Tuesday, May 8, 2012

ANA Recognized Terminologies

HIMSS

It is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare.

frames and leads healthcare practices and public policy through its content expertise, professional development, research initiatives, and media vehicles designed to promote information and management systems' contributions to improving the quality, safety, access, and cost-effectiveness of patient care

NANDA

Implementation of nursing diagnosis enhances every aspect of nursing practice, from garnering professional respect to assuring consistent documentation representing nurses’ professional clinical judgment, and accurate documentation to enable reimbursement. NANDA International exists to develop, refine and promote terminology that accurately reflects nurses' clinical judgments.

Outcome and Assessment Information Set (OASIS)

The purpose of this site is to store and disseminate policy and technical information related to OASIS (the Outcome and Assessment Information Set) data set for use in home health agencies (HHAs), State agencies, software vendors, professional associations and other Federal agencies in implementing and maintaining OASIS.

Clinical Care Classification

provides a standardized framework and a unique coding structure for assessing, documenting, and classifying patient care by nurses and other clinical professionals in any health care setting

being used to document nursing care in the electronic health record (EHR) computer-based patient record (CPR) and Personal Health Record (PHR) Systems. It serves as a language for nursing and other health care providers such as physical, occupational, and speech therapists, medical social workers, etc.

The CCC System is used to:

· Document integrated patient care processes

· Classify and track clinical care

· Develop evidence-based practice models

· Analyze patient profiles and populations

· Predict care needs, resources, and costs

They are also used to develop clinical plans of care, clinical pathways and guidelines as well as for research and educational purposes.

International Council of Nurses

The goals of the Programme are to support eHealth practice, to be recognized as an authority on eHealth, and to be positioned centrally in the eHealth Community. With policies and strategies applicable throughout the ICN pillars and programmes, the ICN eHealth programme seeks to advance nurses' knowledge of and involvement in eHealth worldwide.

AORN

“Association of periOperative Registered Nurses”

AORN’s mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses

SNOMED CT

is the most comprehensive, multilingual clinical healthcare terminology in the world.

contributes to the improvement of patient care by underpinning the development of systems that accurately record health care encounters and to deliver decision support.

ABC Codes

ABC codes are a shorthand means of documenting healthcare procedures and treatments. Codes are an essential tool when computers are used to reduce paperwork and costs. Codes are also essential for managing the healthcare supply chain.

LOINC

“Logical observation Identifiers names and codes”

· is a universal code system for identifying laboratory and clinical observations.

· has standardized terms for all kinds of observations and measurements that enable exchange and aggregation of electronic health data from many independent systems.

0 comments

Canadian Nursing Informatics Association

· exists to help nurses across Canada to learn, share, research, and create informatics-related projects and experiences that can help to boost the competencies, theory, and practice of informatics on a national level.

Goals

· To provide nursing leadership for the development of Nursing/Health informatics in Canada.

· To establish national networking opportunities for nurse informaticians.

· To facilitate informatics educational opportunities for all nurses in Canada.

· To engage in international nursing informatics initiatives.

· To act as a nursing advisory group in matters of nursing and health informatics.

· To expand awareness of Nursing Informatics to all nurses and the healthcare community.

ACENDIO

The Association for Common European Nursing Diagnoses, Interventions and Outcomes is a membership organisation established in 1995 to promote the development of nursing’s professional language and provide a network across Europe for nurses interested in the development of a common language to describe the practice of nursing.

International classifications have potential for nursing: nurses in some countries are using the International Classification of Functioning (ICF). The International Council of Nurses has progressed the development of the ICNP (the International Classification of Nursing Practice).

ACENDIO supports this process by providing:

· Conferences, publications and presentations to advance understanding and work in this area

· A network for nurses in different European countries so that they can share knowledge about developments

· Resources such as reference lists and sample methodologies for developing and evaluating nursing vocabularies

· Interpretation of International standards for terminologies and classifications

EUROPA.EU

The site gives you:

· basic information on how the EU works

· the latest EU news and events

· links to EU information on the websites of EU institutions and agencies.

