Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.466
Filtrar
1.
BMJ ; 377: o1415, 2022 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672046
3.
PLoS One ; 17(5): e0267656, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35613130

RESUMO

Oral health is increasingly seen as a public health challenge due to the remarkable prevalence of oral diseases worldwide, the impact on general health, and health consequences that can arise for individuals. Compared to other health services, oral health services are usually not fully covered by statutory health insurance, which is seen as one reason in decision-making on dental treatments. Nevertheless, patients' reasons for treatment decisions are not well understood although they can provide valuable insights. The objective of this study was to identify reasons of choice for dental treatments and to explore patients' view on cost coverage in Germany. We conducted four focus group interviews with a total of 27 participants. The interviews were audiotaped and transcribed verbatim. Data was analyzed performing conventional content analysis. As part of a qualitative analysis, subcategories and categories were formed from identified reasons using an inductive approach. Our study supports and expands research in exploring patients' decision-making on dental treatments. It highlights a variety of 53 reasons of choice for dental treatments from patients' perspective, split in two categories "health care service", and "dentist & dental office". First category includes reasons regarding dental care performance (subcategories: "preconditions", "treatment", "costs", and "outcomes"). Second category demonstrates reasons regarding dentists, office structures and processes (subcategories: "professional skills", "social skills", "office staff & equipment", and "office processes"). Reasons named "most important" by the participants are out-of-pocket payments, dentists' training, and a relationship of trust between patient and dentist. Although the participants use incentive measures to lower financial burden, several perceived challenges exist. Identified reasons for choosing dental treatments provide a basis for further studies to quantify the relevance of these reasons from patients' perspective. Based on this, the various reasons identified can be considered in future policies to improve patients' utilization behavior, which can range from improved information sources to increased incentive measures.


Assuntos
Contratos , Saúde Bucal , Assistência Odontológica , Odontólogos , Grupos Focais , Humanos , Pesquisa Qualitativa
4.
Artigo em Inglês | MEDLINE | ID: mdl-35564799

RESUMO

The aim of this article is to identify the relationship between the fulfilment of relational and transactional psychological contracts and work results, taking into account the mediation effect expressed in organisational identification. The empirical research was conducted on a group of 402 HR professionals responsible for designing and implementing HR practices in one of the leading companies of the Polish energy sector. Hypotheses were tested using the partial least squares structural equation modelling technique (PLS-SEM). Based on our research, we found that the implementation of both relational and transactional psychological contracts positively influenced the results achieved by HR professionals, both directly and indirectly, through the mediating role of organisational identification. The results indicate that the relationship between the psychological contract and work results is stronger when mediated by organisational identification. It plays an important role, especially in relation to the transactional contract. The collected results lead to the conclusion that organisations, wishing to increase the level of work results achieved by HR professionals, should as much as possible fulfil the expectations of employees and meet the commitments made to them within the framework of the established psychological contract. The study makes an important contribution to the understanding of the "priority" importance of organisational identification in enhancing the efforts of HR professionals to deliver work results that benefit both employees and the organisation.


Assuntos
Contratos , Satisfação Pessoal , Organizações
5.
PLoS One ; 17(5): e0264900, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35511809

RESUMO

This paper studies the impact of strategic customer behavior on retailers' omni-channel strategies. Customers in the market are classified into strategic omni-channel customers and myopic B&M (brick and mortar) store customers. The retailer firstly charges a full price but will then salvage the leftover inventory at a lower price (markdown policy) for strategic omni-channel customers after the customers' demand is realized. The strategic omni-channel customers choose purchase timing to maximize their own expected profit. While, the myopic B&M store customers do not choose purchase timing. By characterizing rational expectation equilibrium, we find that the inventory level under markdown policy is higher than that in the classic model where no markdown policy is implemented. Also, the policy will transfer more strategic customers to the online channel to buy at full price so that the retailer will benefit from it. Besides, inventory commitment policy can further increase retailer's profit based on markdown policy. In addition, we extend the model to the supply chain and present the contrasting view that the total profit of the decentralized supply chain under the wholesale price contract is higher than that of the centralized supply chain. The influence of strategic customer behavior and system parameters on the retailer's optimal decision is discussed through numerical study.


