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Workers' compensation in the United States and the role of the primary care physician

PRIMARY CARE 2000年第4期27卷 831-+页

作者： Pye, H Orris, P Cook Cty Hosp Div Occupat Med Chicago IL 60612 USA Univ Illinois Sch Publ Hlth Great Lakes Ctr Occupat & Environm Safety & Hlth Chicago IL USA

The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking.

关键词：病例管理/组织和管理合格鉴定司法鉴定家庭医学/组织和管理筹资政府/组织和管理卫生服务使用研究密执安模型组织管理职业医学/组织和管理医师的作用政治初级卫生保健/组织和管理私营部门/组织和管理美国华盛顿工人补偿金/组织和管理人类

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Sustainability of health care: a framework for analysis

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HEALTH POLICY AND PLANNING 1998年第3期13卷 287-295页

作者： Olsen, IT DiS Ctr Partnership Dev N-0319 Oslo Norway

This paper introduces a conceptual framework which can be used to study the sustainability of health services in developing countries. A health service is considered sustainable when operated by an organizational system with the long-term ability to mobilize and allocate sufficient resources for activities that meet individual or public health needs. The framework includes three clusters: (1) contextual factors, which outline the task and general environment of the services;(2) an activity profile, which describes the services delivered and the activities carried out to deliver them;and (3) organizational capacity, which shows the carrying ability (capability) of the organization in broad terms. In this framework, health care provision is seen as an open system model where five main factors determine how inputs are converted to outputs, linking them through feedback loops. These factors are aims, technology, structure, culture and process. The framework has proven useful in analyzing factors critical to sustainability, and in describing structures and processes both in basic public services and in private not-for-profit services. It should also be tested on more complex systems, such as national health care.

关键词：卫生保健提供/组织和管理发展中国家卫生保健公平提供卫生服务研究/方法模型组织管理私营部门/组织和管理过程评价(卫生保健) 公共卫生管理社会价值人类

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Improving the quality of private sector delivery of public health services: challenges and strategies

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HEALTH POLICY AND PLANNING 1998年第2期13卷 107-120页

作者： Brugha, R Zwi, A Univ London London Sch Hyg & Trop Med Dept Publ Hlth & Policy Hlth Policy Unit London WC1E 7HT England

Despite significant successes in controlling a number of communicable diseases in low and middle income countries, important challenges remain, one being that a large proportion of patients with conditions of public health significance, such as tuberculosis, malaria, or sexually transmitted diseases, seek care in the largely unregulated 'for profit' private sector. Private providers (PPs) often offer services which are perceived by users to be more attractive. However, the available evidence suggests that serious deficiencies in technical quality are often present. Evaluations of interventions to promote evidence-based care in high income countries have shown that multi-faceted strategies which increase provider knowledge have had some success in improving service quality. A wider range of factors needs to be considered in low and middle income countries (LMICs), especially factors which contribute to discrepancies between provider knowledge and practice. Studies have shown that PPs, especially, perceive or experience patient and community pressures to provide inappropriate treatments. LMIC governments also lack the capacity to enforce regulatory controls. Context-specific multi-faceted strategies are needed, including the local adaptation and dissemination to providers of relevant evidence, the education of patients and communities to adopt effective treatment-seeking and treatment-taking behaviour, and feasible mechanisms for ensuring and monitoring service quality, which may include a role for self-regulation by provider organizations or provider accreditation. Developing, implementing and evaluating strategies to improve the quality of service provision will depend on the involvement of the key stakeholders, including policy makers and PPs, Focusing on studies from Asia, Africa and Latin America, this paper develops a model for identifying the influences on PPs, mainly private medical practitioners, in their management of conditions of public health significance

关键词：发展中国家循证医学健康知识态度实践卫生政策卫生服务需求卫生服务研究/发展趋势投资模型组织管理病人接受卫生保健的程度私营部门/组织和管理职业病人关系公共卫生管理/标准质量保证卫生保健/方法人类

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Rhetoric or reality? The participation of disabled people in NGO planning

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HEALTH POLICY AND PLANNING 2000年第2期15卷 177-185页

作者： Flower, J Wirz, S UCL Inst Child Hlth Ctr Int Child Hlth London WC1N 1EH England

User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected European-based international non-governmental organizations (INGOs) facilitate the participation of disabled people in their planning process? The study was exploratory in nature, using both quantitative and qualitative methods to answer the research question. Data were collected using a self-administered questionnaire with 18 INGOs, which was supported by five semi-structured interviews and 20 'e-mail dialogues' with key informants. The findings indicate that the INGOs involve disabled people's organizations (DPOs) in their planning of services and projects in a variety of ways. Most commonly this is through sharing information with them, bur consulting them, including them in decision-making or supporting action initiated by them are other less frequent methods of involvement. INGOs with a specific disability focus involve disabled people in the ways described above more frequently than other INGOs. Although most INGOs regularly provide information and consult DPOs, if there is no assurance that ideas raised will be implemented, then there is no guarantee of DPOs' participation in the planning process of these INGOs. The focus of an INGO and the nature of its projects affect how disabled people are involved in planning, whereas the size of an INGO has little effect. INGOs thus far have failed to match their expressed intentions about participation, but as they help to strengthen DPOs, encourage their formation and move to make disability an issue that cuts across sectoral boundaries, INGOs are changing. There is still a lot of rhetoric about participation, but the participation of disabled people in the planning process of INGOs is a growing reality.

关键词：用户参与/统计学和数值数据用户参与/发展趋势决策组织残疾人/统计学和数值数据欧洲法国大不列颠健康计划/组织和管理国际机构/组织和管理私营部门/组织和管理问卷调查人类

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Private health cave in Nigeria: walking the tightrope

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HEALTH POLICY AND PLANNING 1999年第2期14卷 174-181页

作者： Ogunbekun, I Ogunbekun, A Orobaton, N Mediplan Ltd Lagos Nigeria Gen Hosp Dent Ctr Lagos Nigeria Minist Hlth Basics Project Asmara Eritrea

The persistently low quality and inadequacy of health services provided in public facilities has made the private sector an unavoidable choice for consumers of health care in Nigeria. Ineffective state regulation, however, has meant little control over the clinical activities of private sector providers while the price of medical services has, in recent years, grown faster than the average rate of inflation. Reforms that are targeted at reorganizing the private sector, with a view to enhancing efficiency in the supply of services, are urgently required if costs are to be contained and consumers assured of good value for money.

关键词：发展中国家效率组织坚持准则卫生保健公平提供卫生保健改革卫生保健部门/组织和管理卫生经费支出/发展趋势卫生政策尼日利亚私营部门/经济学私营部门/组织和管理卫生保健质量/标准

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