0 comments

IT Trends

· Security technologies, including biometrics

· “Intelligent" machines and robots that respond to human needs and patterns

Phones 2013

· Phones will be low-powered, lightweight, ear-mounted, and equipped with one follow-you phone number. It will connect to the Net via the PDA.

Writing Pens 2013

· As you write with your pen, it captures your scrawled messages and beams them to your PDA or your tube rollup monitor.

PDA 2013

· The PDA of the future will connect to the Net and replace money, keys, credit cards, and remotes.

PDA Agent ID 2013

· By using new scanning technology that verifies the user's thumb-print, the PDA will open doors to cars, homes, and offices. It will secure access to your personal databases, such as online medical records, and guarantee their privacy.

Laptop 2013

· The laptop with voice recognition will make keyboards obsolete and a rollout LCD screen permits the monitor to scroll.

Computers 2013

· Computer displays and TV monitors are replaced by one lightweight, flat LCD panel that can be placed on a desk or hung on a wall. Your PDA pulls up your personal desktop configuration for work or for play.

Medical Diagnosis 2013

· A camera and LCD screen analyze skin color and provide a real-time link to doctors. "Point-at-what-hurts" interaction aids diagnosis. The device lets you monitor your parents' health, too

E-Map 2013

· Electronic ink and GPS combine to provide a lightweight moving map that displays your exact location in all terrains.

Seating 2013

· Chairs will be made of a gel that conforms to your body shape and will be matched to human tissue to provide a subtle massaging.

· People will be able to heat and cool their chair and change its configurations for
perching, lounging, and sitting.

Connectivity 2013

· Most electrical appliances connected to Web - machine to machine communication.

· Washing machine using too much water—message sent electronically to Maytag that a repair is needed.

Cable 2013

· Television will contain a hard disk to record shows—1 terabyte of space to store hundreds of hours of high-definition programming.

· Shows can be seen when you want to see them—not just when they are transmitted.

· Entertainment sold as a pay-per-view fee or as a monthly subscription.

Identification 2013

· Radio-frequency identification tags (RFID) to keep track of inventory and payment. RFID chips are the size of a grain of rice and will sell for one cent.

· People will bag the products and a RFID will total the products and deduct from your RFID credit card in your wallet.

· RFID will mark the beginning of the end for paper cash money.

Communications 2013

· Reliable speech recognition will allow computers, phones, and household appliances to understand spoken commands.

· Commands such as “Car, how far to the next gas station?” will be common.

Top Technologies in Health

Bar Code Scanner/
Bedside Computers

· Nurses scan a patient’s wrist band and the label on a bottle or IV bag allowing them to confirm that they are giving the right patient, the right drug, the right dose, the right route at the right time.

· Bedside computers give nurses access to the patient’s medication administration record where they can check for drug/drug or drug/ food allergies

Smart Pumps

· are computerized pumps that automatically alert healthcare practitioners when the IV infusion program is set in error and could potentially cause harm to the patient. If the dose entered is above or below the pre-set limits, the smart pump will trigger an alert.

E-detailing

· After office hours physicians can log on to a Web site and interact via a call center with pharmaceutical sales reps who can update them on the latest drugs. They can also participate in Web-based meetings and talk to pharmacists and other clinical specialists about the results of new drug studies or the latest treatment options.

Pharmacy Automation

· automated drug distribution systems free pharmacists from routine tasks by tracking, managing, replenishing drug inventory and dispensing medications. They are often linked with a bar code system that helps assure that the right meds are dispensed to the right patients.

Radio Frequency Identification (RFID)

· Are similar to tags on clothes in a department store. They contain a chip that allows for the tracking of a drug through various points in the distribution system, from the manufacturing plant to the warehouse to the pharmacy or hospital

Computerized Physician Order Enter (CPOE)

· allows prescribers to enter electronically a prescription or other medical instructions into an electronic system that can be transmitted through a computer network where other physicians, pharmacists, nurses, and lab and radiology personnel can gain immediate access. It can help to speed up drug orders and reduce errors associated with poor handwriting and errors in transcription.

