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.     

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.     

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.     

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.     

The paradoxes of national health reform during the Wilson era

The current debate over health care reform may represent yet another opportunity to establish a national health policy. A similar level of activity occurred during the presidency of Woodrow Wilson. In many ways, the failure to enact national health reform (NHR) in the early 20th Century represents a paradigm for subsequent failed attempts to enact NHR.     

Reconsidering the exploration of power distance: an active case study approach

In this paper, we present what we call an “active case study” and we theorize specifically on the relevance hereof for an exploration of power distance (as conceptualized by Hofstede (Culture's Consequences: International Differences in Work-Related Values, Sage, Beverley Hills, CA, 1980)). As Hofstede conceives it, the notion of “power distance” enables an understanding of the predominant ideas about inequality prevalent in a (national) culture, which in turn infuse work relationships. An active case study approach—as we elucidate in the paper—implies an acknowledgement on the part of those organizing the research of the manner in which their intervention might affect the way “respondents” experience their work relationships. We suggest that our proposed active case study approach offers novel possibilities for exploring power distance and should be added to the repertoire of approaches used to examine this in organizational life. We develop our argument in this regard by offering a detailed account of the application of this approach to a Taiwanese organization (the Kaohsiung Harbor Bureau in Taiwan).     

The American health system: a contentious environment in the 21st Century

In the 21st Century, the American public and its elected officials will be unable to reach any overall consensus on our nation's health policies and priorities. With greater demands for health services and fewer fiscal resources, a more contentious environment in the health industry will ensue. As the American health system in the next 100 years continues to behave with an amalgam of competitive and regulatory approaches, it will be difficult to ensure that all Americans will receive universal access, equity, comprehensive benefits, and a high quality of care. For these reasons, the health system is predicted later on to swing away from market-driven to more state-oriented regulatory strategies as the United States attempts to blend such concepts as pluralism, regionalization of resources, and enforcing cost containment.     

Planning reform beyond planning: the debate on an integrated Environment and Planning Act in the Netherlands

Land-use plans serve a dual function. On the one hand, they are programmes for future development, plans for action. On the other hand, they have a regulative function in relation to construction and land use. This paper investigates how the interplay between these functions is playing a role in the current debate about the new integrated Environment and Planning Act (Omgevingswet) in the Netherlands. Initially, the government proposed abolishing local land-use plans and replacing them with a system of by-laws. However, this proposal did not survive the debate on this bill. This paper will shed light on the relationships between planning and regulation by analysing that debate.     

In sickness and in health: An exploration of spousal support and occupational similarity

Abstract

While many studies of interventions have focused on their content and immediate effects, less research has focused on the processes that may explain these effects. The purpose of this study was to show how process evaluation can be used to interpret the results of an intervention study in four industrial canteens in Denmark. Two canteens acted as intervention groups and two as comparison groups. Effects were measured by surveys before and after interventions, and observations and interviews were conducted to provide an in-depth understanding of processes. Analyses were conducted based on the responses from 118 employees. Results showed, contrary to expectations, improvements in working conditions and well-being in one intervention group and in one comparison group, whereas no improvements were found in the two remaining groups. Data from the process evaluation enabled a meaningful interpretation of these results, raising the possibility programme failure rather than theory failure, and thereby constituting an example of how process evaluation can shed light over the factors that may influence outcomes in controlled intervention studies.     

美式认购期权最佳执行时间决策

期权最佳执行时间是一个十分复杂的问题,受到许多随机因素的影响,至今还没有得到很好地解决．本文运用马尔可夫转移概率,讨论了满足齐次性条件的平稳系统中美式认购期权的最佳执行时间决策问题．研究了几种常见概率分布的最佳执行时间集．定理3－6的结论,与期权交易市场的实际情况吻合较好．主要结果可以直接应用到股票、期货交易、工程项目投资决策以及国家重大科技、经济、政治、军事战略决策之中．     

The future of American health care in the "post-reform" era

"As the debate over health care reform rages in Washington, the market is reforming itself. For any given market, it's a question of 'How soon will it hit?', not 'Will it hit?'" Health care reform and market restructuring are ushering in a new era of integrated health care. Although the future is not fully clear, there are at least three competing models for the creation of regional and statewide health systems that will integrate the financing and delivery of services to large enrolled populations of consumers: Payer-driven networks. Provider-sponsored systems. Partnership models. Whatever the future scenario, physician executives will play a larger, more dominant role. Research on integrated health systems has identified three critical success factors for future success: physician-hospital integration, clinical integration and information integration. For managed care to be successful, there must be clinical leadership. The essence of managing care is clinical efficiency, based on "critical-path" treatment protocols and real-time patient care management, supported by integrated information systems.     

