- Email: [email protected]
Research Notes
HEALTHCARE MANAGEMENT
Centre for Health Economics and Policy Analysis, McMaster University Contact: (905) 525-9140 (ext. 22122) Investigators used standardized patients to explore the following two issues in primary care physicians’ practice: (1) the relationship between physician characteristics and the provision of evidence-based preventive care; and (2)the extent of variation in physician charges for health care encounters and the factors associated with this variation.
Provision of Preventive Care to Unannounced Standardized Patients: Correlates of Evidence-Based Practice (#97-4)by B. Hutchison, C. Woodward, G. Norman, J. Abelson and J. Brown This study. found that evidence-based guidelines from the Canadian Task Force on the Periodic Health Examination have only been partially integrated into practice by family physicians. In fact, only 41 percent of the manoeuvres for which the Task Force felt there was good or fair evidence to include in a health examination were performed, offered or advised. Furthermore, 17 percent of those manoeuvres for which there was good or fair evidence to exclude were also performed. Fee-for-service and group practitioners were found to be moderately less likely to follow the recommendations than were those paid by capitation or salary and those in solo practice.
FORUM -
What Factors Influence Primary Care Physicians’ Charges for their Services? An Exploratory Study Using Standardized Patients (#97-5) by C. Woodward, B. Hutchison, G. Norman, J. Brown and J. Abelson In this study, researchers found large variations in the billing patterns of physicians seeing the standardized patients for their initial assessments. Based on a review of the medical records provided by the physicians and Ministry of Health billing data related to each visit, it was found that factors related to the physician are better predictors of variability in charges than factors related to the patients. Time spent with the patient was positively correlated with higher charges. However, spending more time did not necessarily correlate with better care: there was no relationship between time spent and the extent to which physicians followed the recommendations of the Canadian Task Force on the Periodic Health Examination. Female physicians tended to bill more than male physicians, although they did not spend more time with patients in this particular study. Hospital Management Research Unit, Department of Health Administration, Faculty of Medicine, University of Toronto
GESTION DES SOINS DE SANTC
Many Canadian provincial governments are exploring methods to improve the integration of health services in an effort to improve the care provided, while maintaining or reducing the costs. Integrated health delivery systems are being implemented in the United States and in Britain and other European countries. Such systems aim to provide a fill continuum of care to a defined target population under a financing system of capitation. This paper explores the issues associated with the governance responsibilities and functions of an integrated delivery system. A review of potential governance models is completed and the factors that would influence the choice of a governance model for an integrated delivery system are presented. In 1987,Ewe11 identified governing boards as the weakest link in the integrated health care systems of the United States. It is suggested that early attention to governance in the development of IDS models in Canada may improve the effectiveness of these systems. (The authors ’ article on this topic will be published in the winter issue of Healthcare Management FORUM, Volume 10, Number 4. -Ed.)
Dowizing, Re-enginemng and Rightsizing: Long-Term Implicationsfor Healthcare Organizations.(HMRU Technical Report Contact: Letty Antonio, phone: (416) 978-6963; No. 96-04)by P . L e a t t , G.R. Baker, P.K. Halverson e-mail: [email protected] and C. Aird ($7.00) Governing Integrated Health This paper analyses the Delivery Systems: Meeting research and practice literature Accountability Requirements (HMRU Techcal Report 96-05) on the organizational impact byP.LeattandS.Legpt($7.00) of the variety of cost-cutting
FALL 1997, VOL. 10, NO. 3
@ AUTOMNE 1997, VOL. 10, NO. 3
strategies being used in health care, including downsizing, re-engineering, rightsizing and redesigning both the organization and work. Redesigning the organization can include restructuring, reengineering and rethinking the organization. We suggest that the cost-cutting impact on organizations may be mediated by the change process used to implement the cost-cutting strategies. A bottom-up, participatory approach to implementation would appear to be the process of choice. Guidelines are provided for health care managers as they implement cost-cutting strategies and attempt to avoid serious adverse effects. (The authors ’ article on this topic was published in the summer 1997 issue of Frontiers of Health Services Management, Volume 13, Number 4 -Ed.)
Manitoba Centre for Health Policy and Evaluation Contact: Carolyn DeCoster, phone: (204)789-3666;e-mail: [email protected]
Issues in the management of specialist physician resources f o r Manitoba, by N.P. ROOS, R. Fransoo, B. Bogdanovic, D. Friesen and L. MacWilliam Are there enough specialist physicians to meet the health care needs of Manitobans? Is there a shortage looming? Do all Manitobans have adequate access to specialist care? These are questions that the MCHPE addresses in a new study of physician resources released in July 1997.
continued on page 47
HEALTHCARE MANAGEMENT
FORUM
MEMBERS ON THE MOVE NOUVELLES ORIENTATIONS
G E S T ~ O ND E S S O I N S D E S A N T C
Donald P. Schurman, CHE, has moved to Halifax to take on the position of President and CEO of the QEll Health Sciences Centre.