SECURITY AND BIODEFENSE

Isis Pharmaceuticals

· is exploiting its expertise in RNA to discover and develop novel human therapeutic drugs for its pipeline and its partners. The company has successfully commercialized the world's first antisense drug and has 11 antisense products in development to treat metabolic, cardiovascular, inflammatory and viral diseases and cancer.

Cepheid

· is a leading developer, manufacturer and marketer of fully integrated systems that enable genetic assessment when and where it is needed. Founded in 1996, the company is commercializing its technology and products world wide for research, medical, and industrial applications requiring assessment of the human genome, infectious disease and biothreat agents.

Nanotechnology for Healthcare

· 'Nanotechnology for healthcare' offers unique opportunities for radically improved diagnosis, prevention and treatment of diseases. An example is the development of nanoscale sensor elements, such as silicon nanowires that have been coated with a specific disease-related protein or DNA segment.

0 comments

Friday, May 4, 2012

A retrospective analysis of health systems in Denmark and Kaiser Permanente

Abstract

Background

To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy.

Methods

Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability.

Results

A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS).

Conclusion

Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred.

Source: http://www.biomedcentral.com/1472-6963/8/252#sec4

Insights:

This article is about the analysis of Denmark Healthcare System and Kaiser Permanente. Having comparisons and analysis will determine the strengths and weaknesses of the system which will need improvements. According to the results, Denmark has the need of more improvement and development than California. The focus of improvement must be on modifiable and transferable practices, quality documentation, measurement, and outcomes, and medical costs, factor costs, and resource use.

0 comments

Japan’s Health Care System: Containing Costs And Attempting Reform

1. Naoki Ikegami and

2. John Creighton Campbell

Next Section

Abstract

As Japan’s economy declined, more intensive control of prices and even volume through the fee schedule, plus increases in various copayment rates, led to an actual reduction of medical spending in 2002 for the first time in history. To augment established mechanisms of cost containment, case-mix-based inclusive fees for inpatient care were introduced in university hospitals in 2003 and are planned for subacute and long-term care. However, substantial reform, including the introduction of market-based medicine, is not likely to occur in other areas. Progress in making the delivery system more accountable to patients has been meaningful but slow.

Japan cut medical spending in 2002 for the first time in its history, adding fuel to proposals for more radical reforms.

National health spending in japan decreased in fiscal year 2002 for the first time in history. The cut was achieved not by radical restructuring but by relying on traditional measures. In the 2002 regular biennial review, prices of medical services and drugs were cut by an average of 2.7 percent, which led to a change in overall health spending of −0.7 percent.¹ Also, several reform proposals were aimed at efficiency in the payment structure, health insurance system, and medical care delivery, prompted by economic stagnation. Another concern was the criticism that Japan’s health care system is insufficiently accountable. Before describing current and proposed reforms, this paper describes the context in which the recent reduction was achieved. More detailed descriptions of the Japanese health care system have been published elsewhere.²

Previous Section Next Section

Trends In Medical Spending And Prices

Exhibit 1⇓ shows the annual percentage increases in Japan’s gross domestic product (GDP), national medical expenditures (NME), and average medical prices as established by the national fee schedule. NME is the amount calculated by the government for all medical services funded by the public health insurance system and general revenues; it includes patient copayments.³ Since health and fiscal policies are focused on nominal NME rather than the per capita or deflated amount, our analysis uses these figures.

View larger version:

· In this page

· In a new window

· Download as PowerPoint Slide

EXHIBIT 1

Annual Changes In Japan’s Gross Domestic Product (GDP), National Medical Expenditures (NME), And Average Fee-Schedule Prices, 1980–2002

The first point to note is the relationship of NME to GDP (Exhibit 1⇑).⁴ If averaged out for the whole period 1980–2002, NME increased at an annual rate of 5 percent, compared with 4 percent for GDP. However, the pattern is quite different between the 1980s, when the economy expanded at the rate of 6.4 percent, and after 1990, when the rate was just 2.0 percent. From 1980 to 1989, since NME grew at about the same rate as GDP, the ratio remained constant at around 5 percent. However, after 1990 the economy declined sharply; in the latter half of the decade the nominal growth rate of GDP became zero or even negative. During this deflationary period the growth rate of NME actually declined, but less so than that of GDP, so that the health care share of the economy increased from 4.6 percent in 1990 to 6.0 percent in 1999. The rise in this closely watched indicator brought widespread concern that health care costs were out of control. The trend continued: In 2001 the ratio jumped again to 6.5 percent and stayed at that level for 2002, despite the fact that health care spending had actually decreased.

