Can big business foster positive body image? Qualitative insights from industry leaders walking the talk.

The fashion, beauty, and advertising industries have been positioned as key contributors to body dissatisfaction through the promotion of unrealistic and homogenous appearance ideals. Recently, some businesses within these industries have started to disrupt the status quo by taking actions that can be seen to be fostering positive body image (e.g., through representative and diverse imagery, body acceptance messages, and inclusive product ranges). The aim of this study was to explore the opportunities and challenges to foster positive body image from a business perspective. Participants were purposively selected based on their experience of leading business actions to foster positive body image in fashion, beauty, and/or advertising. In total, 45 individuals (82% women) took part in semi-structured interviews, which were transcribed and then analysed using thematic analysis. Four themes were identified: (1) Personal motivations for championing change, (2) Industry ingrained appearance standards, (3) Business barriers to fostering positive body image, and (4) Fostering positive body image as an effective corporate social responsibility (CSR) strategy. This study provides future directions for research aimed at creating healthier body image environments in addition to considerations for businesses seeking to foster positive body image.

Desafios da participação social nos conselhos de saúde / Challenges of social participation in health councils

O objetivo do artigo é explicitar, por meio de uma análise teórica, a importância do papel da sociedade e da construção de sujeitos políticos na implementação do SUS através dos Conselhos de Saúde. Visa contribuir para a discussão sobre modos de participação social que vêm sendo construídos no interior das arenas dos colegiados de participação na democracia brasileira. Discutem-se as transformações políticas deflagradas entre os anos 1970 e 1990, em que diferentes modos de participação social encontrariam seus principais desafios políticos. Em seguida, analisam-se alguns dos dilemas da participação da sociedade nos conselhos sob uma perspectiva teórica, sustentada pela reflexão sobre novos movimentos sociais e representação de interesses (ou neocorporativismo). Os Conselhos de Saúde, nos anos 1990, se institucionalizaram e expressaram a necessidade da aproximação entre Estado e sociedade. Formalizaram a participação da sociedade e o controle social na construção das agendas políticas da saúde, sendo profundamente influenciados pela conjuntura política nacional. Conclui-se sobre a mudança operada nos Conselhos de Saúde e o papel efetivamente desenvolvido por eles nos dias de hoje.(AU)

Dentistry at the crossroads.

The dental practice pattern is shifting from small dental office to large corporate dental groups. This article analyzes the powers behind this change, and discusses the choices dental practitioners are facing and the reasons why many may choose to work in a corporate practice setting. Dental associations and specialty groups need to reaffirm their mission to provide quality oral health care. Dental treatment should not be viewed as a commodity used to measure corporate profitability.

The clinic as a good corporate neighbor.

Clinics today specialize in health repair services similar to car repair shops; procedures and prices are standardized, regulated, and inflexibly uniform. Clinics of the future have to become Health Care Centers in order to be more respected and more effective corporate neighbors in offering outreach services in health education and preventive health care. The traditional concept of care for health is much broader than repair management and includes the promotion of lay health competence and responsibility in healthy social and natural environments. The corporate profile and ethics of the clinic as a good and competitive local neighbor will have to focus on [a] better personalized care, [b] education and services in preventive care, [c] direct or web-based information and advice for general, seasonal, or age related health risks, and on developing and improving trustworthy character traits of the clinic as a corporate person and a good neighbor.

[Implementing population-based integrated care for a region: a work-in-progress report on the project "Gesundes Kinzigtal"]. / Integrierte regionale Versorgung in der Praxis: Ein Werkstattbericht aus dem "Gesunden Kinzigtal"

The regional integrated care model "Gesundes Kinzigtal" pursues the idea of integrated health care with special focus on increasing the health gain of the served population. Physicians (general practitioners) and psychotherapists, physiotherapists, hospitals, nursing services, non-profit associations, fitness centers, and health insurance companies work closely together with a regional management company and its programs on prevention and care coordination and enhancement. The 10 year-project is run by a company that was founded by the physician network "MQNK" and "OptiMedis AG", a corporation with public health background specialising in integrated health care. The aim of this project is to enhance prevention and quality of health care for a whole region in a sustainable way, and to decrease costs of care. The article describes the special funding model of the project, the engagement of patients, and the different health and prevention programmes. The programmes and projects are developed, implemented, and evaluated by multidisciplinary teams.

The cost of psoriasis.

Crown discussed findings of a Medstat study probing the economic burden of psoriasis and the presence of comorbidity in psoriasis patients. He also discussed current economic issues in the marketplace, concluding with some thoughts on health economics and biologics--which are shifting the landscape of pharmacotherapy.

Restructuring hospital-physician relationships for future success.

Integrating physicians into the Healthfirst administration through employment sowed seeds of mutual understanding among these two groups that would benefit the system immeasurably over the next several years. The immediate future, however, saw only cultural upheaval between our hospitals and newly employed physicians, hospitals and nonemployed physicians, employed and nonemployed physicians, as well as specialists and primary care providers. Traditional physician-relationship-building efforts became difficult, if not impossible, to maintain. Essentially, administration was forced to scrap ten years of physician-development plans in order to reconfigure a relations effort that would maintain hospital support from all sides while restructuring the employed medical group. This article describes the evolution of Healthfirst's approach to maintaining effective physician relationships within our healthcare system and its affiliated entities over the past decade. Specifically, the article details the manner in which our system has evolved physician-relations activity to maintain an effective strategy during times of significant change in the healthcare industry.

