Managing Demand in Primary Care: The Market for Night Visits

We analyse the demand for and the supply of night visits in primary care. A model of demand management by general practitioners and of their choice between meeting demand by making visits themselves or passing them to commercial deputising services is presented. Demand and supply equations are derived and estimated using panel data from English primary care health authorities over the 1984-1994 period. The introduction of differential fees for GP and deputy visits in April 1990 led GPs to increase their own visits and to reduce the number made by deputies. GPs also responded by either reducing efforts to manage demand downwards or increasing efforts to induce demand. GPs manage demand downwards in response to exogenous demand increases. We also find that demand is not affected by the likelihood that the visit is made by a GP or a deputy, suggesting that patients do not perceive these visits as being of differential quality.Primary care, night visits, demand management.

Measuring Performance in Primary Care: Econometric Analysis and DEA

We use data from the Health Service Indicators database to compare different methods of measuring the performance of English Family Health Services Authorities (FHSAs) in providing primary care. A variety of regression and data envelopment analysis methods are compared as summary efficiency measures of individual FHSA performance. The correlation of the rankings of FHSAs across DEA and regression methods, across two years of data and across three different specifications of the technology of primary care are examined. Efficiency scores are highly correlated within variants of the two methods, and across years for a given method. Inter method correlations are smaller and correlations across different specifications of the primary care production process are negligible and sometime negative.primary care, efficiency measurement, DEA, stochastic frontier.

Gender Inequality in Health and Work: The Case of Latin America and the Caribbean

This technical paper reviews existing empirical evidence to track the effects of women's paid work on their own and their children's health in Latin America and the Caribbean. It begins with a brief description of the changing nature of labor markets and women's labor force participation. It then explores women's occupational health risks and mentions some initiatives that seek to respond to these risks. The next part of the report looks at the existing evidence for the positive effects of paid work on women's health and child health. The paper ends with policy recommendations.Women, Diseases, Health Policy, Workforce & Employment, occupational health and safety, women in the work force, women employees

Efficiency and Administrative Costs in Primary Care

We construct a simple model of the determinants of administrative managerial effort and apply it explain the doubling of the cost of administering primary care in England in real terms between 1989/90 and 1994/5 following the introduction of the internal market. We find that the main cost driver was the number of GPs, that there are economies of scale but not economies of scope in administration, and that fundholding appeared to increase administrative costs. Most the increase in administrative cost over the period could not be explained by the change in the cost drivers or fundholding, suggesting that the recent abolition of fundholding may do little to reduce primary care administrative costs.primary care; administrative costs; efficiency measurement; performance indicators.

Performance indicators for primary care management in the NHS

There is increased emphasis on the measurement of performance in the NHS. Following the White Paper, additional high level indicators for measuring primary care performance at Health Authority level have been proposed by the NHS Executive. These include measures based on prescribing and on hospital admission rates for certain acute and chronic conditions. It is suggested that higher hospital admission rates for some conditions may indicate deficiencies in their management in primary care. In this paper we argue that there are difficulties with some of the proposed measures. The difficulties arise because individual single indicators are used to attempt to reflect more than one aspect of performance, may have large year to year variation and be subject to confounding. Using data on Family Health Services Authorities (FHSAs) from 1989/90 to 1994/5 we investigate how admission rates, and the ranking of FHSAs by admission rates, vary as socio-economic and secondary and primary care supply conditions are allowed for. The impact of socio-economic factors on admission rates and rankings is at least as large as the impact of the age and sex structure of FHSA populations. Allowing also for secondary care supply conditions has a smaller, but still noticeable, effect. We suggest that if admission rates are used as performance indicators in primary care they should be standardised for socio-economic and supply conditions, as well as for demographic factors. We also make a number of other suggestions for improving the indicators. Length: 34 pagesperformance indicators; policy implications

A stochastic interspecific competition model to predict the behaviour of Listeria monocytogenes in the fermentation process of a traditional Sicilian salami

The present paper discusses the use of modified Lotka-Volterra equations in order to stochastically simulate the behaviour of Listeria monocytogenes and Lactic Acid Bacteria (LAB) during the fermentation period (168 h) of a typical Sicilian salami. For this purpose, the differential equation system is set considering T, pH and aw as stochastic variables. Each of them is governed by dynamics that involve a deterministic linear decrease as a function of the time t and an "additive noise" term which instantaneously mimics the fluctuations of T, pH and aw. The choice of a suitable parameter accounting for the interaction of LAB on L. monocytogenes as well as the introduction of appropriate noise levels allows to match the observed data, both for the mean growth curves and for the probability distribution of L. monocytogenes concentration at 168 h.Comment: 19 pages, 2 figures, 2 tables. To be published in Eur. Food Res. Techno

Thermodynamic Assessment of Cooled and Chilled Ammonia-based CO2 Capture in Air-Blown IGCC Plants

The energy impact of different post-combustion CO2 capture plants integrated in an advanced air-blown IGCC is simulated in this paper. Ammonia scrubbing is considered as the CO2 capture technology and chilled and cooled modes are investigated with reference to operation temperatures at the absorber equal to 7 °C and 20 °C respectively. Ammonia slip is controlled by means of an absorption-desorption cycle just before a final acid wash, where use of the H2S removed from the coal-derived gas at the desulphurization unit of the IGCC is made. Focusing on three levels of CO2 capture, from 80% to 90%, it is possible to appreciate that the cooled mode is promising as far as a reduction of the energy cost related to CO2 capture is concerned. As a matter of fact, the energy saving, possible when adopting an air cooling system instead of a chilling plant, is significant with the specific primary energy consumption for 90% of CO2 avoided which decreases from 2.79 MJ/kgCO2 to 2.54 MJ/kgCO2, when switching from the chilled to the cooled mode, with a difference equal to about 0.7 percentage point in IGCC efficiency