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The purpose of this paper is to present the three critical changes needed to reform the US health care system – these changes will drive cascades of other beneficial changes. These three changes include the use of transparent market prices, alignment of incentives and systematic assessment and ratings of quality.

The paper used an analysis based on the literature on the comparison between non-market and market systems. The current US health care system is similar to the Soviet economic system, and the paper proposes moving it gradually to where it can respond to market-based signals.

The US health care system needs to adopt transparent and real pricing, independent quality assessment of health provider organizations and portable electronic patient records. These changes will lead to continuing cascades of innovation and improvement.

The recommended changes will be opposed by vested interest groups, and so will be easier with regulatory guidance and encouragement. It would also be useful to protect against “regulatory capture” by interested parties during the change process.

Health care in the USA will gradually become better and cheaper. Health organizations will become more transparent. Regulators would have to set up and supervise private quality ratings agencies.

Social implications of this paper include greater labor mobility and higher productivity, as well as increased competitiveness of the USA.

In spite of numerous writings on the subject, this issue has not been analyzed in this way. This paper is unique in the way in which it layouts the process of movement to a market-based system for the US health care system.

Purpose – This research considers how self-help groups (SHGs) and self-help organizations (SHOs) contribute to consumerist trends in two different societies: United States and United Kingdom. How do the health care systems and the voluntary sectors affect the kinds of social changes that SHGs/SHOs make?

Methodology/approach – A review of research on the role of SHGs/SHOs in contributing to national health social movements in the UK and US was made. Case studies of the UK and the US compare the characteristics of their health care systems and their voluntary sector. Research reviews of two community level self-help groups in each country describe the kinds of social changes they made.

Findings – The research review verified that SHGs/SHOs contribute to national level health social movements for patient consumerism. The case studies showed that community level SHGs/SHOs successfully made the same social changes but on a smaller scale as the national movements, and the health care system affects the kinds of community changes made.

Research limitations – A limited number of SHGs/SHOs within only two societies were studied. Additional SHGs/SHOs within a variety of societies need to be studied.

Originality/value of chapter – Community SHGs/SHOs are often trivialized by social scientists as just inward-oriented support groups, but this chapter shows that local groups contribute to patient consumerism and social changes but in ways that depend on the kind of health care system and societal context.

The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.

Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.

The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.

The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.

Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health insurance affect public opinion toward the current US health-care system. Opinions about the health-care system were measured in terms of consumer confidence and perceived need for health-care reform. Data come from the 2008 Cooperative Congressional Election Study (CCES), a nationwide survey of 1,000 respondents. All data were collected in November 2008, thus providing a useful alternative to volatile polling data because they were collected prior to and are thus immune to the polarized tone of the debates that have occurred over the past few years. Overall, we found that public confidence in medical technology and quality of care were consistently high, while confidence in the affordability of medical care was much lower among respondents. Younger adults, those with poor health, and those without health insurance had particularly low confidence in their ability to pay for health care. Although a strong majority of the population agreed that the US health-care system was in need of major reform, support for particular types of government-sponsored health insurance programs was primarily determined by political affiliation. In an era where a large proportion of the population has little access to health care (due to lack of insurance) and where the US government is facing tremendous opposition to the implementation of major reform efforts, it is useful to understand which subgroups of the population are most confident in the current health-care system and most likely to support reform efforts, as well as those who are most resistant to change given their precarious health needs, their inability to access health care (as a result of insurance or noninsurance), or their political affiliation.

The COVID-19 pandemic stressed the health care sector's longstanding pain points, including the poor quality of frontline work and the staffing challenges that result from it. This has renewed interest in technology-centered approaches to achieving not only the “Triple Aim” of reducing costs while raising access and quality but also the “Quadruple Aim” of doing so without further squeezing wages and abrading job quality for frontline workers.

How can we leverage technology toward the achievement of the Quadruple Aim? I view this as a “grand challenge” for health care managers and policymakers. Those looking for guidance will find that most analyses of the workforce impact of technological change consider broad classes of technology such as computers or robots outside of any particular industry context. Further, they typically predict changes in work or labor market outcomes will come about at some ill-defined point in the medium to long run. This decontextualization and detemporization proves markedly problematic in the health care sector: the nonmarket, institutional factors driving technology adoption and implementation loom especially large in frontline care delivery, and managers and policymakers understandably must consider a well-defined, near-term, i.e., 5–10-year, time horizon.

This study is predicated on interviews with hospital and home health agency administrators, union representatives, health care information technology (IT) experts and consultants, and technology developers. I detail the near-term drivers and anticipated workforce impact of technological changes in frontline care delivery. With my emergent prescriptions for managers and policymakers, I hope to guide sectoral actors in using technology to address the “grand challenge” inherent to achieving the Quadruple Aim.

The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.

Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.

Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.

By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.