A bibliometric review of the leadership development field: How we got here,where we are,and where we are headed

The development of leaders and leadership is a formative research area and a considerable industry in practice. Existing reviews are often restricted in scope or by subjective inclusion of topics or documents which limits integrative implications for the leader/ship development (LD) field. We address theoretical and methodological limitations by mapping the LD field with a comprehensive, objective, and integrative review. To do so we employed three bibliometric approaches, historiography, document co-citation, bibliographic coupling, and included 2390 primary and 78,178 secondary documents. We show patterns in the evolution of the LD field, followed by four central observations about the current state and trends in LD. To shift the science and practice of LD we develop tangible suggestions for future research within the three research directions: (1) Pursuing research within the current framing of LD, (2) Striving for frame-breaking LD research, and (3) How We Can Get There – Transforming LD Research.     

Why Rates of Growth of Employment Differ: A Quantitative Approach to an International Comparison

ABSTRACT: This essay aims at presenting a quantitative assessment of the incidence of structural differences in output and employment composition, and of differential dynamics of the sectoral production and productivity, in order to explain the divergences in net employment growth in advanced market economies. The point of reference is the extremely divergent record, in terms of employment creation, of the United States on one hand, and Western European countries on the other. In the period 1973-80, for example, although the average growth rates of GNP were, on a cyclical average, similar in the U. S. A. and the EEC areas as a whole, additional job openings were about 14 million in the USA against less than half a million in the EEC. A structural, medium-run differential in the aggregate Employment/GNP elasticity appears to have characterized the performances of these economic systems. The 'source’of this differential are analyzed, utilizing a model of sectoral decomposition of employment and output trends. Simulation exercises are carried out, in order to assess the specific role of productivity, sectoral demand composition and sectoral employment composition, in determining the overall elasticity result. The comparative analysis takes into consideration the differential factors for the USA and Japan, together with the four major Western European countries (German Fed. Rep., France, Italy, and the United Kingdom).     

A performative exploration of the lifeworlds of human capital and financial capital: an intellectual capital case vignette

Journal of Management and Governance - The primary purpose here is to briefly outline and illustrate how one particular relationist/realist ontological approach to performative research, with a...     

Management by values as a core tool of HRD during the economic transition: an example of Russian enterprises

The article analyses the role and the significance of management by values in the conditions of transition from one socio-economic system to another. The theoretical aspects of the problem and the results of empirical research conducted in a number of Russian companies are examined. An assumption is made about organizational values influencing the formation of personal priorities and guiding principles of the employees, which leads to the increase of the degree of social responsibility of a given business.     

Some thoughts on becoming an ACPE Fellow (American College of Physician Executives)

Why pursue Fellowship in the American College of Physician Executives? Three physician executives talk about their experiences and explain why becoming an ACPE Fellow is an opportunity to become a leader in shaping the future of the College and medical management. The greatest value of Fellowship is that it shows that you have stature in the profession and it distinguishes you from your colleagues. Becoming a Fellow is evidence of attaining a next higher level of expertise. The process and requirements for becoming a Fellow are outlined, along with many ways to contribute to the field of medical management.     

Dispensing death,desiring death: an exploration of medical roles and patient motivation during the period of legalized euthanasia in Australia

A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's cort, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.     

Cultural values as determinants of executive attitudes on decision making: An empirical evaluation

This article presents an empirical, cross-cultural investigation of executive attitudes on decision making, risk taking, and executive courage. Twenty-nine Arab and 40 American executives participated in this study. Six hypotheses were tested, with the results showing significant differences between managers from the two business cultures. Recommendations and directions for future research are provided.     

Why trustworthiness in an IT vendor is important even after the vendor left: IT is accepting the message and not just the messenger that is important

Trustworthiness is the assessment that another person or others can be trusted because in the past they had shown adequate ability, integrity, and benevolence. Trust is the actual willingness to depend on the trusted party to fulfill its future obligations when there is risk that this trusted party might take undue advantage of the situation. In the current conceptualization of trust theory, trustworthiness is important because it leads to trust. Applied to the management of IT adoption and assessment, research has indeed shown that both trustworthiness and trust, often combined statistically, have a direct effect on IT adoption and assessment. There are circumstances, however, such as in this study, when the trusted party has left the scene, making its future actions and the risk of dependence on these actions irrelevant to the trusting party. The question arises whether trustworthiness still plays a role in such cases. Seemingly, at least based on the current conceptualization, this should make the trustworthiness of the trusted party an insignificant consideration. Logic is advanced why even in such a case trustworthiness may still be important, but should play an indirect role. The proposition suggested is that the trustworthiness of the messenger is important, as previously suggested, but what really counts is accepting the message this messenger conveyed. An argument is raised why in this case interpersonal justice increases trustworthiness and user acceptance of the message. The data support these propositions. Theory and managerial implications are discussed.