The second point is the impact of revisions in the national fee schedule on NME growth. The fee schedule sets the price for all procedures, drugs, devices, and so on, and it applies uniformly to all plans for reimbursement to virtually all hospitals and physicians’ offices. Revisions are politically negotiated between the government and providers, usually on a biennial basis. Exhibit 1⇑ also shows the global average rate of change in prices for all procedures and drugs, adjusted for volume. It can be seen that medical inflation was sharply constrained in this period, averaging only 0.46 percent per year—one percentage point lower than the Consumer Price Index (CPI) of 1.46 percent. Thus, prices rose less for medical care than in the general economy. Control by the fee schedule has had a substantial effect on the NME, in that the correlation of changes in the two indices is 0.78 for 1980–2002.

However, the fee schedule only sets the price, and providers are basically paid fee-for-service. How has volume been controlled? The answer is that prices are revised individually, adjusted for each procedure and drug, and not by an across-the-board conversion rate. In particular, the prices of procedures that show large increases in volume tend to be decreased. For example, the fee for magnetic resonance imaging (MRI) of the head was reduced by 30 percent from 16,600 Yen ($151) to 11,400 Yen ($104). In addition, under tight billing rules already in effect, if imaging was performed by MRI and by computed tomography (CT) scanning in the same calendar month, the CT scan cannot be billed.⁵ Such examples of limiting usage via micromanagement of the fee schedule in the biennial fee revisions could be multiplied many times over. The impact on costs of introducing high-tech equipment can thereby be negated, or at least blunted. This approach has not been explored in the United States, where prices, even if regulated, are allowed to remain the same or increase.⁶

The government has decomposed changes in NME beyond those caused by fee-schedule revisions into three factors: population growth, population aging, and “other.” Population growth and aging have together had a constant effect because of concurrent declines in the birth rate and aging of society. In 1980 the increase in the NME because of population growth was 0.8 percent, while that of aging was 1.0 percent, for a cumulative effect of 1.8 percent. In 2002 the population effect had fallen to 0.1 percent, while the aging effect increased to 1.7 percent, for a cumulative effect of 1.8 percent. The cumulative effect of the two has remained in the range of 1.7 to 2.1 percent (mean 1.8 percent) throughout these years. It has been pointed out that aging is a negligible factor in health care spending increases in the United States.⁷ Its impact on costs is higher in Japan because the rate of aging is faster, and its relative share of the cost increase is far greater because other factors have much less impact than in the United States.⁸

The most problematic item is the residual, the “other,” which includes both changes in volume (the number of patient visits and hospital admissions) and additional factors that in Japan, as elsewhere, are ascribed to “technology.”⁹ The average annual increase of the “other” category was 2.8 percent during 1980–2002. That accounts for 56 percent of the total increase in NME over the period, with a higher proportion in the 1980s (67 percent) than in the 1990s (44 percent).

Although the official NME calculations do not break down the “other” category, additional data on volume as measured by the number of episodes of care provide some insight.¹⁰ Volume rose steadily from 1980 until 1996, when it reached a plateau and then declined. One factor in the drop was an increase in the copayment rate from 10 percent to 20 percent for employees in 1997, bringing a 2.8 percent drop in employee medical spending in 1998.¹¹ Similarly, after a long political struggle, the government raised the copay in old-age health insurance from a nominal fee to 10 percent beginning in October 2002.¹² The effect was immediate: Spending for this group had risen by 2.1 percent during the first half of the fiscal year (April to September) but fell by 1.4 percent in the second half.

