Comparing efficiency of health systems across industrialized countries: a panel analysis.

BackgroundRankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data.MethodsWe primarily use the OECD Health Data for 25 OECD countries. We compare results from stochastic frontier analysis (SFA) and fixed effects models. We estimate total life expectancy as well as life expectancy at age 60. We explore a combination of control variables reflecting health care resources, health behaviors, and economic and environmental factors.ResultsThe US never ranks higher than fifth out of all 36 models, but is also never the very last ranked country though it was close in several models. The SFA estimation approach produces the most consistent lead country, but the remaining countries did not maintain a steady rank.DiscussionOur study sheds light on the fragility of health system rankings by using a large panel and applying the latest efficiency modeling techniques. The rankings are not robust to different statistical approaches, nor to variable inclusion decisions.ConclusionsFuture international comparisons should employ a range of methodologies to generate a more nuanced portrait of health care system efficiency

Longitudinal Analysis of Electronic Health Records on Staffing Mix in Community Health Centers

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications

What’s on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings

Objective To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. Design Systematic review Methods We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. Results Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection

Do Years of Experience with Electronic Health Records Matter for Productivity in CHCs?

OBJECTIVE Community health centers’ (CHCs) patient panels are expected to increase in the coming years. This study investigated to what the years of experience with an electronic health record (EHR) was related to the productivity of CHCs. DATA/SETTING We primarily drew from the 2012 Uniform Data System, an annual reporting system of 1198 CHCs receiving federal Section 330 grants. We also used the “Readiness Survey” to categorize CHCs by years of experience with an EHR. DESIGN/METHODS We estimated a log-linear model of average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. We compared the productivity of each type of medical staff by presence of an EHR, EHR vendor, and years of EHR experience. RESULTS Physician productivity significantly improved in CHCs with three to four years of EHR experience. Nurses experienced a notable negative productivity impact in the early years of EHR adoption, although the trend was not statistically significant. CONCLUSIONS Attention should be paid as to whether nurses are diverted away from clinical duties to manage administrative tasks related to EHRs, and whether staffing levels are sufficient to support the implementation of EHRs. CHCs may need additional support and training especially for nurses in order to maintain the CHCs’ current patient panel, and even more so if the patient population expands as Medicaid coverage expands under the Affordable Care Act

The Missing Technology: An International Comparison of Human Capital Investment in Healthcare

This article explores human capital investment to understand cross-sectional variation and differences in growth of health spending among the US, Australia and Canada. Using a human capital model developed by Mincer, the article examines how rate of return to schooling and years of schooling impact wage rate levels in healthcare. The model is extended to approximate the probable trajectory of healthcare wage rate growth and thus the impact on health spending. The results suggest that a higher rate of return to schooling and a more educated healthcare workforce in the US may contribute to higher healthcare wage rates and thus contribute to higher health spending levels than in Canada and Australia. The results also suggest that average healthcare wage rates are growing at the rate of potential GDP; healthcare wage rates are not driving the growth of health spending.Medical-education, Technology.

Pathways to Middle-Skilled Allied Health Care Occupations

This 33-page paper was written by Bianca K. Frogner and Susan Skillman and is provided by the National Academy of Sciences. This paper "discusses the current supply of and the projected demand for middle-skilled occupations in health care, the policy and demographic context in which these occupations are demanded, and the education and training paths to entering these occupations and on which to build a long-term career." The following sections are included: Overview of the allied health field, Changing health care landscape, Education and training, Career Pathways, Regulation, and Conclusions and recommendations. A table showing health care jobs that require less than a 4-year degree is also included. This table includes information about total employment, projected number of jobs, on-the-job training length, and median pay for a number of health care occupations.Â

Pathways to Middle-Skilled Allied Health Care Occupations

These slides are from a presentation given by Bianca Frogner and Susan Skillman at the Symposium on the Supply Chain for Middle-Skill Jobs: Education, Training, and Certification Pathways. This presentation discusses allied health education and career pathways. Topics of the presentation include Defining Allied Health, Supply and Demand, Transforming Health System, Education and Training, Career Pathways, Regulation, Challenges and Opportunities, and Conclusions and Recommendations.Â