ETHICAL ISSUES REGARDING
e are often “of two minds” about something in life. Conflicting fac-
tors pull us in opposite directions and “we can see it both ways,” so
to speak. We feel ambivalent because there is a good deal to be said on
each of two diametrically opposed sides. This produces the sort of situation
which Marxist theoreticians liked to refer to as a contradiction. In such
cases the operation of conflicting forces impels us towards divergent and
laboratory services networks. We
also suggest that the core knowledge processes deserve a
system approach, for example, by applying a risk-based qual-
ity management system.
Clin Chem Lab Med 2010;48:919–25.
Keywords: clinical pathology; deliveryofhealthcare; effi-
ciency, organizational; health care economics and organiza-
tions; healthcare reform; integrated health care systems;
organizational models; quality assurance, health care.
*Corresponding author: Prof. Dr. Norbert Blanckaert, Department
of Laboratory Medicine, UZLeuven, Herestraat 49, 3000 Leuven,
Jahrbücher f. Nationalökonomie u. Statistik (Lucius & Lucius, Stuttgart 2007) Bd. (Vol.) 227/5+6
Die Ausgestaltung von Versorgungsverträgen:
Eine vertragstheoretische Analyse
A Contract Theory Approach to Health Care Contracting
Von Axel Mühlbacher, Neubrandenburg
JEL I11, I18, L14
Deliveryofhealthcare, integrated health care delivery systems; selektive contracting, risks, methods;
transactioncost, contract theory, principal-agent theory, incomplete contracts.
Transaction costs are an obstacle to the efficient operation of selective contracting. Health
To compare healthcare utilization and outcomes using the Carpenter-Coustan (CC) criteria vs. the National Diabetes Data Group (NDDG) criteria for gestational diabetes mellitus (GDM).
This is a retrospective cohort study. Prior to 8/21/2013, patients were classified as “GDM by CC” if they met criteria. After 8/21/2013, patients were classified as “GDM by NDDG” if they met criteria and “Meeting CC non-GDM” if they met CC, but failed to reach NDDG criteria. “Non-GDM” women did not meet any criteria for GDM. Records were reviewed after delivery.
There was a 41% reduction in GDM diagnosed using NDDG compared to CC (P=0.01). There was no significant difference in triage visits, ultrasounds for growth or hospital admissions. Women classified as “Meeting CC non-GDM” were more likely to have preeclampsia than “GDM by CC” women [OR 11.11 (2.7, 50.0), P=0.0006]. Newborns of mothers “Meeting CC non-GDM” were more likely to be admitted to neonatal intensive care units than “GDM by CC” [OR 6.25 (1.7, 33.3), P=0.006], “GDM by NDDG” [OR 5.56 (1.3, 33.3), P=0.018] and “Non-GDM” newborns [OR 6.47 (2.6, 14.8), P=0.0003].
Using the NDDG criteria may increase healthcare costs because while it decreases the number of patients being diagnosed with GDM, it may also increase maternal and neonatal complications without changing maternal healthcare utilization.
A recent settlement between Massachusetts and Partners HealthCare, along with successful antitrust actions by the Federal Trade Commission, may signal the beginning of the end of two decades of consolidation of health care providers. This consolidation has been associated with higher prices resulting from market power, justifying the antitrust actions. However, the appropriate remedy for the health sector is a unique challenge. The proposed settlement appears to lock into place the legacy of the hospital-based delivery model, rather than orchestrating a pathway to a new care delivery models. Clearly, we need a regulatory framework that will introduce innovative alternatives into the market, not enshrine the current costly paradigm.
Background: Diabetic ketoacidosis (DKA) is a life-threatening condition occurring in patients with newly developed type 1 diabetes.
Objective: To investigate the factors associated with the risk of DKA and the duration of diabetic symptoms reflected by glycated hemoglobin (HbA1c) level.
Methods: The study group included 652 children admitted to our department with newly diagnosed diabetes. Clinical data were collected from available medical records. The distance between the patient’s house and the hospital was calculated using a Google Maps-based distance calculator.
Results: Ketoacidosis of any severity was present in 189 patients (30.14%). The mean HbA1c level at admission was 11.76%±2.57%. Children admitted directly to the specialist center were less likely to develop DKA: odds ratio (OR) (95% confidence interval, 95% CI)=0.45 (0.26–0.78). Older age exerted a protective effect: OR (95% CI)=0.92 (0.87–0.96). Patients living farther from the center had higher HbA1c levels: β (95% CI)=0.10 (0.01–0.18). Having a parent with diabetes promoted an earlier diagnosis of diabetes, as evidenced by lower HbA1c: β (95% CI): –0.18 (–0.27 to –0.96) and marginally lower risk of DKA: OR (95% CI)=0.50 (0.22–1.12).
Conclusion: Rapid transfer to the specialist center plays a crucial role in the prevention of DKA.
Introduction: Chronic venous insufficiency (CVI) is a very common chronic disease, yet often overlooked by healthcare providers. Education of physicians may have a positive impact on better recognition and treatment of patients with CVI. Material and Methods: During the one year period (2011), we conducted a series of specialized courses on CVI for physicians in the South Bačka region. Before and after each course, the attendants were asked to complete entry and exit tests. During two three-year periods, before and after the education courses (2008 - 2010, and 2012 - 2014), data on hospital morbidity and number of patients with CVI, examined by physicians in general practice and in dermatological outpatient facilities in South Bačka region, Province of Vojvodina, were gathered and analyzed. Results: In the period 2008 - 2010, a total of 1.128 patients were hospitalized due to CVI with an average length of stay of 6.42 days. In the period 2012 - 2014, 1.296 patients were hospitalized and the average length of stay was 3.76 days. The number of hospitalizations increased in second period by 14.89%, and the average length of stay decreased by 41.43%. In the period 2008 - 2010, the total number of patients with CVI in the general practice was 13.624 and in the second period 14.931 patients. The number of examinations increased by 9.59%. In the period 2008 - 2010, there were 1.094 patients with CVI in dermatological outpatient facilities, and 1.165 patients in the second period,. A slight increase of 6.09% was noticed. After analyzing the entry and exit test results, on average, there were 7.35 correct answers in the entry test, and 8.89 correct answers in the exit test. An increase in knowledge by 20.95% was established. Conclusion: Education of physicians in primary and secondary health care facilities may have a positive impact on early diagnosis and better treatment of patients with CVI.
sufficient quantity. While in some
countries donor HM has been considered an effective tool in
the deliveryofhealthcare to infants, skepticism regarding
its nutritional and immunological quality has limited its dis-
tribution in other countries. The purpose of this paper is to
summarize the clinical benefits of donor HM in preterm
infants, and to discuss common concerns limiting its distri-
bution as standard care. Clinically, the use of donor HM has
been shown to prevent NEC, reduce feeding intolerance and
improve long-term outcomes in premature infants. Common
disattend the lack of assessments, instead continuing with
`business at usual'. Patients display an orientation to the absence, using
various strategies `unsuccessfully'. Implications are discussed in relationship
to aliation and social support, important in the deliveryofhealthcare.
Several explanations for absent assessments in medical interviews are
Keywords: medical interviews; physician-patient communication;
assessments; social support; conversation analysis.
A medical interview is accomplished through the talk of two partici-
pants: a medical