable from a health care point of view--the elderly. This effort culminated in the passage of Medicare under President Johnson. This article will focus on antecedents to passage of Medicare that can be found in the Eisenhower and Kennedy administrations. It will also discuss other facets of health reform proposals from the Eisenhower administration. While most proposals never became law, the legislative intent of many of them--outlawing cancellation of policies, a minimum standard health benefit package, establishment of regional health authorities, preference for prepayment plans, and establishment of a reinsurance pool administered by the federal government--is currently under active discussion by the Clinton health reform task forces.     

The impact of health care reform on group practice

Just two years ago, it would have been very difficult to imagine that reform of the health care system would today be a national domestic priority and that Congress would be considering one of the most significant and far-reaching pieces of legislation in the past 50 years. The issue is still in doubt, but it seems clear that, in this session of Congress or the next, legislation of far-reaching consequences will likely be passed. In fact, change on a widespread scale has already begun. During 1993, every state legislature except those of Nevada and Wyoming considered measures that would alter the way medical care is financed and delivered. Of the states that acted, both last year and in recent legislative sessions, eight have passed laws with the ultimate objective of ensuring access to medical care for all citizens. Government, at both the state and federal level, is clearly taking on the health care issue. The impact of reform on physicians, and thus on group practices, will be substantial. This article outlines the current course of health care reform and addresses its specific implications for the management of group practices.