This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure. This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure.

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures. As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby boomers becoming eligible every day, and the ongoing national conversation about healthcare more generally, approaches to Value-Based Purchasing (VBP) are becoming more common. Organizations seeking to identify the types of VBP arrangements in which they should enter have precious little information on the comparative performance of VBP approaches relative to outcomes measures. Different structures create different incentives through the plan design and risk/reward. The convergence or dissipation of the plan incentives at the level of the provider, particularly in primary care, may be a source of variance. This study is retrospective, non-experimental, and uses publicly available data on the performance of Medicare ACO and HMO plans in calendar year 2015, for the identified measures. Using the Donabedian Structure-Process-Outcome framework, this study explores the impact of structure by type of plan and size of population served, relative to the outcomes. Race, average Hierarchical Condition Category (HCC) risk score and duration of operations are control variables. The analysis uses multiple hierarchical regression to better understand the relationship between the independent variables (IV) and DVs, after the impact of the control variables (CV). After controls, the IVs did offer some explanation of variation in outcomes. The ACO plans fared better on HbA1c control, while HMO plans had fewer ER visits per 1,000. No discernable difference existed between the HMO and ACO plans with regard to colon cancer screening rate. Serving larger populations led to better performance on all three measures. In general performance was worse on each measure in both models when the percent of not-White patients or average HCC risk score increased. A longer duration of operations also associated to better performance on the outcome measures.

Accountable care organizations (ACOs) are a new health care reform initiative that has been highlighted as one of the most important organizational structures that could lead to quality improvements and cost savings in the United States through shared savings. The inability of health care managers to successfully implement ACOs could result in financial losses, reduced patient access to health care, and poor patient outcomes. Grounded by von Bertanlaffy's general systems theory, the purpose of this multiple case study was to explore the system change strategies health care managers used to implement an ACO to meet ACO quality and cost standards. Health care managers from Arizona, New York, and Wisconsin who successfully implemented ACO system change strategies in their organizations comprised the population for this study. Data were collected through face-to-face semistructured interviews with 9 health care managers. Data were analyzed using methodological triangulation, thematic analysis, and Yin's 5 analytic techniques to identify patterns and themes. Three main themes resulted from the data analysis and included leaders with system change strategies improved successful ACO implementation, leaders who implemented health information technology improved successful ACO implementation, and leaders with care management system change strategies improved successful ACO implementation. The application of the findings from this study may contribute to positive social change because health care managers may use these system change strategies to successfully implement ACOs to improve patient care and access and reduce the financial burden of health care costs throughout the United States.

