From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

Flynn, Kathryn E.; Smith, Maureen A.; Davis, Margaret K.

doi:10.1177/107755802237811

Cited by 31 publications

(20 citation statements)

References 110 publications

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“…42 Because the professional status of providers is linked so strongly to their autonomy, they may resist system efforts to manage the process of medical care as infringing on their autonomy and degrading their professional status. Recognizing potential resistance and obtaining strong support from key opinion leaders 43 is essential to effective implementation of the SEIPS model.…”

Section: Box 3 Seips Model For Accident Investigationmentioning

confidence: 99%

Work system design for patient safety: the SEIPS model

Carayon

Hundt

Karsh

et al. 2006

Qual Saf Health Care

1,312

1,244

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Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described. Most errors and inefficiencies in patient care arise not from the solitary actions of individuals but from conflicting, incomplete, or suboptimal systems of which they are a part and with which they interact. To improve the design of these systems, the US Institute of Medicine (IOM) has proposed the application of engineering concepts and methods-in particular, human factors and systems engineering. 1-3Emphasis on system design was promoted in a recent report by the National Academy of Engineering and the IOM: ''… it is time to… establish a vigorous new partnership between engineering and health care and hasten a transition to a patient-centered 21st century health care system''.4 Our research program, the Systems Engineering Initiative for Patient Safety (SEIPS, http:// www2.fpm.wisc.edu/seips/), originally funded by the Agency for Healthcare Research and Quality, meets this challenge through a novel integration of human factors and healthcare quality models and proposes the SEIPS model of work system 5-7 and patient safety. Patient safety researchers clearly recognize the need for human factors engineering and systems approaches to patient safety research, analysis, and improvement. However, noticeably missing from the patient safety literature are models to guide studies to empirically examine system design in relation to patient safety and medical errors. The model described by Reason, 8 often referred to as the ''Swiss cheese'' model, is probably the most well known system model used within the patient safety community. Vincent et al 9 have expanded Reason's model and described seven categories of factors that influence clinical practice, such as organizational and management factors, work environment, team factors, task factors and patient characteristics. The Haddon model, which is used commonly in epidemiology and injury prevention, has been proposed for use in quality and safety. A comparison of the strengths and weaknesses of the SEIPS model, the Reason/Vincent model, and Donabedian's quality model is shown in table 1. The SEIPS model explains how the design of the work system can impact not only the safety of patients but also employee and organizational outcomes. Employee outcomes include safety, health, satisfaction, stress and burnout; organizational outcomes include rates of turnover, injuries and illnesses, and organizational health (profitability).In this paper we describe the SEIPS model and its research and pra...

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Section: Box 3 Seips Model For Accident Investigationmentioning

confidence: 99%

Work system design for patient safety: the SEIPS model

Carayon

Hundt

Karsh

et al. 2006

Qual Saf Health Care

1,312

1,244

View full text Add to dashboard Cite

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“…Savings mainly concern pharmaceutical costs ( Galt et al, 2001). Other studies have confirmed the unpopularity of gatekeeping due to its intrinsic limitations regarding choice of a medical practitioner (Flynn et al, 2002).…”

Section: Controlling Patient Care Consumptionmentioning

confidence: 94%

Medical Practice under Managed Care: Cost-control Mechanisms and Impact on Quality of Service

Simonet

2005

Public Organiz Rev

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The paper investigates the US experience of Managed Care. It describes the cost controlling measures and the new modes of payment that were implemented along with managed Care. Using theory and field surveys, it reviews how these measures have affected physician practices. The paper also investigates their impact on the quality of health services. Copyright Springer Science + Business Media, Inc. 2005HMO, Managed Care, patient, US, physician payment,

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“…In the capitation payment system, all health-care providers should recalculate the allocation of the cost of services and the cost of medications, thus improving the quality of service. One study conducted by the Division of Health Services Research and Policy, University of Minnesota also has proved that this method of financing health-care provider influence behavior [3]. Satibi et al Table 3 shows that the average percentage of the cost of drugs to the clinic capitation pratama in clinical pharmacy pratama worth 15.91%, meaning that this value is greater than the pharmacy network.…”

Section: Analysis Of the Percentage Of Drug Costs To The System Of Camentioning

confidence: 99%

Drug Cost Analysis on National Health Insurance Era in Health Support Facilities

Satibi

Dewi

Akhmad

et al. 2017

Asian J Pharm Clin Res

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Objective: In national health insurance (JKN) era, pharmacy can play roles in the form of behind refer pharmacies, or networking pharmacy and clinic pharmacy pratama. Behind refer pharmacies drug cost can be claimed directly to BPJS, meanwhile for the other type of pharmacy have to negotiation first with the primary health care. Drug cost variations in the JKN era affect the profitability of the business pharmacies. This research aims to the drug percentage charges against capitation and variety of drug costs. Methods:This research is analytic observational cross-sectional. This research uses secondary data from a JKN prescription patient. This research was conducted on 6 affiliated pharmacies, 6 networking pharmacies, and 7 clinical pharmacy pratama in DIY. The sampling in this research is by purposive with 8.430 prescriptions. Data drug costs JKN era was analyzed by descriptive statistics and comparative test (Kruskal Wallis test). Results:The result showed that average percentage of drug costs for capitation fee in the networking pharmacy is 13.58% and primary health care is 15.91%. Pharmacy in JKN era has drug cost variations (p=0.000). Drug cost in JKN era depends on the pattern of play roles with the health facilities and BPJS. The average percentage of drug costs against capitation health facilities in networking pharmacy is lower than clinical pharmacy pratama. Conclusions:Drug costs in an era of JKN depending on the pattern of cooperation with health facilities pharmacies and BPJS. The average percentage of the cost of drugs to the pharmacy capitation health facilities in networking lower than clinic pharmacy pratama. Differences in drug costs JKN era influenced by the long days of drug administration, the number of prescription sheets, margin.

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From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

Cited by 31 publications

References 110 publications

Work system design for patient safety: the SEIPS model

Work system design for patient safety: the SEIPS model

Medical Practice under Managed Care: Cost-control Mechanisms and Impact on Quality of Service

Drug Cost Analysis on National Health Insurance Era in Health Support Facilities

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