Assuntos
Comércio , Miopia , Comportamento do Consumidor , Contratos , Humanos , Marketing , Políticas
6.
Bioethics ; 36(6): 666-672, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35452149

RESUMO

The failure of many patients with chronic conditions to correctly follow medical advice that they hope or intend to follow is a major concern, especially as effective long-term therapies for chronic conditions materialize. Some US healthcare providers have responded with strategies that involve implementing contracts with their patients, including provisions that may deny future treatments after continued nonadherence. This is among the first articles to explicitly discuss the ethics of patient contracts.


Assuntos
Contratos , Cooperação do Paciente , Doença Crônica , Humanos
7.
Plast Reconstr Surg ; 149(6): 1488-1497, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35436247

RESUMO

BACKGROUND: Supply chain optimization is an effective method of generating front-end cost savings and increasing hospital profits. Through the negotiation and renegotiation of supply chain contracts, plastic surgeons can dramatically change the price at which they purchase surgical supplies and implants. This study characterizes the potential impact of supply chain optimization and puts forth a generalizable, systematic approach for successful sourcing. METHODS: From October of 2017 to September of 2018, the authors examined all patients taken to the operating room for either a facial fracture or a hand fracture. Cost data were collected, Supply Chain Information Management numbers were used to determine whether each item used during the study period was under contract, and cost savings based on contract negotiation were calculated. Potential cost savings were calculated using the BillOnly calculator. RESULTS: For the 77 facial trauma cases and 63 hand trauma cases performed, a total of 330 items (70 distinct items) were used, 47 percent of which were under contract (47 percent contract use), with an average negotiated discount of 49 percent. Based on BillOnly material cost estimates, the authors' institution would need to increase its contract use to 70 percent to achieve a net savings of 19 percent, and to 90 percent to achieve a net savings of 39 percent. The authors also estimated that if contract use increased to 90 percent, net savings would increase commensurately with increases in the average discount negotiated. CONCLUSION: Supply chain optimization offers plastic surgeons the potential to significantly decrease surgical costs while maintaining surgical quality.


Assuntos
Contratos , Negociação , Comportamento do Consumidor , Redução de Custos , Humanos , Salas Cirúrgicas
8.
Artigo em Inglês | MEDLINE | ID: mdl-35270792

RESUMO

The environmental awareness of consumers and enterprises has gradually increased, and green production and green consumption have become the main theme of social economy. On the other hand, the complementary product market has become an important source of competitive advantage for enterprises. Considering a complementary product supply chain, and taking account of the consumers' environmental awareness and the green subsidies provided by the government, this paper examines members' decisions in relation to four contract models based on game theory. By solving the model, it is shown that the government's green subsidy plan improves the green degree of subsidized products and complementary products. Furthermore, compared to wholesale price contracts, revenue-sharing and cost-sharing contracts motivate manufacturers to improve the greenness of subsidized products, and they achieve a Pareto improvement for the whole supply chain and its members, when the contract parameters are appropriate. Numerical experiments also reveal that both the greenness of the complementary products and the profit for members increase with the green innovation spillover effect as a result of the complementary products and the scale of green consumers with environmental awareness in the market. This study provides good guidance for decision-making concerning the complementary product supply chain, and further contributes to environmental protection.


