Has the DRG System Influenced the Efficiency of Diagnostic Technology in Portugal?

The use of Diagnostic Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (ex. Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospital-specific and national DRG case-mix rates. Since implementation in 1990, the percentage of each hospital's budget based on hospital specific costs was to decrease, while the percentage based on DRG case-mix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospital-specific cost basis. While all other non- NHS third party payers are currently paying based on DRGs, the adoption of DRG case-mix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a two-stage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e. technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992-1994, using both parametric and non-parametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Influences of Intensive Professional Development in Writing Instruction on Teachers\u27 Dispositions and Self-Efficacy: It\u27s a Matter of Practice

After 20 years of nation-wide literacy reforms only one third of America\u27s students perform at or above grade level on the National Assessment of Educational Progress (NAEP) writing assessment. Policies such as NCLB (2002) that focused on reading achievement have done little to raise scores on this national assessment of students writing progress (National Center for Educational Statistics, 1999, 2011). With 90% of American jobs now requiring higher level literacy skills (Darling-Hammond, Barron, Pearson, & Schoenfeld, 2008), most states have adopted new standards that are designed to ratchet up rigor in order to put American students on a trajectory to meet the demands of a college educated work force. The level of writing called for in the Common Core State Standards (2010) is so ambitious that it calls into question whether teachers are confident and able to lead students toward meeting these new demands

Hospital production in a national health service: the physician's dilemma

There is a paucity of literature concerning the relation between the resource utilization decisions of the salaried hospital based physician and patient outcomes in a national health service. The purpose of our study is to model and test hospital production where the major decision makers are physicians. We view the output of the hospital as a distribution function over final health states of the patient. Our model contains a utility function for physicians whose arguments include the expected final health status of the patient and a pressure function which reflects the resource allocation and hospital financing policy of the Portuguese Health Ministry. Two sets of first order conditions derived from the theoretical model are estimated within a simultaneous equations framework using data consisting of inpatient discharges for the most frequent non-obstetric DRG during the 1992-1999 time period. We find evidence that budget setting methods and the possession of a third party payer outside of the NHS are important predictors for use of the resource in question. Moreover, we find that use of the resource is important in predicting the final health status of the patient.

Student Performance on End of Year State Assessments and Correlation to Teacher’s Worth

This study explored how accountability over the years has shifted with attention mainly focusing how well students are performing on their end of the year assessments and how that determines a teacher’s worth. Through these assessments, the teachers are being told of their worth if a student meets their goal or being told of their ineffectiveness when the teachers and students fail to measure up. Teachers were considered to have value-added as an educator when their students attained their goals. Other educators faced dismissal or reassignment when their students did not meet their goals. The focus is placed upon the educator and the educator’s career is heavily impacted by low test scores and even the high test scores. With teacher value being associated with test scores, other problems came to the surface of the research. High teacher turnover rates, discourse amongst peers when scores were being compared or incentive pay being offered, and educators becoming teachers that teach to the test. The goal was determine how educators and those studying this new shift felt and reacted

It’s a Matter of Practice: Influences of a Writing Methods Course on Inservice Teachers’ Dispositions and Self-Efficacy

This mixed-methods study examined the influences of a graduate writing methods course on the dispositions and instructional practice of twelve elementary classroom teachers, six who participated in the course and six who did not, during their post-graduate education. Data from interviews, classroom observation notes, and protocols have been analyzed, compared, and integrated. Outcomes of this study link participation in this course with increased confidence and readiness to teach the complexities of writing, as well as enhanced instructional practice and student learning opportunities. Findings suggest implications for teacher professional development, literacy teacher educators, and teacher education researchers

What about Writing?: A National Study of Writing Instruction in Teacher Preparation Programs

This study explores how writing instruction is taught to pre-service teachers across the US. Despite growing writing demands in K-12 classrooms, our national survey of literacy teacher educators revealed that colleges and universities rarely offer stand-alone writing instruction courses. Instead instructors are responsible for embedding writing instruction into their reading courses. Equally concerning, our data revealed a lack of confidence among many teacher educators regarding teaching writing. This study highlights the need for greater attention to writing in teacher education and adds to the conversation of why these issues continue to plague higher education

Field study of surcharge effects on a steel sheet pile bulkhead

This thesis presents the results of a field study conducted to determine surcharge effects on a steel sheet pile bulkhead

Engaging Teachers in Digital Products and Processes: Interview Feature Articles

Students sit in pairs interviewing each other--talking, laughing, taking notes with pen and paper. Computers begin to appear on tables, as students segue into drafting feature articles-- those splash-of-color pieces that go beyond straight news in magazines and news source. Conversation diminishes to a soft hum, as focus shifts to the interplay of thinking, written notes, and the emerging text on the computer screen. Words continue to waft over the room as comments and questions pertaining to content and processes are directed to others. Computer screens are filling up with these words… Thus begins, the first day of writing workshop in our teacher education courses

Gaps in Teacher Education: Defining, Developing and Diverting on the Path to an Equity Stance

Heeding the call for equity and transformative praxis in teacher education, teacher education programs often focus on equity and justice in mission statements and program design. This bounded case study explores how the construct of equity stance is framed by one teacher education program and then how the enactment of an equity stance is actualized in clinical field experiences. Feedback from clinical supervisors during observation cycles along with focus group interviews, surveys, and the examination of addressing an equity stance in teacher education are the focus of this article. Findings documented a continuum of equity enacted practices building from inclusive pedagogy to a heightened awareness of inequities, and the development of more equitable teaching practices. We recognize that both teacher candidates and teacher educators need to continue development of an equity stance moving from awareness to action within educational contexts

Hospital production in a national health service: the physician's dilemma

There is a paucity of literature concerning the relation between the resource utilization decisions of the salaried hospital based physician and patient outcomes in a national health service. The purpose of our study is to model and test hospital production where the major decision makers are physicians. We view the output of the hospital as a distribution function over final health states of the patient. Our model contains a utility function for physicians whose arguments include the expected final health status of the patient and a pressure function which reflects the resource allocation and hospital financing policy of the Portuguese Health Ministry. Two sets of first order conditions derived from the theoretical model are estimated within a simultaneous equations framework using data consisting of inpatient discharges for the most frequent non-obstetric DRG during the 1992-1999 time period. We find evidence that budget setting methods and the possession of a third party payer outside of the NHS are important predictors for use of the resource in question. Moreover, we find that use of the resource is important in predicting the final health status of the patient.Fundação para a Ciência e a Tecnologia (FCT