This article examines the various kinds of health care financing models found in selected developed countries. A discussion of health care delivery models is followed by an overview of the national health delivery systems found in European, South America, Asian, and North American. A discussion on health reform focuses on the shift in financial resources from private to public sources in the economies of most nations.
Background The purpose of this study was to examine factors influencing a woman’s decision to participate in a breast cancer prevention clinical trial. Nine health care organizations in Massachusetts cooperated in the present project. Methods We performed a case-control study to compare responses between the study group (STAR trial eligible, but not enrolled) and the control group (STAR trial participants) on 12 factors previously identified as barriers to accrual for clinical trials. Eight hypotheses were tested using multiple logistic regression to estimate the strength of the association for each factor on the dependent variable (study participation). Results The study samples were similar to the general population of eligible breast cancer prevention clinical trial subjects in the counties where the participating organizations were located, the state of Massachusetts, and to nationally published STAR-trial data. Results of a mailed questionnaire showed that when adjusting for subject demographics, and in the presence of other questions, four factors (1) clinician expertise and qualifications (p =.012, OR: 4.903; 95% CI: 1.41 to 17.04); (2) personal desire to participate (p =.033, OR: 3.16; 95% CI: 1.10 to 9.06); (3) perceived value of the trial (p =.020, OR: 2.92; 95% CI, 1.18 to 7.21); and, (4) level of trial inconvenience (p =.002, OR: 0.10; 95% CI, 0.02 to 0.44), significantly influenced a woman’s decision to enroll onto a breast cancer prevention clinical trial more than other eligible subjects. Conclusions We conclude that addressing these issues in the relationship between patients and clinicians should improve accrual onto breast cancer prevention clinical trials.
In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.
The impact of recently passed health reform legislation may cause substantial changes in community health center (CHC) operations. The new legislation provides federal funding for center expansion, increased Medicaid enrollment, enhanced Medicare payments, training to increase primary care providers, and incentives to develop CHCs as accountable care organizations. Health reform could place CHCs in a vulnerable financial situation. Newly insured patients may seek care at private providers, whereas CHCs are left caring only for the uninsured. Thus, CHCs are unable to benefit from enhanced insurance payments needed to offset care given to the uninsured. Conversely, if CHCs participate in developing comprehensive care networks for low-income populations by strengthening referral networks, developing primary medical care homes and accountable care organizations, and investing in infrastructure, then health center medical care will be a desired option for the newly insured, and a robust safety-net system may result.
It is useful for health care managers to understand Medicare's history and the impact on providers of ever-changing Medicare payment methods. Initially, Medicare payments resembled those of commercial insurance plans and Blue Cross Blue Shield plans. When Congress became concerned about the increasing costs of Medicare, new payment methods were created to limit payments to providers. The prospective payment system, imposed on hospitals in 1987 and later on nursing homes, home health agencies, and other services, has been adapted by commercial plans, Blue Cross Blue Shield associations, and state Medicaid programs. Changes in payer reimbursements require health care managers to adjust the department's charge master and exert more control of departmental costs. The story of Medicare's beginnings and development can provide some insight into the possibility of national health insurance, given the historic and current politics that limit publicly financed social programs. This article discusses the development of Medicare and its administration and serves as an introduction to the complex realities of health care reimbursement policy.
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