Suchergebnisse

Im Zusammenhang mit der Einführung wettbewerblicher Strukturen in Bereichen des Sozial- und Gesundheitswesens steht ein Anstieg der privaten Anbieter wohlfahrtsstaatlicher Leistungen. Der vorliegende Artikel richtet den Fokus auf die ambulante Pflege und untersucht, gestützt auf qualitatives Interviewmaterial, die hier anzutreffende unternehmerische Praxis privater Dienste vor dem Hintergrund des durch die Pflegeversicherung gesetzten Rahmens. Dabei wird deutlich, dass die privaten Dienste aus einer Zwischenstellung heraus agieren: Einerseits handeln sie auf Basis von Versorgungsverträgen und bieten Pflege als Versicherungsleistung nach politisch definierten Standards an; andererseits befinden sie sich als Marktakteure im Wettbewerb, wobei der selbständige Erwerb mit Risiken behaftet ist. Beobachten lässt sich ein heterogen strukturiertes Feld sowie ein Nebeneinander von Markt- und Fürsorgeorientierungen.

Im Zusammenhang mit der Einführung wettbewerblicher Strukturen in Bereichen des Sozial- und Gesundheitswesens steht ein Anstieg der privaten Anbieter wohlfahrtsstaatlicher Leistungen. Der vorliegende Artikel richtet den Fokus auf die ambulante Pflege und untersucht, gestützt auf qualitatives Interviewmaterial, die hier anzutreffende unternehmerische Praxis privater Dienste vor dem Hintergrund des durch die Pflegeversicherung gesetzten Rahmens. Dabei wird deutlich, dass die privaten Dienste aus einer Zwischenstellung heraus agieren: Einerseits handeln sie auf Basis von Versorgungsverträgen und bieten Pflege als Versicherungsleistung nach politisch definierten Standards an; andererseits befinden sie sich als Marktakteure im Wettbewerb, wobei der selbständige Erwerb mit Risiken behaftet ist. Beobachten lässt sich ein heterogen strukturiertes Feld sowie ein Nebeneinander von Markt- und Fürsorgeorientierungen. ; The introduction of competitive structures in some areas of Germany's health and social system created a sharp rise in private providers of social services. Working with the example of the outpatient care sector, the article is examining entrepreneurial practices in this field, taking the background of the institutional framework established by Germany's long term care insurance into consideration. It can be observed that private providers of elderly care are situated in an intermediate position: on the one hand their entrepreneurial scope is limited by supply contracts, defining the character of provided care services as an insurance service according to politically established standards; on the other hand, as market participants, they have to persist in competition and their self-employment involves risks. The ambulatory care sector is characterized by its heterogeneous structure and a coexistence of more care-orientated and more market-orientated practices.

Background: Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim: This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India's largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method: A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results: There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion: Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations' needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.

This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2007. Ambulatory medical care utilization is described in terms of patient, provider, and visit characteristics. Data from the 2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined to produce annual estimates of ambulatory medical care utilization. Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 405.0 visits per 100 persons annually. This was not significantly different than the rate of 381.9 visits per 100 persons in 2006, neither were significant differences found in overall visit rates by age, sex, or geographic region. Visit distribution by ambulatory care setting differed by poverty level in the patient's ZIP Code of residence, with higher proportions of visits to hospital OPDs and EDs as poverty levels increased. Between 1997 and 2007, the age-adjusted visit rate increased by 11 percent, fueled mainly by a 29 percent increase in the visit rate to medical specialty offices. Nonillness and noninjury conditions, such as general and prenatal exams, accounted for the largest percentage of ambulatory care diagnoses in 2007, about 19 per 100 visits. Seven of 10 ambulatory care visits had at least one medication provided, prescribed, or continued in 2007, for a total of 2.7 billion drugs overall. These were not significantly different than 2006 figures. Analgesics were the most common therapeutic category, accounting for 13.1 drugs per 100 drugs reported, and were most often utilized at primary care and ED visits. The number of viral vaccines that were ordered or provided increased by 79 percent, from 33.2 million occurrences in 2006 to 59.3 million in 2007; significant increases were also noted for anticonvulsants and antiemetics. ; "April 2011." ; Also available via the World Wide Web. ; Includes bibliographical references.

This article describes chronic care management in ambulatory settings and strategies for integrating care across treatment settings to increase efficiency and improve the quality of chronic care. Chronic care management should be client focused, recognizing the client as the primary care manager and promoting educated participation in shared decision making; care must be integrated across health and social service provider settings through case management and advanced information technology; methods must be used for identifying those who are at risk of disability progression and high-cost care; treatment protocols are needed to plan and monitor care and improve outcomes; access to interdisciplinary care teams is required to meet complex care needs; ongoing prevention services are needed to reduce or delay disability and decline; and financial incentives must be aligned to support integration of acute and long-term care.

Integration of ambulatory pharmacists and their roles in new and emerging models of healthcare / Mary Ann Kliethermes, Kelly Epplen, PharmD, and Starlin Haydon-Greatting -- Planning and steps to building the ambulatory practice model / Christie Schumacher and Elizabeth Van Dril -- Preparing a business plan for an ambulatory practice / Erika Smith, Spencer Crook, and Nasir Salim -- Marketing your ambulatory practice / Tim R. Brown, Mary Ann Kliethermes, Nasir Salim -- Creating the ambulatory patient care model / Michelle L. Cudnik and Kristina L. Butler -- Optimizing information technology / Shelly Spiro and Samm Anderegg -- Generating revenue through healthcare reimbursement / Betsy Bryant Shilliday, Jamie J. Cavanaugh, and Sandra Leal -- Value and quality for ambulatory pharmacist patient care practice / Mary Ann Kliethermes -- The art of pharmacist-provided patient care / Mary Ann Kliethermes.