Unfortunately, it is not possible to incorporate volume changes precisely in the NME calculations. We therefore cannot estimate the impact of “technology,” the residual, on spending growth. It is clear, however, that for nearly every year in this period, spending attributable to technology grew at a rate lower than that of GDP growth. The point is important because technology is widely believed to be the main driver of health care cost increases.¹³ That this is manifestly not true in Japan raises questions because technology per se should be at more or less the same level everywhere in the industrialized world. Evidently the key impact on spending is not technology itself but how it is priced, as illustrated in the decrease in fees for MRIs. In contrast to the United States, where expenditures are so enormous because of higher prices, the Japanese system works to keep that impact low even though many types of high-tech medical practice, particularly in diagnostics, have become widely available.¹⁴

Previous Section Next Section

Structural Reforms In Japan

Economic stagnation not only has led to greater pressure to contain expenditures within the existing framework, but also has added fuel to long-standing proposals for more radical reforms.

Reform Proposal 1: introduction of new reimbursement methods.

Officials and experts have criticized fee-for-service reimbursement as being inherently high cost for years, despite the fact that expenditures have been relatively contained and the fact that diagnosis-related groups (DRGs) and prospective payment systems (PPSs) have not contained Medicare spending in the United States. Thus, it was largely ideological motives that led the government to introduce an inclusive payment system for acute inpatient care starting in April 2003. This system is limited to the eighty main hospitals at universities and the two national centers (for cancer and cardiovascular diseases). Patients are grouped into Diagnosis and Procedure Combinations (DPCs). These differ from the U.S. DRG/PPS system in that fees are per diem, albeit declining as the patient stays longer, and differ by each hospital, to take into account the differences in the average length-of-stay (29.1 days for the longest in Japan and 15.8 days for the shortest). Japan was considering expanding the use of the DPC-based payment to other hospitals in April 2004. However, its application will remain limited because, among other reasons, only 10 percent of all hospitals are usingInternational Classification of Diseases (ICD) coding, the prerequisite for accurate coding.¹⁵

In contrast to this gradual expansion in the acute care sector, inclusive payment in the long-term care (LTC) sector may move more rapidly and have a bigger effect on hospitals, since so many actually function like nursing homes. Since fee-for-service payment is particularly ill suited to LTC, about one-fifth of all hospital beds are already paid by a flat per diem rate. However, the flat rate has acted as a disincentive to admit heavy-care or subacute patients. One of the objectives of the new public LTC insurance system, which started in April 2000, was to deal with this problem by transferring LTC hospital beds from health to LTC insurance, where fees vary by level of disability.¹⁶ However, relatively few beds have actually been transferred primarily because the municipalities, as LTC insurers, did not want these costly patients unloaded onto their system. Consequently, the proportion of LTC inpatients paid for by health insurance has declined only marginally. Since there is a general consensus for reform in this area, a case-mix-based system, similar to the resource utilization groups (RUGs) used in U.S. nursing homes, is likely to be introduced into health insurance. Although case-mix-based payment probably would not cut spending, it would help in standardizing care and improving the accountability of the delivery system.

Reform Proposal 2: restructure health insurance.

All Japanese have nearly the same health care coverage, but it is provided through insurance fragmented into more than 5,000 different programs according to employer or residence. Employees and their dependents—including elders with low incomes who are dependents of their children—are enrolled in Employee Health Insurance (EHI), either in company-specific plans or, if in smaller firms, in a national program managed by the government. Self-employed or nonworking people, including most retired pensioners, are insured by their municipal governments in Citizens’ Health Insurance (CHI). There is a sizable subsidy from general revenues to make up for lower average incomes in CHI, and the heavy costs of health care for the elderly are further subsidized by transfers from EHI plans.¹⁷ Economic stagnation has hit the insurance system in two ways. First, declining incomes have meant that workers’ premium contribution rates have had to be raised. Second, the fiscal state of CHI has become even more precarious, as laid-off workers with low incomes have enrolled and as more people have been unable to pay premiums.¹⁸

To address these structural issues, in December 2002 the Ministry of Health, Labor, and Welfare (MHLW) came up with two alternative proposals for reform. The more radical one called for cross-subsidization among all plans to adjust for differences in the age and income structure of the enrolled and the eventual merging of all plans into a uniform financing system within each prefecture.¹⁹This would resolve all of the problems arising from increasing burdens on the pooling fund as society ages, the CHI fiscal crisis, and the fragmentation of insurance plans in one stroke. The EHI plans opposed this proposal because it would increase their level of cross-subsidization; they also argued that the premium assessment would be unfair because self-employed people routinely underreport their income. Another problem is that the prefectures oppose taking an active role in health care, because of their inexperience and the fiscal risks they would incur.