John Connors has been appointed Chief Executive Officer of VON Hamilton-Wentworthin addition to VON’s ongo
has launched a new career as view Place, a 277-bed, propri-
The authors evaluated current specialist physician supply using expert committee recommendations and comparisons with other provinces. They assessed access to specialists relative to area of residence and socioeconomic status by analyzing frequency of consultation and surgical procedure rates. To estimate the impact of aging on the hture need for specialists, the authors developed a new approach based on utilization by age and Statistics Canada’s projections.
ting home, corporate ervices to meet the needs of
HE, is now Executive Director of District in Melville, Saskatchewan.
The study found that Manitoba is well supplied with most specialists compared to the rest of Canada, that a shortage is not expected in the future and that access to specialists is uneven. The report concludes with a number of policy directions suggested by the findings. @
hester Health System has changed its
BOOK REVIEW -continuedfrom page 46 lerman Prize for Educational Leadership prize recognizes individuals who have ontributions to the field of health practice and who demonstrate the proonal values of great educators. Id-Rencz, CHE, has joined the sociation as their new Director of Research. est maintenant directeur Eastman, Quebec. inted Executive
Association. Mvles 1. F. Noel, FCCHSE, completed the requirements toward the College’s fellowship designation and is now a Fellow of the College. Myles is General Manager of the Tilbury Regional Hospital Laundry in Delta, B.C. . I
FALL 1997, VOL. 1 0 , NO. 3
__
support for strategic initiatives; developing mechanisms to be more responsive to the needs of the community; assessing how the work is done; and providing necessary training, development and education programs. The final element is policy. Government must assume a leadership role by acting as the catalyst for IDS development and implementation and enacting legislation to remove specific barriers. In addition, the organization of provincial ministries of health should reflect integrated care versus traditional provider silos. Before a U.S. model is embraced, it will also be crucial to elucidate the context of a Canadian IDS by identifying Canadian values, including the principles of the Canada Health Act (universality, accessibility, portability, etc.). Other values such as equity, affordability, quality, choice and evidence-based service provision are also worthy of consideration. Considering the complexity of the topic, the paper is clear, concise and easily followed. It provides the reader with an understanding of the key concepts of an IDS and possible solutions to various challenges posed by an IDS. This paper should incite further discussion and development of the notion of a Canadian IDS. I believe that this paper serves as an invaluable resource and stepping-stone for those considering the development and implementation of an IDS in Canada. Its merit lies in the strength of input from the 100 Canadian health care leaders. @
AUTOMNE I 9 S 7 , VOL. 10, NO. 3
Centre for Health Economics and Policy Analysis, McMaster University Contact: (905) 525-9140 (ext. 22122) Investigators used standardized patients to explore the following two issues in primary care physicians’ practice: (1) the relationship between physician characteristics and the provision of evidence-based preventive care; and (2)the extent of variation in physician charges for health care encounters and the factors associated with this variation.
Provision of Preventive Care to Unannounced Standardized Patients: Correlates of Evidence-Based Practice (#97-4)by B. Hutchison, C. Woodward, G. Norman, J. Abelson and J. Brown This study. found that evidence-based guidelines from the Canadian Task Force on the Periodic Health Examination have only been partially integrated into practice by family physicians. In fact, only 41 percent of the manoeuvres for which the Task Force felt there was good or fair evidence to include in a health examination were performed, offered or advised. Furthermore, 17 percent of those manoeuvres for which there was good or fair evidence to exclude were also performed. Fee-for-service and group practitioners were found to be moderately less likely to follow the recommendations than were those paid by capitation or salary and those in solo practice.
FORUM -
What Factors Influence Primary Care Physicians’ Charges for their Services? An Exploratory Study Using Standardized Patients (#97-5) by C. Woodward, B. Hutchison, G. Norman, J. Brown and J. Abelson In this study, researchers found large variations in the billing patterns of physicians seeing the standardized patients for their initial assessments. Based on a review of the medical records provided by the physicians and Ministry of Health billing data related to each visit, it was found that factors related to the physician are better predictors of variability in charges than factors related to the patients. Time spent with the patient was positively correlated with higher charges. However, spending more time did not necessarily correlate with better care: there was no relationship between time spent and the extent to which physicians followed the recommendations of the Canadian Task Force on the Periodic Health Examination. Female physicians tended to bill more than male physicians, although they did not spend more time with patients in this particular study. Hospital Management Research Unit, Department of Health Administration, Faculty of Medicine, University of Toronto
GESTION DES SOINS DE SANTC
Many Canadian provincial governments are exploring methods to improve the integration of health services in an effort to improve the care provided, while maintaining or reducing the costs. Integrated health delivery systems are being implemented in the United States and in Britain and other European countries. Such systems aim to provide a fill continuum of care to a defined target population under a financing system of capitation. This paper explores the issues associated with the governance responsibilities and functions of an integrated delivery system. A review of potential governance models is completed and the factors that would influence the choice of a governance model for an integrated delivery system are presented. In 1987,Ewe11 identified governing boards as the weakest link in the integrated health care systems of the United States. It is suggested that early attention to governance in the development of IDS models in Canada may improve the effectiveness of these systems. (The authors ’ article on this topic will be published in the winter issue of Healthcare Management FORUM, Volume 10, Number 4. -Ed.)
