Factors related to treatment intensity in Swiss primary care

BACKGROUND: Questions about the existence of supplier-induced demand emerge repeatedly in discussions about governing Swiss health care. This study therefore aimed to evaluate the interrelationship between structural factors of supply and the volume of services that are provided by primary care physicians in Switzerland. METHODS: The study was designed as a cross-sectional investigation, based on the complete claims data from all Swiss health care insurers for the year 2004, which covered information from 6087 primary care physicians and 4.7 million patients. Utilization-based health service areas were constructed and used as spatial units to analyze effects of density of supply. Hierarchical linear models were applied to analyze the data. RESULTS: The data showed that, within a service area, a higher density of primary care physicians was associated with higher mortality rates and specialist density but not with treatment intensity in primary care. Higher specialist density was weakly associated with higher mortality rates and with higher treatment intensity density of primary care physicians. Annual physician-level data indicate a disproportionate increase of supplied services irrespective of the size of the number of patients treated during the same year and, even in high volume practices, no rationing but a paradoxical inducement of consultations occurred. The results provide empirical evidence that higher densities of primary care physicians, specialists and the availability of out-patient hospital clinics in a given area are associated with higher volume of supplied services per patient in primary care practices. Analyses stratified by language regions showed differences that emphasize the effect of the cantonal based (fragmented) governance of Swiss health care. CONCLUSION: The study shows high volumes in Swiss primary care and provides evidence that the volume of supply is not driven by medical needs alone. Effects related to the competition for patients between primary care physicians, specialists and out-patient hospital clinics and an association with the system of reimbursing services on a fee-for-service basis can not be excluded.

Avoidable hospitalizations in Switzerland: a small area analysis on regional variation, density of physicians, hospital supply and rurality.

BACKGROUND Avoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care. We examine regional variation of AH in Switzerland and the factors that determine AH. METHODS We used hospital service areas, and data from 2008-2010 hospital discharges in Switzerland to examine regional variation in AH. Age and sex standardized AH were the outcome variable, and year of admission, primary care physician density, medical specialist density, rurality, hospital bed density and type of hospital reimbursement system were explanatory variables in our multilevel poisson regression. RESULTS Regional differences in AH were as high as 12-fold. Poisson regression showed significant increase of all AH over time. There was a significantly lower rate of all AH in areas with more primary care physicians. Rates increased in areas with more specialists. Rates of all AH also increased where the proportion of residences in rural communities increased. Regional hospital capacity and type of hospital reimbursement did not have significant associations. Inconsistent patterns of significant determinants were found for disease specific analyses. CONCLUSION The identification of regions with high and low AH rates is a starting point for future studies on unwarranted medical procedures, and may help to reduce their incidence. AH have complex multifactorial origins and this study demonstrates that rurality and physician density are relevant determinants. The results are helpful to improve the performance of the outpatient sector with emphasis on local context. Rural and urban differences in health care delivery remain a cause of concern in Switzerland.

Reversal of gender differences in Educational Attainment – historical analysis of the West German Case

Background information: During the late 1970s and the early 1980s, West Germany witnessed a reversal of gender differences in educational attainment, as females began to outperform males. Purpose: The main objective was to analyse which processes were behind the reversal of gender differences in educational attainment after 1945. The theoretical reflections and empirical evidence presented for the US context by DiPrete and Buchmann (Gender-specific trends in the value of education and the emerging gender gap in college completion, Demography 43: 1–24, 2006) and Buchmann, DiPrete, and McDaniel (Gender inequalities in education, Annual Review of Sociology 34: 319–37, 2008) are considered and applied to the West German context. It is suggested that the reversal of gender differences is a consequence of the change in female educational decisions, which are mainly related to labour market opportunities and not, as sometimes assumed, a consequence of a ‘boy’s crisis’. Sample: Several databases, such as the German General Social Survey, the German Socio-economic Panel and the German Life History Study, are employed for the longitudinal analysis of the educational and occupational careers of birth cohorts born in the twentieth century. Design and methods: Changing patterns of eligibility for university studies are analysed for successive birth cohorts and gender. Binary logistic regressions are employed for the statistical modelling of the individuals’ achievement, educational decision and likelihood for social mobility – reporting average marginal effects (AME). Results: The empirical results suggest that women’s better school achievement being constant across cohorts does not contribute to the explanation of the reversal of gender differences in higher education attainment, but the increase of benefits for higher education explains the changing educational decisions of women regarding their transition to higher education. Conclusions: The outperformance of females compared with males in higher education might have been initialised by several social changes, including the expansion of public employment, the growing demand for highly qualified female workers in welfare and service areas, the increasing returns of women’s increased education and training, and the improved opportunities for combining family and work outside the home. The historical data show that, in terms of (married) women’s increased labour market opportunities and female life-cycle labour force participation, the raising rates of women’s enrolment in higher education were – among other reasons – partly explained by their rising access to service class positions across birth cohorts, and the rise of their educational returns in terms of wages and long-term employment.

Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

DESINDUSTRIALIZAÇÃO DO ABC: EMPREGO E DESEMPREGO EM TEMPOS DE MUDANÇA.

O presente trabalho pretende mapear a região do ABC dando ênfase ao processo de desenvolvimento industrial e ao aumento da densidade demográfica decorrente. Isto se dá a partir do estudo quantitativo da mão de obra necessária. que reflete diretamente no emprego. O enfoque será mais acurado nesse aspecto. Num primeiro momento, aborda-se o contexto histórico, análise do processo de urbanização do século passado, que culmina com a instalação das indústrias na região. A abertura econômica do início dos anos 90, a aplicação de novas tecnologias e novas ferramentas de administração também fazem parte desse contexto. Nesse período o processo de industrialização sofre uma reestruturação comprometendo a aptidão regional, a chamada desindustrialização . O foco principal será a indústria automobilista, sem dúvida a de maior importância para e na região. No segundo momento, descreve-se quantitativamente o processo de mudança do comportamento da região e, analisa-se em paralelo, o desemprego e emprego nos setores industrial e de serviços. no período que compreende a última década do século XX , início do XXI. Por fim, mas não de menor importância, busca-se descrever e entender o surgimento das novas aptidões, geradas principalmente pela mudança de alocação das indústrias. Analisando questões como transformação da aptidão regional emprego e desemprego com base nos dados disponibilizados pelas instituições de pesquisa, buscando correlações entre variáveis para enfim, determinar como de fato se encontra hoje o emprego, o trabalhador e principalmente o processo industrial da região.(AU)

DESINDUSTRIALIZAÇÃO DO ABC: EMPREGO E DESEMPREGO EM TEMPOS DE MUDANÇA.

O presente trabalho pretende mapear a região do ABC dando ênfase ao processo de desenvolvimento industrial e ao aumento da densidade demográfica decorrente. Isto se dá a partir do estudo quantitativo da mão de obra necessária. que reflete diretamente no emprego. O enfoque será mais acurado nesse aspecto. Num primeiro momento, aborda-se o contexto histórico, análise do processo de urbanização do século passado, que culmina com a instalação das indústrias na região. A abertura econômica do início dos anos 90, a aplicação de novas tecnologias e novas ferramentas de administração também fazem parte desse contexto. Nesse período o processo de industrialização sofre uma reestruturação comprometendo a aptidão regional, a chamada desindustrialização . O foco principal será a indústria automobilista, sem dúvida a de maior importância para e na região. No segundo momento, descreve-se quantitativamente o processo de mudança do comportamento da região e, analisa-se em paralelo, o desemprego e emprego nos setores industrial e de serviços. no período que compreende a última década do século XX , início do XXI. Por fim, mas não de menor importância, busca-se descrever e entender o surgimento das novas aptidões, geradas principalmente pela mudança de alocação das indústrias. Analisando questões como transformação da aptidão regional emprego e desemprego com base nos dados disponibilizados pelas instituições de pesquisa, buscando correlações entre variáveis para enfim, determinar como de fato se encontra hoje o emprego, o trabalhador e principalmente o processo industrial da região.(AU)

An evaluation of the operation of subarea advisory councils /

Mode of access: Internet.

Study of needs for sewage works; report.

Report no. 2 issued jointly by the Office for Local Government and the Dept. of Health.

Illinois Department of Public Health long-term care facility profiles.

Title from caption.

DESINDUSTRIALIZAÇÃO DO ABC: EMPREGO E DESEMPREGO EM TEMPOS DE MUDANÇA.

O presente trabalho pretende mapear a região do ABC dando ênfase ao processo de desenvolvimento industrial e ao aumento da densidade demográfica decorrente. Isto se dá a partir do estudo quantitativo da mão de obra necessária. que reflete diretamente no emprego. O enfoque será mais acurado nesse aspecto. Num primeiro momento, aborda-se o contexto histórico, análise do processo de urbanização do século passado, que culmina com a instalação das indústrias na região. A abertura econômica do início dos anos 90, a aplicação de novas tecnologias e novas ferramentas de administração também fazem parte desse contexto. Nesse período o processo de industrialização sofre uma reestruturação comprometendo a aptidão regional, a chamada desindustrialização . O foco principal será a indústria automobilista, sem dúvida a de maior importância para e na região. No segundo momento, descreve-se quantitativamente o processo de mudança do comportamento da região e, analisa-se em paralelo, o desemprego e emprego nos setores industrial e de serviços. no período que compreende a última década do século XX , início do XXI. Por fim, mas não de menor importância, busca-se descrever e entender o surgimento das novas aptidões, geradas principalmente pela mudança de alocação das indústrias. Analisando questões como transformação da aptidão regional emprego e desemprego com base nos dados disponibilizados pelas instituições de pesquisa, buscando correlações entre variáveis para enfim, determinar como de fato se encontra hoje o emprego, o trabalhador e principalmente o processo industrial da região.(AU)

Design of bicycling suitability maps for hilly cities

Post-print version. Pictures and tables separated from main text and presented at the end.

