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Use of business planning methods to monitor global health budgets in Turkmenistan.

Ensor, T.; Amannyazova, B.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica
Publicado em //2000 Português
Relevância na Pesquisa
36.18%
After undergoing many changes, the financing of health care in countries of the former Soviet Union is now showing signs of maturing. Soon after the political transition in these countries, the development of insurance systems and fee-for-service payment systems dominated the discussions on health reform. At present there is increasing emphasis on case mix adjusted payments in larger hospitals and on global budgets in smaller district hospitals. The problem is that such systems are often mistrusted for not providing sufficient financial control. At the same time, unless further planned restructuring is introduced, payment systems cannot on their own induce the fundamental change required in the health care system. As described in this article, in Tejen etrap (district), Turkmenistan, prospective business plans, which link planned objectives and activities with financial allocations, provide a framework for setting and monitoring budget expenditure. Plans can be linked to the overall objectives of the restructuring system and can be used to ensure sound financial management. The process of business planning, which calls for a major change in the way health facilities examine their activities, can be used as a vehicle to increase awareness of management issues. It also provides a way of satisfying the requirement for a rigorous...

The ‘Alternative Quality Contract’ in Massachusetts, Based on Global Budgets, Lowered Medical Spending and Improved Quality

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Português
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46.23%
Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups. Overall, participation in the contract over two years led to a savings of 3.3% (1.9% in year-1, 3.3% in year-2) compared to spending in groups not participating in the contract. The savings were even higher for groups whose previous experience had been only in fee-for-service contracting. Such groups’ quarterly savings over two years averaged 8.2% (6.3% in year-1, 9.9% in year-2). Quality of care also improved within organizations participating in the Alternative Quality Contract compared to control organizations in both years. Chronic care management, adult preventive care, and pediatric care improved from year 1 to year 2 within the contracting groups. These results suggest that global budgets coupled with pay-for-performance can begin to slow the underlying growth in medical spending while improving quality.

Exploring global changes in nitrogen and phosphorus cycles in agriculture induced by livestock production over the 1900–2050 period

Bouwman, Lex; Goldewijk, Kees Klein; Van Der Hoek, Klaas W.; Beusen, Arthur H. W.; Van Vuuren, Detlef P.; Willems, Jaap; Rufino, Mariana C.; Stehfest, Elke
Fonte: National Academy of Sciences Publicador: National Academy of Sciences
Tipo: Artigo de Revista Científica
Português
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36.32%
Crop-livestock production systems are the largest cause of human alteration of the global nitrogen (N) and phosphorus (P) cycles. Our comprehensive spatially explicit inventory of N and P budgets in livestock and crop production systems shows that in the beginning of the 20th century, nutrient budgets were either balanced or surpluses were small; between 1900 and 1950, global soil N surplus almost doubled to 36 trillion grams (Tg)·y−1 and P surplus increased by a factor of 8 to 2 Tg·y−1. Between 1950 and 2000, the global surplus increased to 138 Tg·y−1 of N and 11 Tg·y−1 of P. Most surplus N is an environmental loss; surplus P is lost by runoff or accumulates as residual soil P. The International Assessment of Agricultural Knowledge, Science, and Technology for Development scenario portrays a world with a further increasing global crop (+82% for 2000–2050) and livestock production (+115%); despite rapidly increasing recovery in crop (+35% N recovery and +6% P recovery) and livestock (+35% N and P recovery) production, global nutrient surpluses continue to increase (+23% N and +54% P), and in this period, surpluses also increase in Africa (+49% N and +236% P) and Latin America (+75% N and +120% P). Alternative management of livestock production systems shows that combinations of intensification...

Global Budgeting in the OECD Countries

Wolfe, Patrice R.; Moran, Donald W.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1993 Português
Relevância na Pesquisa
36.27%
Many of the Organization for Economic Cooperation and Development countries use global budgeting to control all or certain portions of their health care expenditures. Although the use of global budgets as a cost-containment tool has not been implemented in the United States in any comprehensive way, recent health care reform initiatives have increased the need for research into such tools. In general, the structure, process, and effectiveness of global budgets vary enormously from country to country, in part because the underlying social welfare system of each country is unique.