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

L'accès aux thérapeutiques de reperfusion (thrombolyse/thrombectomie) dans les délais recommandés constitue l'enjeu principal de la prise en charge de l'accident vasculaire cérébral (AVC) à la phase aiguë. Actuellement, seuls 20% des patients éligibles en bénéficient, en raison de difficultés à identifier l'AVC et de délais de prise en charge prolongés. La filière de soins optimale pour l'AVC à la phase aiguë comprend l'appel au 15 dès la survenue des symptômes et un transfert direct du patient en unité neurovasculaire (UNV). Cependant, une 1ère étude menée dans le Rhône en 2006-2007 (AVC 69) avait objectivé que la filière de soins passait par les urgences dans 80% des cas et que seuls 10% des patients éligibles étaient thrombolysés. Les principaux retards identifiés dans la prise en charge concernaient au niveau préhospitalier, l'identification de l'AVC et l'appel au 15 par le patient ou les témoins, et au niveau intrahospitalier, le parcours de soins dans les services d'urgences, l'obtention de l'imagerie cérébrale et le transfert en UNV. Pour répondre à ces problématiques, nous avons mis en place un programme visant à améliorer la prise en charge de l'AVC en région Rhône-Alpes. Notre travail de thèse rapporte 3 projets menés au sein de ce programme : Le premier projet ciblait la phase préhospitalière. Il a permis d'évaluer la perception de l'AVC au sein de la population générale, afin de proposer une campagne d'information pertinente. Nous avons étudié l'impact de cette campagne dans le Rhône sur l'appel au 15 et les connaissances de la population sur l'AVC. Le second projet a évalué une intervention multifacettes de formation des professionnels des services d'urgences dont l'objectif était de diminuer les délais de prise en charge intrahospitaliers et améliorer l'accès à la thrombolyse. Le troisième projet a porté sur l'étude de la validité des bases de données médico-administratives hospitalières pour identifier les AVC, en vue de l'utilisation de ces bases à des fins épidémiologiques ou pour la construction d'indicateurs de suivi de la performance. Les interventions déployées au sein du programme ont permis d'améliorer le recours à l'appel au 15 et le taux de thrombolyse, néanmoins l'ampleur des effets observés reste limitée et aucun effet sur les délais n'a pu être mis en évidence. Un approfondissement des mécanismes d'action des interventions est nécessaire pour pouvoir proposer des interventions plus efficaces / The main issue in the management of acute stroke is access to reperfusion strategies (ie thrombolysis or thrombectomy) within the recommended time window. Currently, fewer than 1 in 2 eligible patients are receiving this treatment, partly because of difficulties in stoke identification and extended treatment delays. The optimal care pathway for acute stroke includes immediately calling emergency medical services (EMS) at symptoms onset followed by a direct transfer to the stroke unit (SU). However, a previous study carried out in 2006-2007 in the Rhône region (AVC69) pointed out that 80% of patients were managed in the emergency unit and only 10% of eligible patients were thrombolysed. Delays in management were identified at different stages: at the prehospital level, for stroke identification and the EMS call, and at the inhospital level with inefficicent processes in emergency units, delays in cerebral imaging obtaining and for SU transfert. To address these problems, we have set up a program to improve stroke management in the Rhône-Alpes region. Our work reports 3 projects carried out within this program: The first project identified stroke representations in the general population in order to design a relevant information campaign. Then, we studied the impact of this campaign on the number of EMS call for stroke suspicion and on population's knowledge about stroke. In the second project, we developed and evaluated a multifaceted training intervention for emergency units professionals aimed at reducing inhospital management times and improving access to thrombolysis. The third project analyzed the validity of hospital medico-administrative databases to identify strokes, in anticipation of the use of these databases for epidemiological studies or for the construction of performance indicators. Interventions within the program improved the EMS call and thrombolysis rate, but the magnitude of observed effects remained limited and no effect on management times could be observed. A deeper understanding of the mechanisms of intervention is needed to further design more effective interventions

No description available.

