ABSTRACT
Assessing and compensating performance in professional organizations is extremely difficult in direct public management settings of health services. Performance assessment is technically complex and, more so, with multiplicity of principals influencing goal setting. Incentives are a lever to generate directionality and motivation, both structural (for attracting and retaining workers) and specific ones (rewarding performance and directing behavior towards institutional goals). Incentives influence the behavior of workers in various ways, and their effectiveness seams weak and controversial in publicly run health services. To overcome the problems of deciding and evaluating performance, both good governance models and the revitalization of contractual management are required. To improve the effectiveness of incentive models, it is convenient to: 1) widen the conceptual framework of incentives, to incorporate the structural aspects of employment contract and payment; 2) improve the designs from a greater understanding of the determinants of motivation; and 3) broaden the lens to survey the extra-mural factors that alter the behavior of workers, trying to counter them.
Subject(s)
Motivation , Reimbursement, Incentive , Humans , Delivery of Health CareABSTRACT
In Spain, the compensation model for statutory health personnel is complex, heterogeneous, and more oriented to rewarding complementary functions and activities, than to paying for the actual performance in the position of employee. The various attempts to incorporate incentives have been distorted by a civil service egalitarianist culture, and weak systemic governance. External attractors (private practice, etc.) for healthcare professionals are becoming more important and neutralize many intramural incentives. There are few prospects of relevant or general changes, since the main actors involved are reforms-averse; but some environmental factors can lead to incremental improvements in employment contracts, in the information available to improve benchmarking, and in the creation of islands of good clinical governance and management. The economic scenario, increasingly concerned about inflationary trends and sustainability risks, may have a revitalizing effect of some governance and management reforms.
ABSTRACT
No disponible
Subject(s)
Humans , National Health Systems/organization & administration , National Health Systems/trends , Hospitals, Public/trends , SpainSubject(s)
Clinical Governance , Forecasting , Health Care Rationing , Organizational Innovation , State Medicine/organization & administration , Health Care Reform , Health Resources , Humans , Quality of Health Care/standards , Quality of Health Care/trends , Spain , State Medicine/economics , State Medicine/trendsABSTRACT
No disponible
Subject(s)
Humans , Emergency Medical Services/organization & administration , Emergency Treatment/methods , Chronic Disease/epidemiology , Primary Health Care/statistics & numerical data , Frail ElderlyABSTRACT
Desde su promulgación en 1986, la Ley General de Sanidad (Ley 14/1986) ha sufrido sucesivos cambios que han consolidado un modelo de Sistema Nacional de Salud. La Ley se plasmó en 113 Artículos, 10 Disposiciones Adicionales, 5 Disposiciones Transitorias, 2 Disposiciones Derogatorias y 15 Disposiciones Finales, en total tiene 143 artículos. Tras la revisión de toda la legislación aparecida desde 1986 hasta la actualidad podemos ver que hay 106 artículos (74,2%) que han perdido efectividad normativa y merecen un análisis o reflexión. Todos pueden ser clasificados en cuatro grupos, 26 artículos derogados y modificados (18,2%), 33 artículos clasificados como obsoletos (23,1%), 6 artículos denominados inmaduros (4,2%) y, finalmente, el grupo crítico (temas controvertidos con redacción ambigua) que tiene 41 artículos (28,6%). Tras un cuarto de siglo de vigencia de la Ley hay dos tercios de la misma que deben ser revisados. Vista esta debilidad jurídica, parece que una nueva Ley del Sistema Nacional de Salud para el siglo XXI debería ser el objetivo central del pacto político por la sanidad(AU)
Since its enactment in 1986, the General Health Law (Law 14/1986) has undergone several changes that have consolidated a model of National Health System. The law was embodied in 113 articles, ten Additional Provisions, five transitional arrangements, two Repeal and fifteen Final Provisions, has altogether 143 articles. After reviewing all legislation that appeared from 1986 to until today we can see that there are 106 articles (74.2%) that have lost regulatory effectiveness and merit analysis or reflection. All these items can be classified into four groups, the repealed and amended 26 articles (18.2%), 33 items of obsolete group (23.1%); the group of ill-developed are 6 articles (4.2%) and the critical (controversial and under ambiguous wording) group that has 41 articles (28.6%). After a quarter century of enforcement of the Act, two thirds of it to be reviewed. This legal weakness suggest the need of a new General Health Act for the Spanish National health System, being it a central objective of a political wide agreement(AU)
Subject(s)