Global Budgets of Atmospheric Glyoxal and Methylglyoxal, and Implications for Formation of Secondary Organic Aerosols

Fu, Tzung-May; Jacob, Daniel J.; Wittrock, Folkard; Burrows, John P.; Vrekoussis, Mihalis; Henze, Daven K.
Fonte: American Geophysical Union Publicador: American Geophysical Union
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.33%
We construct global budgets of atmospheric glyoxal and methylglyoxal with the goal of quantifying their potential for global secondary organic aerosol (SOA) formation via irreversible uptake by aqueous aerosols and clouds. We conduct a detailed simulation of glyoxal and methylglyoxal in the GEOS-Chem global 3-D chemical transport model including our best knowledge of source and sink processes. Our resulting best estimates of the global sources of glyoxal and methylglyoxal are 45 Tg a−1 and 140 Tg a−1, respectively. Oxidation of biogenic isoprene contributes globally 47% of glyoxal and 79% of methylglyoxal. The second most important precursors are acetylene (mostly anthropogenic) for glyoxal and acetone (mostly biogenic) for methylglyoxal. Both acetylene and acetone have long lifetimes and provide a source of dicarbonyls in the free troposphere. Atmospheric lifetimes of glyoxal and methylglyoxal in the model are 2.9 h and 1.6 h, respectively, mostly determined by photolysis. Simulated dicarbonyl concentrations in continental surface air at northern midlatitudes are in the range 10–100 ppt, consistent with in situ measurements. On a global scale, the highest concentrations are over biomass burning regions, in agreement with glyoxal column observations from the SCIAMACHY satellite instrument. SCIAMACHY and a few ship cruises also suggest a large marine source of dicarbonyls missing from our model. The global source of SOA from the irreversible uptake of dicarbonyls in GEOS-Chem is 11 Tg C a−1...

Why Are There Large Differences Between Models in Global Budgets of Tropospheric Ozone?

Wu, Shiliang; Mickley, Loretta J.; Jacob, Daniel J.; Logan, Jennifer A.; Yantosca, Robert M.; Rind, David Michael
Fonte: American Geophysical Union Publicador: American Geophysical Union
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
36.23%
Global 3-D tropospheric chemistry models in the literature show large differences in global budget terms for tropospheric ozone. The ozone production rate in the troposphere, P(O x ), varies from 2300 to 5300 Tg yr−1 across models describing the present-day atmosphere. The ensemble mean of P(O x ) in models from the post-2000 literature is 35% higher than that compiled in the Intergovernmental Panel on Climate Change (IPCC) Third Assessment Report (TAR). Simulations conducted with the GEOS-Chem model using two different assimilated meteorological data sets for 2001 (GEOS-3 and GEOS-4), as well as 3 years of GISS GCM meteorology, show P(O x ) values in the range 4250–4700 Tg yr−1; the differences appear mostly because of clouds. Examination of the evolution of P(O x ) over the GEOS-Chem model history shows major effects from changes in heterogeneous chemistry, the lightning NOx source, and the yield of organic nitrates from isoprene oxidation. Multivariate statistical analysis of model budgets in the literature indicates that 74% of the variance in P(O x ) across models can be explained by differences in NOx emissions, inclusion of nonmethane volatile organic compounds (NMVOCs, mostly biogenic isoprene), and ozone influx from stratosphere-troposphere exchange (STE). Higher NOx emissions...