近年來，隨著臺灣醫療產業的重要性漸增及其所面臨的種種挑戰，個別醫院面臨的生存壓力漸增，醫院組織的策略議題也漸受重視，過去文獻多著重於營利組織的策略管理探討，醫院組織雖非以營利為目的，卻仍須重視成本控管與績效表現，以提供更優質的醫療服務，其中，提升資源運用與配置效率是相當重要的課題。 智慧資本導航分析法(ICN)過去多應用於營利企業，本研究目的在於引進ICN分析技術，以量化指標和圖形呈現輔助，分析醫院對於智慧資本資源運用之管理議題。本研究以某個案醫院為例，研究期間歷時10個月，訪談對象為8位來自醫院各部門的高階經營主管，於專業領域的經歷與年資皆相當豐富，各主管針對醫院資源的相對比重及資源間的轉換進行評估，並提出理想狀況的資源轉換關係，作為未來策略發展的參考依據。 研究結果分別回答三大研究議題，就醫院中各項資源的轉換關係來看，「人力資本」主要貢獻於醫師、醫療人員及聲譽形象，且期望於未來投入更多於組織策略與行銷的能力提升和顧客關係的建立；「組織資本」主要貢獻於行政人員、醫師、醫療人員、資訊管理、創新學習、財務管理和流程管理，以吸引人才、提升人力素質和提升組織管理效率為組織創造價值；「關係資本」主要貢獻於強化組織與外部利害關係人之關係。就各項資源間轉換的對稱性而言，各項資本對「關係資本」的投入普遍大於從「關係資本」所獲得的反饋，代表組織未來可思考提升「關係資本」對其他資本的貢獻。此外，傳統資源對智慧資本的貢獻亦大於從智慧資本所獲得的反饋，部分原因可能來自智慧資本的反饋較難具體衡量，而未來仍應以策略目標作為提升智慧資本運用效率的前提。最後，就個案醫院而言，「人力資本」不僅是最重要的資源，同時也是組織價值創造的來源，其中又以醫師、醫療人員和高階管理為主，代表知識與專業是醫院高績效表現最重要的兩項資源。 / This research aims at adopting the intellectual capital perspective and its analytical approach in the managerial practice of a health-care organization. The concept of intellectual capital has been applied to the practice of for-profit organizations. However, health-care organizations, which were regarded as non-for-profit, have not been paied close attention to their resource management. Based on intellectual capital perspective, this research introduces Intellectual Capital Navigator (ICN) approach to evaluate the efficiency of using resources.. This research is conducted by an in-depth study on a hospital, demonstrating the importance of needed resources and analyzing the resource transformation among human capital, organizational capital, relational capital, physical capital and monetary capital. The conclusion of this research found that human capital contributed more to itself and organizational capital. Moreover, it is expected to contribute more to relational capital in the future. When it comes to the symmetry of transformations, ICN analysis shows that each capital contributed to relational capital more than getting from it, and that traditional capital contributed to intellectual capital more than getting from them. This study also found that human capital is the most important value source in the hospital. Therefore, the hospital should pay more managerial attention to the balance and asymmetric transformation among resources to enhance the effectiveness and efficieny of its resource management. The adoption of ICN analytical approach into health-care organization extends the application of intellectual capital management.

Po Lietuvos neprikausomybės atkūrimo, šalies politinis ir ekonominis vystymąsis atskleidė daugybę, neišspręstų ar naujai iškilusių, socialinių problemų (klausimų), todėl iškilo socialinių darbuotojų poreikis įvairiose visuomenės gyvenimo srityse, tame tarpe ir sveikatos priežiūroje. Sparčiai didėjo supratingumas, kad sveikatos priežiūra yra ne tik ligų diagnozavimas, gydymas, prevencija. Labai svarbi visuomenės sveikatos sudėtinė dalis yra pačio paciento slauga. Šiandien socialinių paslaugų pasiūla pacientams yra nepakankama Lietuvoje. Savarankiškumą praradę ar sunkiai sergantys ligoniai turi gauti kvalifikuotas socialines paslaugas. / After Lithuania regained its independence, many of the country's unsolved social problems soon became apparent. These problems illustrated the need for a properly trained labor force of social workers equipped to deal with them, particularly in the field of health care. It soon became clear that effective health care prevention was every bit as important as diagnosing and curing disease. A very important component of such health care is the nursing care and social support that patients receive, but the provision of such care is still insufficient in Lithuania . Patients that have lost their independence and are seriously ill must receive adequate care and support.

The Patient Protection and Affordable Care Act (PPACA) represents one of the most significant pieces of legislation in the history of United States healthcare. The PPACA has two main goals: to increase the insured patient population in the US and to reduce the overall cost while improving the quality of healthcare in the US. To accomplish the latter goal, healthcare providers are experiencing a movement toward integrated, team-oriented models that place increasing accountability on the providers and institutions. At the same time, these integrative models emphasize effective preventive care, which is critical in reducing the country’s overall healthcare costs. As more health care institutions and providers across the country adopt the healthcare reform models of the Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) directly under the PPACA, the demand for pharmacists is increasing. In addition, the role of the pharmacist through Medication Therapy Management (MTM) is growing as more public and private sectors adopt MTM and its standards are being used as the medication-related cornerstone for the ACOs. There is a call for lower costs and higher quality outcomes in healthcare, and the pharmacists are increasingly integrated into direct patient care and medication management. The newly integrated responsibilities of the pharmacist are numerous and almost limitless. The roleof pharmacists is expanding, and as many studies suggest, their contributions produce auspicious results.