Dowizing, Re-enginemng and Rightsizing: Long-Term Implicationsfor Healthcare Organizations.(HMRU Technical Report Contact: Letty Antonio, phone: (416) 978-6963; No. 96-04)by P . L e a t t , G.R. Baker, P.K. Halverson e-mail: [email protected] and C. Aird ($7.00) Governing Integrated Health This paper analyses the Delivery Systems: Meeting research and practice literature Accountability Requirements (HMRU Techcal Report 96-05) on the organizational impact byP.LeattandS.Legpt($7.00) of the variety of cost-cutting
FALL 1997, VOL. 10, NO. 3
@ AUTOMNE 1997, VOL. 10, NO. 3
strategies being used in health care, including downsizing, re-engineering, rightsizing and redesigning both the organization and work. Redesigning the organization can include restructuring, reengineering and rethinking the organization. We suggest that the cost-cutting impact on organizations may be mediated by the change process used to implement the cost-cutting strategies. A bottom-up, participatory approach to implementation would appear to be the process of choice. Guidelines are provided for health care managers as they implement cost-cutting strategies and attempt to avoid serious adverse effects. (The authors ’ article on this topic was published in the summer 1997 issue of Frontiers of Health Services Management, Volume 13, Number 4 -Ed.)
Manitoba Centre for Health Policy and Evaluation Contact: Carolyn DeCoster, phone: (204)789-3666;e-mail: [email protected]
Issues in the management of specialist physician resources f o r Manitoba, by N.P. ROOS, R. Fransoo, B. Bogdanovic, D. Friesen and L. MacWilliam Are there enough specialist physicians to meet the health care needs of Manitobans? Is there a shortage looming? Do all Manitobans have adequate access to specialist care? These are questions that the MCHPE addresses in a new study of physician resources released in July 1997.
continued on page 47
HEALTHCARE MANAGEMENT
FORUM
MEMBERS ON THE MOVE NOUVELLES ORIENTATIONS
G E S T ~ O ND E S S O I N S D E S A N T C
Donald P. Schurman, CHE, has moved to Halifax to take on the position of President and CEO of the QEll Health Sciences Centre.
John Connors has been appointed Chief Executive Officer of VON Hamilton-Wentworthin addition to VON’s ongo
has launched a new career as view Place, a 277-bed, propri-
The authors evaluated current specialist physician supply using expert committee recommendations and comparisons with other provinces. They assessed access to specialists relative to area of residence and socioeconomic status by analyzing frequency of consultation and surgical procedure rates. To estimate the impact of aging on the hture need for specialists, the authors developed a new approach based on utilization by age and Statistics Canada’s projections.
ting home, corporate ervices to meet the needs of
HE, is now Executive Director of District in Melville, Saskatchewan.
The study found that Manitoba is well supplied with most specialists compared to the rest of Canada, that a shortage is not expected in the future and that access to specialists is uneven. The report concludes with a number of policy directions suggested by the findings. @
hester Health System has changed its
BOOK REVIEW -continuedfrom page 46 lerman Prize for Educational Leadership prize recognizes individuals who have ontributions to the field of health practice and who demonstrate the proonal values of great educators. Id-Rencz, CHE, has joined the sociation as their new Director of Research. est maintenant directeur Eastman, Quebec. inted Executive
Association. Mvles 1. F. Noel, FCCHSE, completed the requirements toward the College’s fellowship designation and is now a Fellow of the College. Myles is General Manager of the Tilbury Regional Hospital Laundry in Delta, B.C. . I
FALL 1997, VOL. 1 0 , NO. 3
__
support for strategic initiatives; developing mechanisms to be more responsive to the needs of the community; assessing how the work is done; and providing necessary training, development and education programs. The final element is policy. Government must assume a leadership role by acting as the catalyst for IDS development and implementation and enacting legislation to remove specific barriers. In addition, the organization of provincial ministries of health should reflect integrated care versus traditional provider silos. Before a U.S. model is embraced, it will also be crucial to elucidate the context of a Canadian IDS by identifying Canadian values, including the principles of the Canada Health Act (universality, accessibility, portability, etc.). Other values such as equity, affordability, quality, choice and evidence-based service provision are also worthy of consideration. Considering the complexity of the topic, the paper is clear, concise and easily followed. It provides the reader with an understanding of the key concepts of an IDS and possible solutions to various challenges posed by an IDS. This paper should incite further discussion and development of the notion of a Canadian IDS. I believe that this paper serves as an invaluable resource and stepping-stone for those considering the development and implementation of an IDS in Canada. Its merit lies in the strength of input from the 100 Canadian health care leaders. @
AUTOMNE I 9 S 7 , VOL. 10, NO. 3