The other proposal was to reduce the burden on the EHI plans by creating an independent health plan for everyone age seventy-five and older, with higher premiums than elders now pay in the CHI (elders who are insured as dependents in EHI do not pay any premiums now). On the surface this proposal looks attractive, but a quick look at the sums required reveals that unless the new plan would continue to be heavily subsidized, from EHI premiums and new tax revenues, elders’ premiums would be so high that they would provoke a strong political reaction. As a practical matter, it is hard to find anyone willing to manage a program that is likely to be in perennial deficit. And as an ethical matter, underfinanced and substandard care for the elderly could result if a separate plan were to be created.

In a move that observers of Japanese decision making found rather typical, in March 2003 the Cabinet adopted both plans, with some modifications. It called for a new independent insurance plan for people older than age seventy-five but also for cross-subsidization among the various plans to cover people ages 65–74. The merit of this idea is that limiting cross-subsidization according to differences in pensioners’ income levels among plans would assuage concerns about under-reporting of income by the self-employed in CHI. However, so far there have been no clear answers to the extremely difficult question of how to finance the independent plan for people age seventy-five and older, and of course the problem of fragmentation and imbalances among insurers would remain unsolved.

Any system of universal health care coverage requires cross-subsidies from the healthier and wealthier segments of the population. Political resistance is inevitable and will intensify in a sour economy. Japan seems to be improvising piecemeal structural reforms to deal with these pressures. However, if the past is any indication of the future, these reforms are likely to be in the direction of more equality, which will be in line with reforms in Europe and stand in marked contrast to those in the United States.

Reform Proposal 3: new “free market” ideas.

The contrast between American economic success and Japanese failures in the latter half of the 1990s led to demands for market-oriented reform throughout Japan’s economy, society, administrative organization, and public policy. The manifest lack of success of health policy in the United States has not inhibited the generation of allegedly free-market-based reorganizations of medical care. In particular, ideas have come from the Economic and Fiscal Council and the Regulation Reform Council in the Cabinet Office, official advisory bodies that were reinvigorated by Prime Minister Junichiro Koizumi to pursue his election promises of fighting entrenched interests through deregulation and shrinking the role of government. Health care was one of the many targets for zealous economists and business leaders on the two councils. They advocated introducing balance billing into the reimbursement system and allowing investor-owned hospitals to be created.

Balance billing, or charging the patient over and above the reimbursement from health insurance, is not allowed under Japan’s current system. Physicians and hospitals cannot bill more than the amount set by the fee schedule for consultations and procedures. In addition, if a physician prescribes drugs for a condition that has not been recognized or exceeds the posted dosage, either the provider cannot be reimbursed for this part, or it must all be private-pay. Both the MHLW and the Japanese Medical Association (JMA) oppose balance billing and have argued that there should be equal treatment for all patients.²⁰

So far the arguments about balance billing have been mainly ideological, and the practical problems of introducing this practice have scarcely been mentioned. First, since private insurance companies would have neither the incentive (being at risk for only the balanced-billed services) nor the expertise to review these claims, there would be no mechanisms to prevent physicians from pushing marginally effective treatments. Second, most of the hospitals that could offer high-tech and high-quality care are in the public sector. It would be politically difficult for them to treat patients differently based on ability to pay.²¹

The debate about allowing investor-owned hospitals has also been more ideological than practical. Reformers call for market competition, and opponents—the MHLW and the JMA—argue that hospitals should not put the interests of shareholders ahead of those of patients and the community. Such arguments ignore the following points. First, company-owned hospitals that existed in 1948, when “profits” were banned, were allowed to continue, mainly to provide services to their employees and the local community. However, the fact that their number has declined sharply (from 267 in 1965 to 59 in 2003) indicates that investor ownership by itself does not confer a competitive edge (indeed, most lose money).²² Second, although physician-owned hospitals are technically not classified as investor-owned because they cannot pay dividends, for all practical purposes they seek “profits” to pay as earnings to the owner. In fact, they are taxed at the same rate as commercial companies.