MIT Integrated Global System Model (IGSM) Version 2: Model Description and Baseline Evaluation

Sokolov, Andrei P.; Schlosser, C. Adam.; Dutkiewicz, Stephanie.; Paltsev, Sergey.; Kicklighter, David W.; Jacoby, Henry D.; Prinn, Ronald G.; Forest, Chris Eliot.; Reilly, John M.; Wang, Chien.; Felzer, Benjamin Seth.; Sarofim, Marcus C.; Scott, Jeffery.;
Fonte: MIT Joint Program on the Science and Policy of Global Change Publicador: MIT Joint Program on the Science and Policy of Global Change
Tipo: Relatório Formato: 1515580 bytes; application/pdf
Português
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36.13%
The MIT Integrated Global System Model (IGSM) is designed for analyzing the global environmental changes that may result from anthropogenic causes, quantifying the uncertainties associated with the projected changes, and assessing the costs and environmental effectiveness of proposed policies to mitigate climate risk. This report documents Version 2 of the IGSM, which like the previous version, includes an economic model for analysis of greenhouse gas and aerosol precursor emissions and mitigation proposals, a coupled atmosphere-ocean-land surface model with interactive chemistry, and models of natural ecosystems. In this global framework the outputs of the combined anthropogenic and natural emissions models provide the driving forces for the coupled atmospheric chemistry and climate models. Climate model outputs then drive a terrestrial model predicting water and energy budgets, CO2, CH4, and N2O fluxes, and soil composition, which feed back to the coupled climate/chemistry model. The first version of the integrated framework (which we will term IGSM1) is described in Prinn et al. (1999) and in publications and Joint Program Reports and Technical Notes provided on the Program’s website (http://mit.edu/globalchange/). Subsequently...

Beyond Keynesianism : Global Infrastructure Investments in Times of Crisis

Lin, Justin Yifu; Doemeland, Doerte
Fonte: Banco Mundial Publicador: Banco Mundial
Português
Relevância na Pesquisa
36.12%
As the world recovers only slowly from the 2008 financial crisis and Europe is facing a looming debt crisis, concerns have increased that the "new normal" -- a period of high unemployment, low returns on investment, high risks, and low growth -- may become protracted in advanced economies. If growth remains weak, unemployment rates and debt levels will be slow to recede. Consequently, the global recovery may continue to be fragile for years to come. What the world needs now is a growth-lifting strategy. This strategy could take the form of a global infrastructure initiative. Since debt levels are high, governments in the United States and Europe could increase demand and support growth through investments in bottleneck-releasing infrastructure projects that are self-financing. An infrastructure initiative should, however, go beyond the borders of advanced countries and include developing countries. Economic and social returns to infrastructure investments tend to be high in developing countries, which have become increasingly important drivers of global growth. At the same time...

System-Wide Impacts of Hospital Payment Reforms : Evidence from Central and Eastern Europe and Central Asia

Moreno-Serra, Rodrigo; Wagstaff, Adam
Fonte: Banco Mundial Publicador: Banco Mundial
Português
Relevância na Pesquisa
36.18%
Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect)...

Hospital Global Budgeting

Dredge, Robert
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
46.31%
This paper is a practitioners guide to the introduction of a global budget into a hospital setting based on real World Bank projects in emerging, former soviet countries and in the UK NHS. It traces the steps from a centrally allocated, line item type allocated budget to one that is set on predetermined objective and measurable factors. These are based, where possible, on the health needs of the population served by the hospital. It considers how a global budget can be established and managed to generate local ownership and commitment to its delivery. It deals with incentives for both efficiency and performance. Examples of different contracting regimes, and how they fit into a global budget framework are given. Mechanisms for the periodic revision of the budget for issues such as inflation are given. There are separate notes on how a global budget can fit into a policy regime, how to cost services, and how to arrange contract for individual services. There are also suggestions on how to fund special payments that may vary from year to year...

How to Pay? Understanding and Using Incentives

Langenbrunner, John C.; Xingzhu, Liu
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
46.18%
Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation. The authors argue that no one set of incentives will address the multiple objectives of purchasers, providers, and patients. As a result, purchasers and policymakers must understand and address policy objectives explicitly. With more sophisticated systems, part or all of the financial risk is transferred from the purchaser back to the provider and patient. Most observers caution against full risk but encourage some supply-side cost sharing only...

What Are the Implications for Global Value Chains When the Market Shifts from the North to the South?

