Employee Health Benefits: Corporate Strategies for Cost Containment

With health care costs increasing and a major portion of employee benefits attributableto health care, employers have turned their attention to a range of strategies for controllingcosts. A typology of the employer role in employee health care is presentedwhich suggests that cost containment strategies may bring increasing influence by theemployer in the health care decisions of employees. Four roles for employers havebeen identified: (1) the Enabler, providing traditional health benefits, with increasinguse of deductibles and copayments; (2) the Advocate, providing benefit and alternativedelivery options (e.g., HMOs) with incentives for less costly choices; (3) the Mediator,providing programs which intervene in health care utilization decisions (e.g., secondsurgical opinions); and (4) the Provider, providing direct services at the workplace(e.g., screening and health promotion programs). Implications for employers, employees,and the health care system are raised

Organizational Structure and Professional Norms in an Alternative Health Care Setting: Physicians in Health Maintenance Organizations

The development of new organizational forms for the delivery of health and medical care in the U.S. includes health maintenance organizations (HMOs), designed to provide a set of comprehensive basic health services to a defined population for a fixed prepaid premium. As complex organizations, HMOs have the potential for limiting the autonomy of professionals working in them. This paper describes the legal requirements and organizational mechanisms under which physicians practice in HMOs and considers the potential for conflict between the organization and professional norms. On the basis of document and interview data from nine HMOs, it appears that mechanisms developed to implement the mode of physician reimbursement and legal requirements for quality assurance and member grievance procedures do not limit physician autonomy in these HMOs. Variation was observed among the three organizational models: staff, group, and independent practice association

The lumbar spine has an intrinsic shape specific to each individual that remains a characteristic throughout flexion and extension.

The final publication is available at Springer via http://dx.doi.org/10.1007/s00586-013-3162-1PURPOSE: We have previously shown that the lumbar spine has an intrinsic shape specific to the individual and characteristic of sitting, standing and supine postures. The purpose of this study was to test the hypothesis that this intrinsic shape is detectable throughout a range of postures from extension to full flexion in healthy adults. METHODS: Sagittal images of the lumbar spine were taken using a positional MRI with participants (n = 30) adopting six postures: seated extension, neutral standing, standing with 30, 45 and 60° and full flexion. Active shape modelling (ASM) was used to identify and quantify 'modes' of variation in the shape of the lumbar spine. RESULTS: ASM showed that 89.5% of the variation in the shape of the spine could be explained by the first two modes; describing the overall curvature and the distribution of curvature of the spine. Mode scores were significantly correlated between all six postures (modes 1-9, r = 0.4-0.97, P < 0.05), showing that an element of intrinsic shape was maintained when changing postures. The spine was most even in seated extension (P < 0.001) and most uneven between 35 and 45° flexion (P < 0.05). CONCLUSIONS: This study shows that an individual's intrinsic lumbar spine shape is quantifiable and detectable throughout lumbar flexion and extension. These findings will enable the role of lumbar curvature in injury and low back pain to be assessed in the clinic and in the working and recreational environments.AVP is supported by a PhD studentship kindly donated by Roemex Ltd. to the Aberdeen Centre of the Oliver Bird Rheumatism Programme at the Nuffield Foundation

The Cosmos of a Public Sector Township: Democracy as an Intellectual Culture

The public sector plays an important role in responding to the rights of citizens and evolving norms of social interest (Qu 2015). Qu argues that the nature of public enterprise is never final and there is a constant negotiation between the private and the public emergence of life and rights. One such space where the tension between the private and the public manifests itself is the public sector township or the residential colony in India. The sociality of hierarchy in public sector organizations manifest itself in the public sector township and may nurture everyday aspirations, angsts and divides. The officer lives in a bigger hone, in a bungalow, and the clerk lives in a smaller home, many times with a larger family. [excerpt

Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises.</p> <p>Methods/Design</p> <p>In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices.</p> <p>Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home.</p> <p>The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity.</p> <p>Discussion</p> <p>To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN80064281">ISRCTN80064281</a></p