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91.
Burn T 《Physician executive》1996,22(3):20-25
The purpose of this article is to outline the contrasts between the traditional AMC and an organization oriented toward the delivery of population-based managed care. Academic medical centers differ from one another considerably in the extent to which they serve as quaternary care community resources, the degree to which they emphasize primary care in training and care delivery, and the amount of research undertaken. Nor is there a single organizational structure for managed care; successful managed care is practices in IPAs, multispecialty groups, PHOs, and staff-model HMOs. Nonetheless, the contrasts outlined here between AMCs and managed care organizations (MCOs) are valid in most cases. 相似文献
92.
The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation. 相似文献
93.
SupposeL(X) is the law of a positive random variableX, andZ is positive and independent ofX. Admissible solution pairs (L(X),L(Z)) are sought for the in-law equation $\hat X \cong X o Z$ °Z, where $L\left( {\hat X} \right)$ is a weighted law constructed fromL(X), and ° is a binary operation which in some sense is increasing. The class of weights includes length biasing of arbitrary order. When ° is addition and the weighting is ordinary length biasing, the class of admissibleL(X) comprises the positive infinitely divisible laws. Examples are given subsuming all known specific cases. Some extensions for general order of length-biasing are discussed. 相似文献
94.
Weil TP 《Physician executive》1997,23(8):19-24
At the end of World War II, one-third of the nation's hospital administrators were physicians. During the 1950's through the mid-1980's a new breed of masters'level administrator, with well-honed coordinating skills, orchestrated a major expansion of new programs, services, and facilities. With the advent of the Medicare prospective payment system (PPS), more governing boards restructured their administrative staffs with corporate titles. Meanwhile, physicians sensed that trustees were becoming far more concerned with bottom line performance to repay a mounting debt that hospitals had incurred to remain technologically competitive. Since mergers and integrated health systems by themselves will be unable to generate significant operating efficiencies, governing boards will be forced to change direction and shift back to recruiting physicians as their CEOs or in other senior positions to assure themselves of the clinical leadership required to implement the managed care concepts of reducing utilization and cost, and simultaneously enhancing quality of patient care. 相似文献
95.
96.
Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions. 相似文献
97.
Sussman S Galaif ER Newman T Hennesy M Pentz MA Dent CW Stacy AW Moss MA Craig S Simon TR 《Evaluation review》1997,21(1):94-123
Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events. 相似文献
98.
US theoretical models of assimilation of ethnic groups within a larger culture usually assume a unilinear, unidimensional process, which is simplistic, does not account for the persistence of ethnicity, and oversimplifies the process of social change. The argument is advanced that ethnic identity is both primordial and situational (a private sense that is self-maintaining, cumulative, deepening, and self-affirming). Typically, a person has one primary ethnic identity, but where ethnic boundaries overlap, there is instrumental identity. Chinese in Thailand mostly adopt Thai values, speak the Thai language, go to Thai schools, join Thai associations, and celebrate Thai religious festivals. Their secondary identity as Chinese is integrated into their associations with other Chinese and in the home through the use of the Chinese language. Their Chinese identity appears also in ancestor worship. There are symbiotic relationships between native Thais and Chinese Thais along class lines. The Chinese are known to have great financial and economic resources, while the Thais have political and administrative control. These differences with the power elites separate the Chinese from the Thais and interfere with assimilation. The power is balanced. If the Chinese gained in political and administrative power, the balance would be upset, and the interests of both groups would be threatened. The view of Whitten and Whitten acknowledges that individuals and groups act to make the best of the situation and are not merely victims of social forces. Actions are maintained and resisted. The important consideration in theory-building is not the terms of assimilation but the terms specifying the conduct of the group as a whole and as individuals in daily social interactions. The theoretical discussion focuses on border crossings, the Skinner view of the Chinese, bilingualism and cultural education, socioeconomic organizations, occupational differences, and religion, tradition, and ethnic identification. 相似文献
99.
T Klein 《KZfSS K?lner Zeitschrift für Soziologie und Sozialpsychologie》1993,45(4):712-30, 828
"Life expectancy and mortality increasingly are analyzed in the context of social factors. This study analyzes the impact of social position, marital status, and religious confession on cohort life expectancy. The analysis is based on [German data from the] Socio-Economic Panel Survey, wherein proxy-interviewee's parents have been used to estimate cohort mortality. Results confirm a lower mortality risk of the upper classes and of married persons. However, as opposed to other studies, Catholics do not have a lower, but even a higher mortality risk." (SUMMARY IN ENG) 相似文献
100.
Abstract As fertility comes increasingly under voluntary control in a developing society, it can be argued that individual desires or preferences about children will become more salient and more significant for eventual fertility. Hence, the study of preferences is increasingly important as contraceptive use is extended and results in decreasing the number of unwanted births.(1) Further changes in fertility then depend on changes in preferences. The assumption is that people will at least try to achieve the families they want, if the means to do so are available. The fact that contraception is used at all is some evidence of the soundness of this assumption, although it should be recognized that family size desires operate in a complex of preferences, under varying degrees of conflict and control. To expect a one-to-one relationship between attitudes or preferences and overt behaviour would be simplistic. 相似文献