Humans , Male , Female , Jurisprudence/methods , Jurisprudence/policies , Legislation as Topic/organization & administration , Legislation as Topic , Legislation as Topic , Primary Health Care/methods , Financing, Organized/legislation & jurisprudence , Public Health/legislation & jurisprudence , Mental Health Services/legislation & jurisprudence , Occupational Risks , Legislation as Topic/standards , Legislation as Topic/trends , Primary Health Care/organization & administration , Primary Health Care/trends , Primary Health CareABSTRACT
Since its enactment in 1986, the General Health Law (Law 14/1986) has undergone several changes that have consolidated a model of National Health System. The law was embodied in 113 articles, ten Additional Provisions, five transitional arrangements, two Repeal and fifteen Final Provisions, has altogether 143 articles. After reviewing all legislation that appeared from 1986 to until today we can see that there are 106 articles (74.2%) that have lost regulatory effectiveness and merit analysis or reflection. All these items can be classified into four groups, the repealed and amended 26 articles (18.2%), 33 items of obsolete group (23.1%); the group of ill-developed are 6 articles (4.2%) and the critical (controversial and under ambiguous wording) group that has 41 articles (28.6%). After a quarter century of enforcement of the Act, two thirds of it to be reviewed. This legal weakness suggest the need of a new General Health Act for the Spanish National health System, being it a central objective of a political wide agreement.
Subject(s)
Health Care Reform/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Financing, Organized/legislation & jurisprudence , Financing, Organized/organization & administration , Government Regulation , Health Care Reform/organization & administration , Legislation, Drug , Legislation, Medical , National Health Programs/organization & administration , SpainABSTRACT
El comportamiento es un determinante fundamental de la salud, pero los cambios de conducta son difíciles y la promoción de la salud tiene problemas de efectividad. La intervención del Estado en el siglo XX, inspirada en el movimiento modernista, trascendió al control de las externalidades y construyó la trama del Estado del bienestar. Su crisis y la corriente posmodernista tras los años setenta llevaron al debilitamiento de ideologías y valores, al individualismo narcisista y a la falta de confianza en las instituciones; todo ello hace más difícil que la perspectiva social pueda influir en el comportamiento individual. Una revisión del campo de la economía de la salud (en particular de los bienes tutelares) y de la salud pública (centrado en la ética y los valores en torno a la prevención y la promoción de la salud) puede ser útil para entender algunos dilemas en el equilibrio entre intervención pública y autonomía individual. Puesto que muchas decisiones no saludables provienen de preferencias irracionales o distorsionadas de los individuos, se está desarrollando un nuevo y prometedor ámbito de intervenciones en salud pública bajo el término de «paternalismo asimétrico», o en palabras más apropiadas «políticas tutelares asimétricas», que permiten a la sociedad influir selectivamente en aquellos cuyas decisiones sesgadas les llevan a dañarse, a la vez que no se restringe la libertad de opción para otros individuos bien informados y autónomos (aunque sus preferencias no coincidan con las recomendadas socialmente)(AU)
Behavior is a major determinant of health, but changes in individual conduct are difficult, and health promotion lacks effectiveness. State intervention in the last century, rooted in the modernist movement, went far beyond dealing with externalities and built the framework of the welfare state. The crisis of the welfare state and post modernity after the 1970s led to a weakness of ideologies and values, narcissistic individualism, and lack of trust in institutions, all of which hampered the ability of society′s perspective to influence individual behavior. A review of health economics (especially merit goods) and public health (ethics and values of health promotion and prevention) may be useful to understand certain dilemmas in the balance between public intervention and individual autonomy. Given that many unhealthy decisions come from biased or irrational individual preferences, a promising new field in public health interventions is being developed, known as «asymmetric paternalism», or, more appropriately, as «asymmetric policies for merit-goods», which allow society to selectively influence those individuals whose decision biases lead to self-harming behavior, without constraining the autonomy of well informed autonomous individuals (even though their preferences may not coincide with society′s recommended preferences)(AU)
Subject(s)
Humans , 50207 , 16672 , Public Health/trends , Health Promotion/organization & administrationABSTRACT
Several scientific disciplines are focused in the irrational behaviour of individuals. This predictably or systematic irrationality though violates the assumption of "maximising the expected utility", creates a new promising field of research and policy improvement. In this paper five dimensions in the distortion of preferences and decisions are reviewed, and some examples of policy initiatives for redressing and influencing the misled behaviour are provided. The "asymmetric policies for merit goods" have good foundations for future development of public health policy and practice.