Kaplinsky, Raphael; Farooki, Masuma
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
36.13%
Rapid growth in many low-income economies was fuelled by the insertion of producers into global value chains feeding into high-income northern markets. This paper charts the evolution of financial and economic crisis in the global economy and argues that the likely outcome will be sustained growth in the two very large Asian Driver economies of China and India and stagnation in the historically dominant northern economies. Given the nature of demand in low-income southern economies, it is likely to be reflected in sustained demand for commodities, with other southern economy producers in global value chains being forced into lower levels of value added. Standards are likely to be of considerably reduced significance in value chains feeding into China and India.

Shaping Healthier Societies and Building Higher Performing Health Systems in the GCC Countries

World Bank Group
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Relatório
Português
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36.18%
This policy note summarizes the central health sector trends and challenges in the Gulf Cooperation Council (GCC) countries of the Middle East and North Africa region (MENA). These countries are Saudi Arabia, Kuwait, Bahrain, the United Arab Emirates (UAE), Oman, and Qatar. The note also provides an overview of the GCC country context, discussing the commonalities between the six member states, and the major areas of engagement by the health, nutrition, and population (HNP) global practice of the World Bank in support of the health sector reform priorities of these countries. The areas of engagement focus on three main clusters of work: (i) developing multi-layered solutions for improving non-communicable disease and road safety outcomes; (ii) health system strengthening; and (iii) integrating health policy solutions within the wider institutional and policy frameworks in the GCC countries. The note builds on an earlier HNP regional strategy prepared by the World Bank in 2013 focusing on the concepts of fairness and accountability. The strategy highlighted the importance of improvements in health system performance in MENA countries from an equity...

Global Budgets and Excess Demand for Hospital Care

Feldman, Roger; Lobo, Félix
Fonte: John Wiley & Sons Publicador: John Wiley & Sons
Tipo: Artigo de Revista Científica Formato: text/plain; application/pdf
Publicado em //1997 Português
Relevância na Pesquisa
66.45%
Excess demand is a pervasive feature of health care systems that use global budgets to pay for hospital care, regardless of the amount of money spent by those systems. This paper presents a theory that explains this feature of global budgets. The theory emphasizes that hospital administrators control the allocation of their budget, and that they choose quantity and resource intensity to maximize their own utility. The equilibrium quantity of care provided may be less than quantity demanded by consumers, leading to excess demand for admissions. An increase in the hospital’s budget may even be associated with an increase in excess demand.

China : Global Crisis Avoided, Robust Economic Growth Sustained

Vincelette, Gallina Andronova; Manoel, Alvaro; Hansson, Ardo; Kuijs, Louis
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
36.12%
This paper explores how the ongoing crisis, the policy responses to it, and the post-crisis global economy will impact China's medium-term prospects for growth, poverty reduction, and development. The paper reviews China's pre-crisis growth experience, including its relationship to global economic developments. It discusses the pace, composition, sources, and financing of growth during 1995-2007, and the impact of key external and domestic influences. The paper also analyzes the immediate impact of the global crisis on China's economic performance in 2009 and its likely impact in the short run. It then discusses the government's policy response, with a particular focus on the fiscal and monetary stimulus measures. Finally, the paper explores China's medium-term growth prospects in light of the crisis and the key policies for moving to a robust and sustainable growth path post-crisis.

Pricing Health Services for Purchasers : A Review of Methods and Experiences

Waters, Hugh; Hussey, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
Relevância na Pesquisa
46.18%
This paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment; the availability of information on costs, volumes, outcomes, and patient and provider characteristics; methods used to calculate providers' costs; and characteristics of purchasers and providers-including the regulatory environment, provider autonomy, negotiating power, and the degree of competition. The paper focuses on methods for setting levels of payment under different provider payment mechanisms. Line item and global budgets remain the most common reimbursement methods in developing countries. However, many of these countries are implementing mixed payment systems that have greater information demands. The principal payment types used in high-income countries-capitation, payments per case or diagnosis, and fee-for-service-are reviewed here, and implications for low- and middle-income countries discussed. To minimize incentives for under- or over-utilization...

