Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 4 uppsatser.

Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++ / from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.

The private health care market in the United Kingdom is a multi-billion pound industry whose dynamics remain largely unexamined. This is so even though the boundaries between the public and private sectors are becoming increasingly blurred, particularly in England. Given the growing importance of this sector, the policy community needs to know more about the nature of private health care in the UK, how well the private market operates and how successful have been the various attempts within it to improve value for money and health care quality, given that private health care has traditionally been seen by many citizens as unaffordable. In particular this thesis traces recent efforts by the British United Provident Association (Bupa) to reshape the UK private healthcare market. The account provided draws on the author's experience as a senior Bupa manager involved in planning and implementing such changes. The thesis describes a series of Bupa initiatives designed to change provider behaviour in pursuit of improved quality and value-for-money, and the difficulties and obstacles encountered. The latter often centred on tensions or confrontation between the insurer and professional providers that are discussed in relation to the wider literature on the social and economic organisation of health care markets. An attempt has been made to draw some general conclusions via an empirical study of the role and limitations of market-based changes within the UK private sector. The broad conclusion is that the private market in the UK exemplifies those features of health care seen throughout the developed world that create imperfect market conditions. As such the market is highly resistant to insurer initiatives that would reverse the longstanding trend for premiums to rise above the rate of inflation. It is considered unlikely given the current market structure that any insurer, including Bupa, can escape these constraints in the short term. However, Bupa has implemented some successful initiatives that suggest that longer-term incremental change is possible.

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<p> Shared leadership paradigms are becoming more popular in organizations because of the increased responsibilities placed on leaders within health care organizations. Researchers have conducted little research on how individuals on leadership teams perceive their role in engaging with others in their team. The qualitative phenomenological hermeneutic study involved examining how radiology administrators in Northern California describe their lived experiences on shared leadership teams, with an emphasis on their perceptions of team productivity and trust. The conceptual framework for the study included shared leadership theory, which scholars have noted is still a new field of study. Seven research participants representing from three to 18 years of experience as radiology managers with experience serving on shared leadership teams. From the five initial questions and sub questions, the analysis involved breaking down the responses into 175 separate areas of exploration. In addition to the demographics of the groups and types of teams served on, four themes emerged from this data: lived experience on shared leadership teams, knowledge and skills learned from shared leadership teams, key factors affecting team performance on shared leadership teams, and the effect of diversity on shared leadership teams. The implications of the research to leadership are that radiology managers may gain a better understanding of when to use shared leadership and how to best staff the teams to support organizational work, and how to improve shared leadership team dynamics.</p>

<p>Oceanside Durable Medical Equipment (DME) is an accredited start-up company that will offer a comprehensive line of the latest medical supplies and equipment to patients in Long Beach, California. This company will focus on the distribution of leading medical equipment brands to patients who are in need of support for short-term and chronic health conditions. Durable medical equipment can offer help outside of the hospital environment and aid in a better quality of life. </p><p> With more than 2.4 million individuals over 60 years old in Southern California, there appears to be a large market and opportunity for this company. Oceanside DME will contract with leading medical equipment manufacturers and healthcare providers to deliver patients with quality products. A rapidly growing market for medical equipment will allow Oceanside DME to create a presence in this healthcare industry. </p>

<p> Traditional nursing homes are based on a model that can limit a resident&rsquo;s ability to make basic choices, minimize opportunities to direct their own lives, and ultimately destroy the human spirit. As an alternative to the traditional model, the household model is an arrangement in which small groups of residents direct their daily lives in a shared home setting (a household), supported by a decentralized self-led service team of frontline professionals empowered to be responsive to the residents&rsquo; needs. While many frontline nursing staff members are advocates of the need for change, it is also common for them to react negatively toward the process of household model implementation. The purpose of this qualitative study was to examine nurse aides&rsquo; and licensed nurses&rsquo; reactions to household model implementation. Sixteen semi-structured interviews were transcribed verbatim, divided into 524 units of meaning, and coded using concepts of Oreg, Vakola, and Armenakis&rsquo; (2011) theoretical model, derived from 60 years of qualitative studies on change recipients&rsquo; reactions to organizational change. In this model, employee reactions are a function of antecedents, categorized as pre-change (individual characteristics and internal context) and change antecedents (change process, perceived benefit/harm, and change content). Antecedents influence affective, cognitive, and behavioral reactions to change and, subsequently, lead to change consequences, including work-related and personal consequences. Two trained independent coders reviewed transcripts and achieved 70% agreement. Explicit reactions accounted for 48% of comments, followed by antecedents (27%) and change consequences (25%). Most common antecedents were related to change process (71%), perceived benefit/harm (24%), and change recipient characteristics (4%). Study participants reported difficulties with cross training, initial experiences of hardship and fear, confusion over the new model, and perceptions that it would be harmful to staff members and residents. Although experiences improved over time, some staff members, who self-identified as positive individuals, still reported perceived harm and engaged in resistant behaviors. Explicit reactions to change were behavioral (41%), cognitive (33%), and affective (26%). Most staff members supported household model implementation through their actions. They communicated with each other to learn and to cope with change. While three staff members actively resisted changes, they still supported at least some aspects of the household model. Cognitive and affective reactions were mixed, ranging from excitement and happiness to fear, nervousness, and frustration. Core household model components were received as positive, especially for residents. Concerns regarding work accounted for 94% of all reported organizational change consequences and included insufficient household staffing, harder working conditions, insufficient time to get everything done (or to do it well), and widespread feelings of isolation. The theoretical model for analyzing organizational change proved to be useful in understanding nursing staff members&rsquo; reactions to household model implementation and for identifying proactive steps to manage this change. Ongoing education is recommended to ensure staff members follow through with changes over time and to reduce confusion and perceptions of harm. The household model may need to be staffed at a higher level, at least initially, to maintain the same quality of care as in the traditional care delivery model. Ongoing team training within each household can serve to improve operations and balance responsibilities of blended roles. Due to the decentralized environments, potential feelings of isolation among residents and staff members are anticipated, which can be alleviated through regular multi-household gatherings.</p>

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