Assuntos
Comércio , Comportamento do Consumidor , Contratos , Custo Compartilhado de Seguro , Governo
9.
BMC Health Serv Res ; 22(1): 357, 2022 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-35300663

RESUMO

BACKGROUND: Health and welfare technologies (HWT) are becoming increasingly employed in the Nordic countries, and in Sweden in particular. The amount of HWT public procurement is likely increasing at a similar rate, but requirements for evidence for effectiveness placed on bidders during this process may be lacking. METHOD: This study investigated the use of evidence as a requirement in public sector tendering process of HWT, and how it affected bidder attributes and procurement outcomes. A novel type of systematic review and content analysis of requests for tenders for HWT announced prior to June 2021 was therefore conducted in Swedish public procurement databases. RESULT: Ninety requests for tenders for 11 types of HWT met the inclusion criteria for review, accounting for potential contracts worth 246 to 296 million EUR. Criteria requiring evidence for effectiveness were used in 16 requests for tenders, accounting for 183 million EUR in potential contracts. Eight of the requests referred to an established independent standard to confirm such evidence, such as CE standard of conformity, MDR and/or MDD. This prevalence appears to cut across all types of procuring organisations and all types of HWT. The use of any evidence criteria, or lack thereof, does not appear to affect the outcomes of the tendering process. CONCLUSION: Criteria requiring evidence for effectiveness are used in less than a fifth of all public procurements of health- and welfare technologies in Sweden, and less than 10% refer to some form of independent standard as confirmation of such evidence. The procurement process therefore risks creating a legacy of sub-optimal technologies in health- and social care services. More prevalent and specific requirements for evidence and its continual generation in the procurement process are highly recommended. Recommendations for decision makers, procurement managers, and developers are provided.


Assuntos
Contratos , Setor Público , Humanos , Suécia
12.
PLoS One ; 17(3): e0265661, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35324980

RESUMO

The advance selling (AS) has been widely applied in fresh industry for it can elevating the customer experience and increase flexibility thus profit for a retailer. However, the introduction of the AS will have an impact on spot market in pricing strategy, market share and the profit of the retailer. Hence, to coordinate the supply chain and improve the efficiency of the agricultural supply chain, a two-stage game theory model is constructed to analyze the effects of AS on three classic contracts: wholesale price, quantity discount and revenue-sharing contract. This paper also discusses the boundary conditions of whether a retailer should sell in advance. The conclusions of this paper are as follows: First, revenue-sharing contracts are superior to wholesale price and quantity discount contracts when retailers sell in advance, the wholesale price contract can perform better than the quantity discount contract in the presence of AS if the contract parameter is properly set. Second, a revenue-sharing contract that normally coordinates the supply chain can performs poorly when the retailer sells in advance that the social welfare would be higher if using a quantity discount contract instead. These conclusions have important implications for suppliers when retailers sell in advance. Such suppliers need to design appropriate contracts to distribute FAP that carefully take into consideration the AS activities in the market.


Assuntos
Comércio , Comportamento do Consumidor , Contratos , Custos e Análise de Custo , Teoria do Jogo
13.
J Ambul Care Manage ; 45(2): 140-148, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35202031

RESUMO

High-impact health care is a new, employer-driven model that builds on existing employer-direct contracts for primary care centers of excellence and accountable care organizations. High-impact health care proceeds both cautiously and boldly. Cautiously by contracting with providers only after developing relationships with them and assessing their performance-to assure they are top performers; boldly by elevating member feedback to being a top criterion for determining which physicians remain in the network. Driven by the collective purchasing power of large employers, high-impact health care can provide employers a unique path to value-based care.


Assuntos
Organizações de Assistência Responsáveis , Planos de Assistência de Saúde para Empregados , Contratos , Estados Unidos
14.
BMC Health Serv Res ; 22(1): 45, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-35000585

RESUMO

BACKGROUND: Much of spatial access research measures the proximity to health service locations. We advance this research by focusing on whether health service funding is within walkable reach of neighborhoods with high hardship. This is made possible by a new administrative data source: financial contracts data for those human services that are delivered by nonprofits under contract with the government. METHODS: In a prototypical spatial access study we apply a classic 2-step floating area catchment model for walkable network access to analyze 2018 data about contracted nonprofit health services funded by the Chicago Department of Public Health (CDPH). CDPH collected the data for the purpose of this study. RESULTS: We find that the common container approach of aggregating contract amounts by provider headquarter locations in a given area (ignoring satellite service sites) underestimates the share of funding that goes to Chicago neighborhoods with higher hardship. Once service sites and spatial access are taken into account, a larger share of CDPH funds was found to be within walkable reach of Chicago's high hardship areas. This was followed by low hardship areas (which could be driven by more headquarter locations there that do serve areas throughout the city). Medium hardship areas trail both, perhaps warranting closer attention. We explore these results by program type and neighborhood with a spatial decision support system developed for the health department. CONCLUSIONS: The typical approach for analyzing human service contracts based on headquarters is misleading -- in fact, we find that results are reversed when service sites and walkable access are taken into account. This prototype provides an alternative framework for avoiding these misleading results.