The bottom line is that new investor-owned hospitals would not enter the market unless extensive balance billing were allowed. However, the debate has treated these issues quite separately, with no recognition of the fact that they are closely linked. The outcome so far is another political compromise. In July 2003 new investor-owned hospitals were permitted in specific localities (called “special zones” for deregulation). However, they would not be allowed to balance bill: All services will be private-pay, with no reimbursement at all from public health insurance. It is hard to imagine that there is much of a market in Japan for such extremely costly medical care services, particularly since wealthy people can and do go abroad for such treatments if they wish.

A door has thus been opened for market-based medicine, but it has been opened very narrowly. Opposition comes not only from the MHLW and the JMA: Opinion polls have shown that an overwhelming majority of the public does not wish to reform the present system so that the quantity and quality of care one receives would come to reflect one’s ability to pay.²³

Reform Proposal 4: patient-oriented delivery system.

The notion that major changes are needed in the Japanese medical care system is not limited to policy-making circles, or to worries about spending. Patients have been complaining about hospitals and physicians for years: Waiting times are too long, doctors don’t give out much information, and the entire system appears unresponsive and arrogant. Reports of serious medical errors have been getting widespread media attention. The MHLW has been trying to deal with the situation but to many eyes appears ineffectual and too willing to collude with the JMA. However, beyond political and administrative problems, there are formidable structural barriers to reforms of the delivery system.

First, long waits are an inevitable result of patients’ having free access to virtually all hospitals and physicians’ offices. Not unnaturally, many patients prefer to visit prestigious medical centers rather than their local physician’s office, and it is only in the former that long waiting times are common. Partly because of complaints about waiting times, the MHLW has been trying to reduce demand for outpatient care at large hospitals in favor of private-practice physicians—for example, by decreasing their consultation fees and making patients pay more if they come in without a referral. However, the trend has hardly been reversed, partly because its objectives are contradictory: Lower consultation fees for large hospitals are a disincentive to the hospital but an incentive to the patient, since the copay is lower. Gatekeeping by primary care physicians would be the solution, but it would be unpopular with the public and difficult to implement, given the lack of appropriate training in primary care.

Second, Japan’s poor record in information disclosure is largely attributable to short consultation times, encouraged by the fee schedule as well as traditional physician attitudes (although these seem to be changing among younger doctors). Another cause is less a matter of doctors’ hiding information from patients than of the information’s simply not existing because it is not documented.²⁴ Third, the number of medical errors may in fact be lower in Japan than in the United States, because the rate of surgery is about one-third the level in the United States and because the problem of hand-offs between complex systems that the U.S. Institute of Medicine (IOM) identified as a major cause of errors is far less widespread.²⁵ On the other hand, in Japan records are poorly kept and monitoring systems are less developed. Thus, the proportion that is detected among that smaller volume of errors should be lower. The recent increase in the number of errors reported is probably attributable to a greater willingness of staff and patients to speak out.

To meet these challenges, in 2002 the MHLW proposed a reform of the delivery system, stressing the importance of the patient’s perspective and the need for transparency and accountability. Meeting heightened public expectations was the official reason, but one suspects an additional motive, to counter the notion that turning health care into just another business is the best route to a more consumer-oriented system. Among relatively minor changes, restrictions on advertising have been gradually removed since 2001, so now, for example, specialists are able to advertise that they have been board-accredited. Another is investing in electronic medical record keeping, to improve efficiency, standardize medical practice, and make information available to patients. Potentially the most important is the reorganization of medical education. Beginning in April 2004, first- and second-year medical school graduates are allocated to a much broader range of hospitals via a matching program that is focused on primary care, instead of being largely limited to the university hospital where they received their undergraduate education and concentrating in a specialty. This may herald an end to the power exercised by the university clinical department chiefs on the appointment of physicians to their affiliated hospitals, which is the most fundamental reason why professionalization is less developed, and it could lead to a system that is more in line with global standards.