Subject(s)
Behavior , Public Health , Decision Making , HumansABSTRACT
Behavior is a major determinant of health, but changes in individual conduct are difficult, and health promotion lacks effectiveness. State intervention in the last century, rooted in the modernist movement, went far beyond dealing with externalities and built the framework of the welfare state. The crisis of the welfare state and post modernity after the 1970s led to a weakness of ideologies and values, narcissistic individualism, and lack of trust in institutions, all of which hampered the ability of society's perspective to influence individual behavior. A review of health economics (especially merit goods) and public health (ethics and values of health promotion and prevention) may be useful to understand certain dilemmas in the balance between public intervention and individual autonomy. Given that many unhealthy decisions come from biased or irrational individual preferences, a promising new field in public health interventions is being developed, known as <
Subject(s)
Paternalism/ethics , Personal Autonomy , Public Policy , Self-Injurious Behavior/prevention & control , Social Control Policies , Social Welfare , Choice Behavior , Consumer Behavior , Health Policy/legislation & jurisprudence , Health Promotion/ethics , Health Promotion/legislation & jurisprudence , Humans , Nutrition Policy/legislation & jurisprudence , Public Health/economics , Public Health/ethics , Public Health/legislation & jurisprudence , Public Policy/economics , Public Policy/legislation & jurisprudence , Punishment , Reward , Social Control Policies/ethics , Social Control Policies/legislation & jurisprudence , Social Control, Formal , Social Control, Informal , Social Welfare/economics , Social Welfare/ethics , Social Welfare/legislation & jurisprudence , SpainABSTRACT
Diversas disciplinas científicas se están centrando en el estudio del comportamiento irracional de los individuos. La irracionalidad predecible o sistemática, aunque contra- dice la hipótesis de maximización de la utilidad esperada, configura un nuevo campo prometedor para la investigación y la mejora de las políticas. En este artículo se revisan cinco dimensiones de la distorsión de preferencias y decisiones, aportando algunos ejemplos de políticas que permiten mitigar y modular el comportamiento sesgado. Las políticas tutelares asimétricas tienen una base sólida para futuros desarrollos de las políticas y la práctica de la salud pública (AU)
Several scientific disciplines are focused in the irrational behaviour of individuals. This predictably or systematic irrationality though violates the assumption of maximising the expected utility, creates a new promising field of research and policy improvement. In this paper five dimensions in the distortion of preferences and decisions are reviewed, and some examples of policy initiatives for redressing and influencing the misled behaviour are provided. The asymmetric policies for merit goods have good foundations for future development of public health policy and practice (AU)
Subject(s)
Humans , Behavior , Public Health , Decision MakingABSTRACT
Objetivo. El presente artículo trata de hacer una revisión sistemática de las orientaciones registradas en el sector público, particularmente en el área sanitaria, en busca de la excelencia a través de la paulatina adopción de novedosas técnicas de gestión. En él se analizan las principales ventajas e inconvenientes de los sistemas de información basados en indicadores, así como el camino seguido por el sector público sanitario hacia la eficiencia. Método. Se comentan las nuevas técnicas de gestión que tratan de definir las "fronteras" (de forma paramétrica y no paramétrica) y que son empleadas como referente (benchmarkiano) de la eficiencia, describiendo los rasgos, interpretando el método y reflexionando acerca de las peculiaridades del análisis envolvente de datos (AED). Resultados. Se hace mención explícita a las experiencias desarrolladas en el ámbito sanitario empleando técnicas de frontera, tanto por lo que se refiere al tipo de unidades productivas analizadas, como a los inputs y los outputs seleccionados, concluyéndose que probablemente el AED constituye una técnica no paramétrica perfectamente adecuada para la medición de la eficiencia entre las unidades productivas sanitarias públicas