Assuntos
Contratos , Acesso aos Serviços de Saúde , Serviços de Saúde , Humanos , Características de Residência , Análise Espacial
16.
Environ Sci Pollut Res Int ; 29(15): 22325-22349, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34786619

RESUMO

In the context of low-carbon economy, consumers' reference low-carbon effect and supply chain members' altruistic behavior are becoming factors that cannot be ignored, while there is currently little literature which synthetically studies the effect of consumers' reference low-carbon effect and supply chain members' altruistic behavior on supply chain members' decisions from a long-term and dynamic perspective. Therefore, we introduce consumers' reference low-carbon effect into the product demand function and introduce the altruistic behavior of supply chain members into their decision-making objective functions for the first time and then build differential game models based on emission reduction and low-carbon goodwill under four decision scenarios. We obtain the manufacturer's and the retailer's optimal emission reduction strategies and other equilibrium solutions by differential game theory and confirm the conditions for the cost-sharing contract to achieve coordination. Compared with previous studies, we obtain some new findings. First, consumers' reference low-carbon effect will harm the profits of the manufacturer and the retailer and discourage the manufacturer's enthusiasm to reduce emissions and retailer's enthusiasm for low-carbon publicity. Second, the altruistic behavior of the manufacturer and the retailer can not only weaken the negative impact of the reference low-carbon effect, but also promote both parties to actively reduce emissions, help achieve Pareto improvement of their own profit and utilities, and obtain additional social welfare. Third, the cost-sharing contract can encourage the manufacturer to increase emission reduction investment without affecting the retailer's low-carbon publicity investment and can achieve a Pareto improvement of both parties' profits and utilities. In addition, the cost-sharing ratio is only proportional to the marginal profits and altruistic intensity of both parties, and is not affected by the reference low-carbon effect. Meanwhile, the cost-sharing ratio will decrease as the manufacturer's marginal profit and altruistic intensity increase and will increase as the retailer's marginal profit and altruistic intensity increase. In particular, when the retailer is completely altruistic, the cost-sharing contract can achieve perfect coordination of the supply chain.


Assuntos
Comércio , Comportamento do Consumidor , Carbono , Contratos , Teoria do Jogo
17.
Soc Sci Med ; 292: 114564, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34782162

RESUMO

There is a growing trend of physicians becoming employees of hospital systems and employment is viewed as a mechanism to help achieve health system goals. Yet, the research is mixed on the effects of moving physicians to employment models. While the literature has traditionally placed such forms of employment relationships in opposition to professional autonomy, it has often overlooked the effects on other professional values and there is little empirical work that actually assesses how such a shift affects and is perceived by clinicians themselves. To address these gaps, we conducted a mixed method study at one hospital that recently moved all formerly self-employed physicians to employment contracts. We interviewed physicians to understand how the shift into employment was perceived to influence their work in three domains: the patient domain, the individual domain and the organizational domain. We then conducted a follow-up survey across both formerly employed and self-employed physicians to test our initial findings. We find both positive and negative effects in different domains, offering insights into the mixed results found in the current literature.