Since the early 1980s increases in health care spending because of medical inflation, aging, and technology have been kept at a low level in Japan compared with the United States. As the economy declined, more intensive control of prices and even volume through the fee schedule, plus increases in various copayment rates, led to an actual reduction of medical spending in FY 2002 for the first time in history. At the time of this writing, the government had announced that average prices would be reduced by 1.0 percent beginning in April 2004, by cutting drug prices; this indicates to us that time-tested methods for balancing demands from payers and providers to achieve cost containment will continue to be used. However, economic stagnation refueled proposals for more radical reforms. Case-mix-based inclusive fees for inpatient care have been introduced in university hospitals and are planned for subacute care and LTC. The latter is likely to have more impact than the former. In health insurance, half-hearted compromises on reform proposals do not appear likely to bring much change. Some leaders dream of “free market” reforms that would transform health care into a business venture, but these are unlikely to be accepted by the public, even if they could be implemented. On the other hand, limited but meaningful progress has been made in the weakest part of the system, professional accountability.

The barriers to change—resistance from bureaucrats, interest groups, politicians, and the public—plus the sheer practical difficulties of this field are substantial. Thus, any reform is likely to be evolutionary and not radical. Our guess is that the system will not look very different ten years from now—which is not necessarily a bad thing, since by international standards of access, cost, and fairness, health policy in Japan has been quite successful.

Source: http://content.healthaffairs.org/content/23/3/26.full

Insights:

Japan is one of the great countries in the world. They do not allow patients to pay. They have insurance just like in the US although there are some issues and challenges that have arised. One proposed reform was the introduction of new reimbursement methods. Another proposed reform was to restructure health insurance. The Japanese are health insured just like the Americans. Having health insurance at hand makes optimum health easy to achieve. The third is new “free market” ideas. Balance billing in Japan is not allowed in their current system. The fourth is patient-oriented delivery system. Japan records are poorly kept and monitoring systems are less developed. Having developed monitoring systems lessens errors and gives the nurse more time to attend to his/her patient’s needs. The attempting reforms of Japan if successful would be a great success in the field of nursing informatics. Their contribution would make healthcare better and improved.

0 comments

Please clink the country below to view the article. Thank you! :)

South Korea

Insights:

The healthcare system of South Korea for me is like of that of the US. They also have health insurances. Koreans can enjoy their privileges. Healthcare is already at hand. Also, the competence of healthcare system of South Korea is enough to be compared with other countries. The challenges for the healthcare system of South Korea are access and coverage and increase in the elderly population and health financial benefit. Not all the provinces in South Korea were covered by the healthcare system. We cannot deny the fact that our world faces financial crisis. This crisis can also affect the system.

0 comments

Wednesday, May 2, 2012

Making a Post-Operative Bed

I. Purpose

To provide warmth and comfort for the patient.
To provide protection for the bed.
To arrange the bed and other furniture in order to facilitate the transfer of the patient from stretcher to bed.

II. Equipment

The same linen as those used for making on occupied bed plus the following”
Bath towel
Small robber sheet
Woolen blanket
3 hot water bags w/cover p.r.n.

On the Bedside Table:

Stethoscope
Sphygmomanometer
Kidney basin
Swipes
Padded tongue depressor
p.r.n.
Observation Sheet

In the Room

Oxygen tank with complete
Tubbings, humidifier and nassal catheter
Suction apparatus
Stand
Drainage bottles

III. Procedure:

Strip on the bed and turn the mattress.
Make an ordinary bed with the top sheet untucked at the foot part. (If weather is cold, place bath blanket over the top sheet.) Fold back lop side of the sheet about 14 inches and the bottom side folded back even with the foot of the mattress.
Fanfold together the top sheet and blanket towards the side away from the door.
Place the small rubber sheet across the hood part of the bed.
Place the bath towel over the small rubber sheet.
Slip the pillowcase and put the pillow upright against the bars of the head of the bed.
Put the hot water bags at the foot and center of the bed if the weather is cold.
Place the necessary articles on the bedside table and the irrigating stand, suction machine and oxygen set-up adjacent to the bed.
Arrange unit.

Source: http://nursingfile.com

20 comments