Objectives. The present article attempts to make a systematic review of the orientations recorded in the public sector, especially in the health care area, in search for excellence through the gradual adoption of novel management techniques. In it, the principal advantages and disadvantages of the information systems are analyzed based on indicators and the pathway followed by the public health sector towards efficiency. Methods. New management techniques that try to define the "frontiers" (parametrically and non-parametrically) and that are used as reference model (benchmarkian) of efficiency are commented, describing the traits, interpreting the method and reflecting on the characteristics of the data envelopment analysis (DEA). Results. Explicit mention is made about the experiences developed in the health sector using frontier technologies, regarding the type of productive units analyzed, inputs and the outputs used. It is concluded that the DEA probably constitutes a non-parametric technology that is perfectly adapted for the measurement of efficiency among the productive public healthcare units
Subject(s)
Cost Efficiency Analysis , Health Surveillance , Sanitary Management , Economic Indexes/trends , Indicators of Health Services/standards , Indicators of Quality of Life , Public Sector/organization & administration , Bias , Legislation as Topic/trends , Health Education/organization & administration , Health Education/standards , Organization and Administration , 34002ABSTRACT
El sistema español de innovación presenta en 2004 una situación de mejora sustantiva en relación con los últimos 10 años, según describe el recientemente publicado Libro Blanco sobre esta materia. La diversidad y complejidad de la capacidad tecnológica e innovadora, así como su diferenciación entre Comunidades Autónomas, es un rasgo significativo que se refleja en el análisis comparado del conjunto nacional. La calidad del interfaz entre los agentes intervinientes en el sistema de innovación, garantiza no solo su crecimiento, sino también una mayor eficiencia e integración en el entorno económico. La adaptación de las nuevas tecnologías a los procesos productivos, fundamentalmente las tecnologías de la información y comunicación (TIC), la cooperación en actividades de I + D y el pulso innovador de las empresas, hacen necesaria la convergencia de las políticas sectoriales y la participación institucional efectiva de todos los agentes implicados en el sistema de innovación: administraciones públicas, centros empresariales, subsistemas públicos de I + D, organizaciones de apoyo a la innovación (infraestructuras de soporte) y entorno impulsor (educativo, financiero, cultural y social). En el sector sanitario europeo, tanto en su dimensión industrial como de servicio, existe una creciente priorización y esfuerzo hacia los procesos de I + D + i a través de la ejecución del VI Programa Marco. Dimensiones científicas, tecnológicas, financieras, de competitividad y productividad del conocimiento, están en continua tensión como consecuencia del proceso de globalización de los factores esenciales y de la necesidad de garantizar la fortaleza de este sistema preferente de bienestar social. La importancia de la producción científica y tecnológica del sector sanitario en nuestro país, así como su propia contribución económica y social al conjunto de la riqueza y bienestar nacional, exige un compromiso de las instituciones públicas para fomentar y consolidar un subsistema de innovación propio que ayude a "internalizar" una cultura de calidad y excelencia en las prestaciones asistenciales y servicios públicos. Finalmente, la innovación se focaliza como oportunidad de mejora esencial para el Sistema Nacional de Salud (SNS), y desde esta perspectiva se revisan los desafíos de alinear problemas y conocimientos a través de estrategias
Innovation in Spain shows in a 2004 report some improvements in the last 10 years. Diversity and complexity in abilities for innovation and technology, as well as geographical differences are some of the most outstanding features. The quality of the interface between agents involved in innovation, ensures growth efficiency and integration in the economy. Public authorities, private sector, research agencies, and enabler environment (education, financing, culture and society) playa determinant role in the adaptation of new technologies to production processes. VI EU Framework Programme is prioritising and enhancing R + D + i in halth (both in the industrial and the service dimensions). Globalization of essential factors affects the relationship among science, technology, finance, complexity and knowledge-productivity. Public authorities in Space face the challenge of building up a sub-system for innovation, which could help to achieve quality and excellence in health and public services. Finally, innovation is focused as an opportunity for improvement, essential for the Spanish NHS, and it is analysed how could be aligned problems, knowledge through appropriate strategies
Subject(s)
Humans , Organizational Innovation , Health Systems/trends , Technological Development/trends , Biomedical Research/trends , Health Policy , Process OptimizationABSTRACT
No disponible