Assuntos
Contratos , Médicos , Emprego , Hospitais , Humanos , Ocupações
18.
J Appl Psychol ; 107(3): 425-443, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33983781

RESUMO

Breach of the psychological contract between organization and employee often evokes employee hostility, which in turn can instigate deviant behaviors. We examine whether employee mindfulness attenuates these reactions to psychological contract breach. Specifically, we develop and test a two-stage moderated mediation model in which employee mindfulness moderates the mediational path from psychological contract breach via hostility to deviance by attenuating both emotional and behavioral reactions. Findings across four studies (with 872 employee participants) both measuring and manipulating breach and mindfulness demonstrate substantial support for the proposed model. Further analyses including alternative moderators, mediators, and dependent variables provide evidence for discriminatory and incremental validity. We discuss theoretical and practical implications as well as future research avenues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Atenção Plena , Contratos , Emoções , Humanos , Local de Trabalho/psicologia
19.
Int J Psychol ; 57(3): 420-432, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34970737

RESUMO

Psychological contract (PC) breach perceptions are formed when employees detect discrepancies between obligated and delivered inducements. PCB stresses and strains employees to varying degrees and has detrimental consequences for employees and the organisation. Employees activate various coping strategies to respond to the stress elicited by PCB, and effective coping helps enhance employees' well-being. In this study, we propose and test a moderated mediation model, where approach and avoidance coping strategies mediate the relationship between PCB and stress, and employees' goal-based personality (i.e., behavioural inhibition system-BIS and behavioural activation system-BAS) moderates the relationship between PCB and coping strategies. We further examine the effectiveness of the subdimensions of coping, as well as how BIS/BAS influences the choice of these subdimensions in a sample of Western employees. Our results suggest approach coping effectively reduces stress elicited by PCB, whereas avoidance coping increases stress. Moreover, employees with higher BAS are more likely to engage in approach coping, whereas those with higher BIS use avoidance coping. We advance the research on coping with PCB by showing a more nuanced understanding of the subdimensions of coping as well as exploring diverse personality models in moderating the choice of coping strategies.


Assuntos
Adaptação Psicológica , Contratos , Humanos , Negociação , Personalidade
20.
Cien Saude Colet ; 26(11): 5691-5700, 2021 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34852101

RESUMO

The Teaching Hospital Restructuring Program was introduced as a strategy to fight the crisis in this sector. It brings to new funding, management and relationship standards between teaching hospitals and health system. This study presents the results obtained from a multiple case study involving four teaching hospitals whose contracts were executed in 2004. In 2010, a number of 32 interviews were conducted with both hospital and SUS managers, in addition to managers connected with the Federal Government Departments involved in the contracting system. By using elements from the micropolicy of health organizations as theoretical reference, the database was revisited with the goal of analyzing possible changes derived from such governmental policy applied in the daily life of teaching hospitals, in an attempt to explain the position taken by the diverse institutional actors as well as the main role played by the managers and the difficulties encountered in its introduction. Despite the improvements in the financial situation, the changes observed in teaching hospitals were not significant. An analysis of the contracting policy leads to an understanding of how a consistent and idealized project can reproduce the usual conservative behavior found in public management.


O Programa de Reestruturação dos Hospitais de Ensino (HE) foi implantado como uma das estratégias para enfrentar a crise do setor. Pretendia introduzir novos modos de financiamento, de gestão e articulação destes hospitais com a rede de saúde. O artigo apresenta resultados de estudo qualitativo, de caso múltiplo, envolvendo quatro HE contratualizados em 2004. Foram entrevistados, em 2010, 32 dirigentes hospitalares, gestores do Sistema Único de Saúde (SUS) e dos ministérios envolvidos. Utilizando como referencial teórico elementos da micropolítica das organizações de saúde, revisitou-se o banco de dados como objetivo analisar as mudanças decorrentes dessa política governamental no cotidiano dos HE, procurando caracterizar o posicionamento e protagonismo dos diferentes atores institucionais e as dificuldades na sua implementação. A despeito da melhoria das condições financeiras, as mudanças observadas nos HE foram restritas. Analisar a política de contratualização permite compreender como um projeto consistente e idealizado pode reproduzir o comportamento conservador que caracteriza a gestão pública.


Assuntos
Contratos , Atenção à Saúde , Programas Governamentais , Política de Saúde , Hospitais de Ensino , Humanos , Políticas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...