Choice and privatisation in Swedish primary care

2010 ◽  
Vol 6 (4) ◽  
pp. 549-569 ◽  
Author(s):  
Anders Anell
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Financial Incentives ◽  
Degrees Of Freedom ◽  
New Wave ◽  
Improve Performance ◽  
Financial Responsibility ◽  
New Models ◽  
Financial Characteristics

AbstractIn 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

scholarly journals Working for nothing! Payment by results shortfall in an ENT unit

2008 ◽  
Vol 90 (1) ◽  
pp. 30-32 ◽  
Author(s):  
P Stimpson ◽  
T Pezier ◽  
D Bowdler
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Financial Incentives ◽  
Patient Contact ◽  
Financial Problems ◽  
Department Of Health ◽  
Flow Through ◽  
Care System

Many NHS Trusts are currently experiencing severe financial problems, with many resorting to compulsory redundancy for staff in order to balance the books. In 2005 the Department of Health (DH) introduced a system of payment by results (PbR), by which health care Trusts charge the Primary Care Trusts (PCTs) for the care and ser vices they provide. PbR represents a dramatic change to the way in which funds flow through the health care system. The aims of PbR are to ensure services are appropriately rewarded while creating financial incentives for Trusts as well as to 'support wider reform'. This system is based on a series of codes and has pushed the role of clinical coders to the fore in NHS Trusts. Every patient contact with the Trust, every diagnosis and every procedure performed generates a particular code from which a predetermined fee can be calculated.

scholarly journals Prognosis role of clinical practice guidelines compliance in a chronic ischaemic heart disease primary care cohort. The BARIHD study

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P2524-P2524
Author(s):  
R. C. Vidal Perez ◽  
F. Otero-Ravina ◽  
V. Turrado Turrado ◽  
J. Maestro Saavedra ◽  
J. Dopico Pita ◽  
...  
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Clinical Practice ◽  
Ischaemic Heart Disease ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

Introduction

2019 ◽  
pp. 1-6
Author(s):  
Cym Anthony Ryle
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Clinical Practice ◽  
Medical Training ◽  
Diagnostic Error ◽  
Diagnostic Reasoning ◽  
Human Cognition ◽  
Postgraduate Medical Training ◽  
Clinical Encounters

This chapter briefly describes the author’s background in primary care and the origins of his interest in diagnostic reasoning and error. It introduces the key themes of the book: the central role of diagnosis in medicine; the nature of diagnostic terms and classifications; the characteristics of human cognition; diagnostic reasoning; common types of diagnostic error; the implications for patient safety; the potential for changes in education, postgraduate medical training, and clinical practice to reduce diagnostic error; and possible obstacles to the implementation of the proposed changes. Also addressed is actual clinical encounters and how they are addressed by new clinicians and experienced physicians.

The miR-21 potential of serving as a biomarker for liver diseases in clinical practice

2020 ◽  
Vol 48 (5) ◽  
pp. 2295-2305
Author(s):  
Jiawei Zhang ◽  
Dandan Li ◽  
Rui Zhang ◽  
Peng Gao ◽  
Rongxue Peng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Liver Diseases ◽  
Hepatic Disease ◽  
Noninvasive Detection ◽  
Diagnosis And Prognosis ◽  
Expected Performance ◽  
Potential Biomarker ◽  
Disease Condition ◽  
Complex Regulatory Network

The role of miR-21 in the pathogenesis of various liver diseases, together with the possibility of detecting microRNA in the circulation, makes miR-21 a potential biomarker for noninvasive detection. In this review, we summarize the potential utility of extracellular miR-21 in the clinical management of hepatic disease patients and compared it with the current clinical practice. MiR-21 shows screening and prognostic value for liver cancer. In liver cirrhosis, miR-21 may serve as a biomarker for the differentiating diagnosis and prognosis. MiR-21 is also a potential biomarker for the severity of hepatitis. We elucidate the disease condition under which miR-21 testing can reach the expected performance. Though miR-21 is a key regulator of liver diseases, microRNAs coordinate with each other in the complex regulatory network. As a result, the performance of miR-21 is better when combined with other microRNAs or classical biomarkers under certain clinical circumstances.

The Relation Between Financial Incentives, Motivation, and Performance

2017 ◽  
Vol 16 (2) ◽  
pp. 61-76 ◽  
Author(s):  
Anaïs Thibault Landry ◽  
Marylène Gagné ◽  
Jacques Forest ◽  
Sylvie Guerrero ◽  
Michel Séguin ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Work Performance ◽  
Autonomous Motivation ◽  
Compensation Plans ◽  
Work Settings ◽  
Path Analyses ◽  
Three Samples ◽  
And Performance ◽  
Performance Results

Abstract. To this day, researchers are debating the adequacy of using financial incentives to bolster performance in work settings. Our goal was to contribute to current understanding by considering the moderating role of distributive justice in the relation between financial incentives, motivation, and performance. Based on self-determination theory, we hypothesized that when bonuses are fairly distributed, using financial incentives makes employees feel more competent and autonomous, which in turn fosters greater autonomous motivation and lower controlled motivation, and better work performance. Results from path analyses in three samples supported our hypotheses, suggesting that the effect of financial incentives is contextual, and that compensation plans using financial incentives and bonuses can be effective when properly managed.

Enhancing clinical practice: The role of practice guidelines.

1994 ◽  
Vol 49 (1) ◽  
pp. 30-33 ◽  
Author(s):  
J. Jarrett Clinton ◽  
Kathleen McCormick ◽  
Jacqueline Besteman
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines
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