Measuring primary care practice performance within an integrated delivery system: a case study.

This article examines the use of an integrated performance measurement system to plan and control primary care service delivery within an integrated delivery system. We review a growing body of literature that focuses on the development and implementation of management reporting systems among healthcare providers. Our study extends the existing literature by examining the use of performance information generated by an integrated performance measurement system within a healthcare organization. We conduct our examination through a case study of the WMG Primary Care Medicine Group, the primary care medical group practice of WellSpan Health System. WellSpan Health System is an integrated delivery system that serves south central Pennsylvania and northern Maryland. Our study examines the linkage between WellSpan Health's strategic objectives and its primary care medicine group's integrated performance measurement system. The conceptual design of this integrated performance measurement system combines financial metrics with practice management and clinical operating metrics to provide a more complete picture of medical group performance. Our findings demonstrate that WellSpan Health was able to achieve superior financial results despite a weak linkage between its integrated performance measurement system and its strategic objectives. WellSpan Health achieved this objective for its primary care medicine group by linking clinical performance information to physician compensation and reporting practice management performance through the use of statistical process charts. They found that the combined mechanisms of integrated performance measurement and statistical process control charts improved organizational learning and communications between organizational stakeholders.

The emerging medical/industrial complex. The industrialization of medicine.

Until recently, the traditional practice of medicine has been thought of as a cottage industry practiced by individuals or small partnership groups. The transition of practice settings to large groups, multi-specialty groups, and corporations has paved the way to industrialization, with even larger health care organizations primarily managed by non-physicians. The similarities of these events to the industrial revolution and its impact on crafts guilds are striking. In order to understand this point of view, this article explores the function and influence of crafts guilds during stages of industrial development and the dynamics of the changes of employment needs and employability in an industrial environment as a comparison to what is happening in the health care field.

Physician equity in health care delivery systems: three alternative models.

The 1990s have seen many health care organizations attempting to merge, acquire, or affiliate with physician groups. Many have failed to provide physicians a stake in the success of the newly formed enterprise, frequently resulting in declining physician productivity, poor morale, and large operating losses. These problems warrant a reexamination of the traditional acquisition model of growth in favor of structures that retain a physician ownership component. This article examines three models of health care organization in which physicians share in the success of the enterprise and compares them in terms of ownership structure, governance, and funds flow.

The legal framework for effective competition.

Largely because of its indifference to spiraling costs, the professional domination model is being replaced by a market model based on competition among managed care plans and integrated delivery systems. In general, the more fully integrated previously competing providers become--for instance, by assuming financial risk together--the less legal risk is present, because of a decreased possibility of improper conspiratorial or collective behavior. Nevertheless, provider joint ventures and integrated delivery systems face a complex interaction of practical challenges and various legal and regulatory risks. This chapter explores ways in which laws involving fraud and abuse, self-referral, private inurement, corporate practice of medicine, Medicare reimbursement policy, and antitrust enforcement affect typical integrated delivery systems. From a legal standpoint, it might seem logical that the laws regulating health care providers would support and promote integration. A permissive legal environment to foster development of an integrated service network model assumes its development in a delivery system in which networks are at financial risk for the services provided. However, many of the laws and regulations governing integrated provider development were established at a time when joint ventures and other alliances were organizing in a predominantly fee-for-service environment and were generating significant increases in health care costs without producing demonstrable efficiencies or quality enhancements. The results is a fundamental inconsistency in government policy. The demand for collaboration by purchasers and legislatures does not necessarily cause the vast body of health care regulators to revise their concerns that many of the very collaborative activities being encouraged trigger potentially illegal acts and relationships. In a market model, the application of federal and state antitrust laws is especially important. In 1993 and 1994, the Department of Justice and the Federal Trade Commission jointly issued "Statements of Antitrust Enforcement Policy" in a number of areas of provider uncertainty. For integrated delivery systems, the primary focus of antitrust analysis is "market power." Systems without market power (i.e., the ability to force a purchaser to do something that the purchaser would not do in a competitive market) cannot harm consumers and should be free from serious antitrust risk. Where a network may have market power, its activities may be limited only if demonstrable anticompetitive effects outweigh the benefits of the efficiencies claimed by the new arrangement. The chapter concludes that vigorous antitrust enforcement may be required to promote market competition among integrated networks of providers and the managed care plans they serve.

Medical group practice formation.

The vast majority of physicians remain in small, inefficient practices. True group practice formation has been slow to develop, leaving physicians vulnerable to problems as the rest of the health care industry moves toward modernization and consolidation. The idea of integrated health care systems consisting of medical practices working with hospitals or hospital systems is an unattainable dream as long as the underlying medical practices themselves are years behind in evolution. The author describes the many aspects of group practice formation, and why physicians must move quickly toward their development.