Preventive health care and payment systems to providers

Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We present, both the normative and the positive analyses of the change from independent providers to integrated services. We show the evaluation of that change to depend on the particular way payment to providers is done. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care.

The relationships of stress, health and wellbeing among workers

The precise relationship between the positive psychological state of work (i.e. engagement ) and the negative psychological state (i.e. burnout) has recently received research attention. Some view these as opposite states on the same similar continuum, while others take the position that they represent different biobehavioral spheres. This study expands our knowledge of the phenomenta engagement and burnout by analyzing their separate and joint manifestations. Using a sample of 2094 nurses, respondents were analyzed to determine the configuration of antecedents leading to separate and joint states of engagement and burnout, the configuration of engagement and burnout leading to mental, physical and organizational outcomes, and the relationship between engagement, bornout, and risk of metabolic syndrome. The study found that while both work engagement and burnout are highly correlated to health and organizational outcomes, the relative statistical power of burnout has a greater direct effect on health. It is important for workers and managers to adress the sources of burnout before addressing the positive psychological aspects of worker engagement.

The effects of walking while working on productivity and health: a field experiment

Lack of physical activity can cause health problems and diminish organizational productivity. We conducted a 12-months long field experiment in a financial services company to study the effects of slow-moving treadmills outfitted for office work on employee productivity and health. 43 sedentary volunteers were assigned randomly to two groups to receive treadmill workstations 7 months apart. Employees could opt at will for standard chair-desk arrangement. Biometric measurements were taken quarterly and weekly online performance surveys were administered to study participants and to more than 200 non-participants and their supervisors.In this study we explore three questions concerning the effects of the introduction of treadmills in the workplace. (1) Does it improve overall physical activity? (2) Does it improve health measures? (3) Does it improve performance? The answers are as follows. (1) Yes (net effect of almost half an hour a day). (2) Yes (small gains, one minor decline). (3) No and yes (initial decline followed by increase to recover to initial level within one year) – based on weekly employee self reports.

Organisational innovations and health care decentralisation: A perspective from Spain

Recent policy developments in public health care systems lead to a greater diversity in health care. Decentralisation, either geographically or at an institutional level, is the key force, because it encourages innovation and local initiatives in health care provision. The devolution of responsibilities allows for a sort of de-construction of the status quo by changing both organizational forms and service provision. The new organizations enjoy greater freedom in the way they pay their staff, and are judged according to their results. These organizations may retain financial surpluses, develop spin-off companies and commission a range of specialised services (such as Diagnostic and Treatment Centres in UK) from providers outside the institutional setting in order to have more access to capital markets. However this diversity may generate a feeling of lack of commitment to a national health service and ultimately a loss of social cohesion. By fiscal decentralisation to regional authorities or planned delegation of financial agreements to the providers, financial incentives are more explicit and may seem to place profit-making above a commitment to better health care. An evaluation of the myths and realities of the decentralization process is needed. Here, I offer an assessment pros and cons of the decentralization process of health care in Spain, drawing on the experience of regional reforms from the pioneering organisational innovations implemented in Catalonia in 1981, up to the observed dispersion of health care spending per capita among regions at present.

E-Health and Society : An Empirical Study of Catalonia. Research report (synthesis document)

Aquest estudi va analitzar la interacció del canvi organitzatiu, els valors culturals i el canvi tecnològic en el sistema sanitari català. L'estudi se subdivideix en cinc parts diferents. La primera és una anàlisi de contingut de webs relacionats amb la salut a Catalunya. La segona és un estudi dels usos d'Internet en qüestions relacionades amb la salut entre la població en general, les associacions de pacients i els professionals de la salut, i es basa en un sondeig per Internet adaptat a cada un d'aquests grups. La tercera part és un estudi de treball de camp dels programes experimentals duts a terme pel Govern català en diverses àrees i hospitals locals per a integrar electrònicament la història clínica dels pacients. La quarta és un estudi de les implicacions organitzatives de la introducció de sistemes d'informació en la gestió d'hospitals i centres d'assistència primària a l'Institut Català de Salut, el principal proveïdor de salut pública a Catalunya, i es basa en un sondeig per Internet i entrevistes en profunditat. La cinquena part és un estudi de cas dels efectes organitzatius i socials de la introducció de les tecnologies de la informació i la comunicació en un dels principals hospitals de Catalunya, l'Hospital Clínic de Barcelona. L'estudi es va dur a terme entre el maig del 2005 i el juliol del 2007.