Cleaning up neighbourhoods - Environmental Problems and Service Provision in Deprived areas

There has been growing concern that the quality of public services can be affected by the nature and scale of problems in deprived neighbourhoods and that poor services can contribute to a widening gap۪ between deprived and non-deprived neighbourhoods. There is also an increased emphasis within national policy on the quality of neighbourhood environments the so-called liveability۪ agenda. This report explores the challenges of delivering street scene۪ environmental services such as street sweeping and refuse collection in deprived and less deprived areas and examines the gap in environmental amenity between these different neighbourhoods. It also contributes to our understanding of the interplay between poor services and neighbourhood decline. The research involved a telephone survey of chief officers in local authority environmental service departments across the UK and detailed case studies of policy and practice in environmental service provision in four local authorities with significant levels of deprivation. Each case study involved work in three neighbourhoods within the authority two deprived and one less deprived as well as focus groups with residents and frontline environmental operatives, interviews with senior council staff and observation on the ground

Universal Service Policies in Europe & Latam: Evidence on Bridging the Divide in Rural Areas

Broadband access is a key factor for economic and social development. However, providing broadband to rural areas is not attractive to private telecommunications operators due its low or zero investment return. To deal with broadband provision in rural areas, different governance systems based on private and public cooperation have appeared. This paper not only identifies and defines public and private cooperation models but also assesses their impact on overcoming the digital divide in rural areas. The results show that public ownership infrastructure under private management policy has had positive effects on reducing the broadband digital divide and being applied to areas with higher digital divide; subsides to private operators providers only positive effects on reducing broadband digital divide; but public infrastructure with public management programs did not. The results, obtained using quasi-experimental methods, suggest the importance of incentives and control mechanisms in broadband universal service provision plans.

Exploring Customer-Oriented Service Offerings in Public Health: Developing Integrated Health Care Services for Rural Areas

Väestön ikääntyminen pakottaa yhteiskunnan ja julkisen terveydenhuollon muutoksiin. Jotta ikääntyvien ihmisten kotona asuminen voidaan mahdollistaa, palvelujärjestelmän pitää mukautua muuttuvaan tilanteeseen. Tämän diplomityön tarkoituksena on tunnistaa asiakaslähtöisiä lähellä asiakasta tarjottavia palvelukokonaisuuksia. Tutkimuksen teoreettinen viitekehys muodostuu asiakasarvon luomisesta ja palvelutarjoamista. Tarkasteluryhmänä on Etelä-Karjalan alueen 60–90-vuotiaat ja käytetty aineisto on kerätty vastaajilta postitse lähetetyllä kyselyllä. Tutkimus on eksploratiivinen ja tulosten tulkinnassa on hyödynnetty määrällisen tutkimuksen ja verkostoanalyysin menetelmiä. Työn keskeisimmät tulokset ovat tunnistetut asiakassegmentit ja heidän tarpeidensa pohjalta muodostetut palvelupaketit. Tulokset indikoivat asiakkaiden tarpeita ja tuloksia on analysoitu myös tuottajan näkökulmasta. Empiiristen tulosten lisäksi teoriaviitekehystä on kehitetty eteenpäin, jotta palvelukeskeiset teoriat voidaan ymmärtää yritysten näkökulman lisäksi asiakkaan näkökulmasta.

Identifying the areas to preserve passion fruit pollination service in Brazilian Tropical Savannas under climate change

The aim of this study was to identify future distribution areas and propose actions to preserve passion fruit pollination service under a scenario of future climate change. We used four species of Xylocopa bees that are important for passion fruit pollination in Brazilian Tropical Savannas. We also used the known forage plant species (33 species) that are associated with this same area, since passion fruit flowers provide only nectar for bees and only during their blossoming period. We used species distribution modeling to predict the potential areas of occurrence for each bee and plant based on the current day distribution and a future climate scenario (moderate projections of climate change to 2050). We used a geographic information system to classify the models and to analyze the future areas for both groups of species. The current day distribution map showed that Xylocopa and plant species occurred primarily in the southern and central-eastern areas of the Brazilian Tropical Savannas. In the north, Xylocopa species only occurred in a small area between the states of Maranhão and Piauí while forage plant species were only observed in the northern part of the Tocantins State. However, both future scenarios (bees and plants) showed a shift in distribution, with occurrence predominantly detected in the northern areas of Brazilian Tropical Savannas. Possible conservation areas and the use of appropriate agricultural practices were suggested to ensure the maintenance of the bee/plant focal species.