Global Stock-Take of Social Accountability Initiatives for Budget Transparency and Monitoring : Key Challenges and Lessons Learned

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Knowledge Economy Study; Economic & Sector Work
Português
Relevância na Pesquisa
36.18%
Budgets are key documents that lay out a government's economic priorities in terms of policies and programs. Budget transparency refers to the extent and ease with which citizens can access information about and provide feedback on government revenues, allocations, and expenditures. Budget monitoring entails using such information to analyze, critique, and track government finances in order to provide this feedback. Budget transparency is a prerequisite for public participation and accountability, which are instrumental for a democratic and legitimate budget process. Both budget transparency and monitoring efforts also help remove institutional bottlenecks that result in delayed budget allocations, thereby jeopardizing the delivery of vital services to people. Even though they have a far-reaching impact on the lives of people, opening up budgets beyond the exclusive domain of policy makers and administrators is a relatively recent phenomenon that has gained momentum in the last two decades. The stock taking exercise illustrates the range of mechanisms involved in Budget Transparency and Monitoring (BT&M) in different contexts and demonstrates significant promise of influencing governance processes and outcomes. Finally...

Physician Responses to Global Physician Expenditure Budgets in Canada: A Common Property Perspective

Hurley, Jeremiah; Lomas, Jonathan; Goldsmith, Laurie J.
Fonte: Milbank Memorial Fund Publicador: Milbank Memorial Fund
Tipo: Artigo de Revista Científica
Publicado em /09/1997 Português
Relevância na Pesquisa
36.47%
Global expenditure budgets in the fee-for-service physician sector create management problems for both funders and physicians. Global expenditure cap policies must be designed, and appropriate institutional structures created, to mitigate perverse utilization incentives, manage collective utilization, and diffuse the internal professional and the funder–profession tensions created by a capped budget. Two Canadian provinces that adopted different approaches to the design of their physician expenditure cap policies experienced different outcomes in utilization growth. The outcomes, however, are the opposite to what one would predict based on an analysis of the incentive structures embodied in the two provinces' policies. An analytic framework developed for the study of common-property resources is applied to the differing physician responses to global budgets across the two provinces. The insights offered by this framework can guide policy design for global physician budgets, and they indicate the critical importance of physician acceptance of such a policy.

Global physician budgets as common-property resources: some implications for physicians and medical associations.

Hurley, J; Card, R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 15/04/1996 Português
Relevância na Pesquisa
36.47%
Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resources." Analysts studying common-property resources have documented several management principles associated with successful, long-run use of such resources in the face of these conflicting incentives. These management principles include early defining the boundaries of the common-property resource, explicitly specifying rules for using the resource, developing collective decision-making arrangements and monitoring mechanisms, and creating low-cost conflict-resolution mechanisms. The authors argue that global physician budgets can usefully be viewed as common-property-resources. They describe some of the key management principles and note some implications for physicians and the provincial and territorial medical associations as they adapt to global budgets.

Use of business planning methods to monitor global health budgets in Turkmenistan

Ensor,Tim; Amannyazova,Bakhtigul
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2000 Português
Relevância na Pesquisa
46.29%
After undergoing many changes, the financing of health care in countries of the former Soviet Union is now showing signs of maturing. Soon after the political transition in these countries, the development of insurance systems and fee-for-service payment systems dominated the discussions on health reform. At present there is increasing emphasis on case mix adjusted payments in larger hospitals and on global budgets in smaller district hospitals. The problem is that such systems are often mistrusted for not providing sufficient financial control. At the same time, unless further planned restructuring is introduced, payment systems cannot on their own induce the fundamental change required in the health care system. As described in this article, in Tejen etrap (district), Turkmenistan, prospective business plans, which link planned objectives and activities with financial allocations, provide a framework for setting and monitoring budget expenditure. Plans can be linked to the overall objectives of the restructuring system and can be used to ensure sound financial management. The process of business planning, which calls for a major change in the way health facilities examine their activities, can be used as a vehicle to increase awareness of management issues. It also provides a way of satisfying the requirement for a rigorous...