In 1966, spending for personal health care in the U.S. was $39 billion. By 1978, these expenditures had grown to $166 billion. Among regions and states, different patterns and levels of spending emerged, along with different rates of growth. Some of the highlights from the accompanying report which pinpoint personal health care spending differences among regions and states are listed below. In ...

Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and ...

Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity, honesty and transparency; the corpor...

Occupational therapists are involved in delivering their services within a very complex health care environment and it is essential to understand the implications of the health care system in planning and implementing occupational therapy services. This month's column gives the occupational therapist a perspective on the health system and should be a guide for all clinicians and educators in lo...

A generalized right truncated bivariate Poisson regression model is proposed in this paper. Estimation and tests for goodness of fit and over or under dispersion are illustrated for both untruncated and right truncated bivariate Poisson regression models using marginal-conditional approach. Estimation and test procedures are illustrated for bivariate Poisson regression models with applications ...

In this article, activity-based costing, an approach that has proved to be an improvement over the conventional costing system in product costing, is introduced. By combining activity-based costing with standard costing, health care administrators can better plan and control the costs of health services provided while ensuring that the organization's bottom line is healthy.

A key product from the Enhancing Engagement in Medical Leadership project has been the development of a Medical Leadership Competency Framework (MLCF). This document defines the skills and competences needed by doctors to engage effectively in the planning, provision and improvement of health care services. It applies to all doctors and is intended to be acquired across the medical career at ea...

Ethnic minorities form a substantial proportion of the urban population. A household survey in the West Midlands assessed usage of primary and preventative health care services. Asian households made some-what higher use of general practitioner (GP) facilities which can be related to demographic and socio-economic status. Fewer differences were found than expected, and uptake of preventative se...

Little is known of difficulties in accessing health care for recently arrived paediatric refugees in Australia. We reviewed routinely collected data for all 199 East African children attending a hospital Immigrant Health Clinic for the first time over a 16 month period. Although 63% of parents reported medical consultations since arrival, 77% of this group reported outstanding, unaddressed heal...