The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

The purpose of this paper is to develop a perspective on what is “salient” or critical to the discipline of healthcare marketing by analyzing and contrasting the consumer (or patient) perspective with the institutional (or organizational) perspective. This “salience issue” is complicated by the structural problems in healthcare such as societal service systems, advances in medical technology, and the escalating costs of care. Reviewing selected studies, the paper examines how consumers face increasingly difficult health choices.

The paper examines the different priorities and goals for marketing that are implied by both patient and organizational perspectives in healthcare, focusing primarily on the excesses of the more “market‐based” US healthcare system.

Healthcare organizations need to better utilize marketing tools to inform consumers and assist their healthcare decisions. This effort needs to be balanced by healthcare organizations that can support the demand to improve quality and increase accessibility of care.

The perspective on the consumer (or patient) often becomes clouded amid the operation of increasingly complex and convoluted healthcare systems. A new perspective on healthcare marketing needs to be considered. Greater consumer access to healthcare information could improve patient decision making. To accomplish this, greater institutional diffusion of evidence‐based healthcare practices is needed to improve organizational performance.

The aim of this paper is to present a conceptual model on foreign-born health care workers from developing countries working in the US. The model covers their motivations for migration, the consequences in terms of the inequality and exclusion they may experience and the role of institutional responses at micro-, macro- and meso-level of intervention.

The paper is based on: (1) in-depth review of key literature studies on the foundation theories of international migration including sociology, economics, anthropology, psychology and human resource management, (2) analysis of theoretical approaches to medical migration across disciplines, (3) analysis of the international and national documentary sources of micro-, macro- and meso-level policies on migration and (4) analysis of evidence on best practices, solutions and aspirational changes across different levels of institutions.

(1) Migration of international medical graduates (IMGs) from developing countries to the US can be explained from a micro-, macro- and meso-level of analysis. (2) IMGs who identify as racial/ethnic minorities may experience unfair discrimination differently than their US-born counterparts. (3) Although political/legislative remedies have had some successes, proactive initiatives will be needed alongside enforcement strategies to achieve equity and inclusion. (4) While diversity management initiatives abound in organizations, those designed for the benefit of IMGs from developing countries are rare. (5) Professional identity groups and some nonprofits may challenge structural inequities, but these have not yet achieved economies of scale.

Although it is well-documented in the US health care literature how ethnic/racial minorities are unfairly disadvantaged in work and career, the studies are rarely disaggregated according to sub-groups (e.g. non-White IMGs and US-born MGs). The implication is that Black IMG immigrants have been overlooked by the predominant narratives of native-born, Black experiences. In placing the realities of native-born Blacks on the entire Black population in America, data have ignored and undermined the diverse histories, identities and experiences of this heterogeneous group.

An awareness of the challenges IMGs from developing countries face have implications for managerial decisions regarding recruitment and selection. Besides their medical qualifications, IMGs from developing countries offer employers additional qualities that are critical to success in health care delivery. Considering organizations traditionally favor White immigrants from Northern and Southern Europe, IMGs from developed countries migrate to the US under relatively easier circumstances. It is important to balance the scale in the decision-making process by including an evaluation of migration antecedents in comprehensive selection criteria.

The unfair discrimination faced by IMGs who identify as racial/ethnic minority are multilayered and will affect them in ways that are different compared to their US-born counterparts. In effect, researchers need to make this distinction in research on racial discrimination. Since IMGs are not all uniformly impacted by unfair discrimination, organization-wide audits should be in tune with issues that are of concerns to IMGs who identify as racial/ethnic minorities. Likewise, diversity management strategies should be more inclusive and should not ignore the intersectionality of race/ethnicity, nationality, country of qualification and gender.

Immigrant health care workers from developing countries are integral to the health care industry in the United States. They make up a significant proportion of all workers in the health care industry in the US. Although the literature is replete with studies on immigrant health care workers as a whole, research has rarely focused on immigrant health care workers from developing countries. The paper makes a valuable contribution in drawing attention to this underappreciated group, given their critical role in the ongoing pandemic and the need for the US health industry to retain their services to remain viable in the future.

Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health care. The purpose of this analysis is to compare how system-level differences affect IT implementation in health care (HIT) and the implications of these differences for health care equity.

We critically analyzed selected claims concerning the capacity of HIT to provide better care to more individuals at lower costs, thus contributing to health care equity, in the context of current health care reform efforts in the United States. We used the case of HIT implementation in Taiwan’s National Health Insurance system as a contrasting case.

We argue that however much HIT may yield in quality improvements or savings in the context of a universal and publicly financed single payer system, such savings simply cannot be accrued by a system of multiple health plans competing for better customers (i.e., less costly patients) and driven by profit.

It is important to define the level of analysis in debates about the potential of HIT to produce better health care at lower costs and the equity implications of this potential. In these debates, US policy makers should consider the commitment to health care equity that informed the design of Taiwan’s health care system and of HIT implementation in that country. HIT merely provides enabling tools that are of little value without major systemic changes

To our knowledge, the health IT expert literature has overlooked when not ignored the ethical principles informing health care systems, an omission which makes it difficult if not impossible to evaluate the potential of HIT to increase equity in health care.