Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.     

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.     

The influence of the farm size on the parity of a farming family in Poland

This paper aims at statistical identification of the relationship between the parity of farming families and the area of the farm and the role this variable plays among variables describing the model of families' parity. To reach this objective results of a questionnaire survey were used, one performed among the group of individual farmers' families keeping agricultural accounting in 1985. The analysis covered 1291 rural farming couples who married in the years 1920-1984. According to the results obtained, the thesis posed by W. Stys with regard to positive relationships between parity in a family and the farm's area only relates to marriages entered into between 1920-1964. In single five-year marriage cohorts, a change of shape of this relationship was observed. It took the shape of a parabolic function or polynomial of the third order. The research results showed that in marriage cohorts with finished fertility, variable area of the farm turned out to be almost insignificant in explaining changes in the number of live born children compared to other demographic factors, especially cultural and demographic ones.     

Time use in child care and housework and the total cost of children

The use of time for child care and housework among Swedish families is investigated. We allow the effect of children on child care and housework to vary by age of the child and also by whether the child is cared for outside the home or not. Our estimates allow us to compute the total cost of children in the form of the cost of time, and the cost of goods, services and housing.The result shows that time used for child care decreases sharply with the age of the child but this is not the case for time used for other housework. Considerable economies of scale is found to prevail for time used for child care. Child care outside the home reduces time use for other housework but the effect on time used for child care is quite small. For the average family time use cost make up more than half of total child cost. Our estimates indicate that decreased time use cost for children caused by care outside the home are not very different from a typical parental fee for public day care.This research was supported by a grant from the Swedish Council of Social Research (SFR). We thank Lennart Flood for useful comments on an earlier version.     

The power of boards in service providing agencies: three models

Tensions in the relationship between boards and staff are a common feature of voluntary and nonprofit agencies which deliver services. Many of the difficulties reflect lack of clarity about the power of boards. The author describes three models of governance: traditional, membership, and entrepreneurial. Each model has different implications for the power of a board in relation to staff. Practitioners in nonprofit service delivering agencies in the UK have found the models to be a useful tool for explaining the practical difficulties they experience.     

Demographic changes in East European countries and Russia

The authors outline demographic trends in Eastern Europe and Russia since 1970. Aspects considered include population size, birth rate and number of births, marriage and divorce, death rate, infant mortality, natural increase, sex ratio, and life expectancy.     

Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.     

Capitation and informatics

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.