Real reform begins within: an organizational approach to health care reform

Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team-based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations -- that is to say, organizations that have the capacity to function as high-performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change.     

The social roles of Medicare: assessing Medicare's collateral benefits

The Medicare program incorporates a number of functions that go beyond providing health insurance to its beneficiaries. These activities, which we refer to as "collateral" functions, may have important health consequences but are also an increasing source of controversy. In this essay we develop a conceptual framework for categorizing these involvements, introduce some additional options that might complement Medicare's current collateral functions, assess the reaction of policy elites and Medicare's current beneficiaries to these alternatives, and evaluate the role that collateral activities play for Medicare's core mission. A case can be made for expanding some collateral involvements, but only if the Health Care Financing Administration has the strategic direction and administrative capacity to effectively implement these activities.     

公务员薪酬制度改革：实践中的难题及其破解

近年来,各地自发性地进行了公务员薪酬制度改革,但没能从根本上解决一直存在着的、困扰我国公务员薪酬制度改革实践的难题,即全国统一难题和职务、级别二元结构难题以及工资水平确定难题.其破解思路分别是:在公务员的工资结构上,适度加大基本工资的比重,降低津贴、补贴和奖金的比重,制定基本工资全国统一发放制度;建立职务与级别分立的两种体系,借鉴宽带薪酬的做法对我国公务员的薪酬进行改革,分类定薪,注重绩效;建立一个独立的社会薪酬调查机构.     

Health insurance for Americans approaching age sixty-five: an analysis of options for incremental reform

This article provides a systematic evaluation of the options for incremental health insurance reforms aimed at older Americans nearing age sixty-five. It presents three basic arguments for giving special consideration to this age group: (1) early retirement and its effect on access to employer insurance; (2) changes in health and health care expenses associated with increasing age; (3) the vulnerability to unexpected economic or health "shocks" that will affect people throughout their retirement. The analysis of policy options begins by specifying criteria for evaluating alternative approaches to reform. The proposed criteria emphasize that reforms for this age group should be designed to fit with other financial plans and decisions made during such a transitional stage of life. Policy options should be judged according to fundamental goals such as equity and efficiency, not simply ranked according to the number of uninsured who will gain coverage. After offering a comprehensive catalog and evaluation of available options, the analysis identifies and discusses a preferred approach-which preserves choices while offering universal and subsidized access to Medicare before age sixty-five.     

Globalization of technology-based growth: the policy imperative

The United States became the dominant technology-based economy after World War II and held that position for decades by accumulating a huge base of superior technical, physical, organizational, and marketing assets. However, the world is witnessing the rapid globalization of technology-based competition, which is the result of major commitments by many nations to investment in technology and its effective utilization. The changing dynamics of such competition requires revisions to the centuries’ old law of comparative advantage and the Schumpeterian process of creative destruction. However, U.S. technology-based growth policies have at best stood still for most of this period. The R&D intensity of the U.S. economy is below its peak in the 1960s and its vaunted “high-tech sector” is too small and increasingly challenged to carry the remaining sectors, as was the case before globalization began in earnest. A major reason for inadequate adaptation is the “installed base effect,” which results from the accumulation of the above types of economic assets and in turn creates both complacency and resistance to the need for adaptation. Weak recoveries from the most recent recessions and the sluggish growth in real incomes are major indicators of structural problems that are not being addressed. Catch-up will require adoption of more comprehensive growth policies, implemented with considerably more resources and based on substantive policy analysis capabilities.

Medicare program: data, standards and methodology used to establish fiscal year 1993 budgets for fiscal intermediaries and carriers--HCFA. Final notice

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which requires us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final, and responds to comments about, the data, standards, and methodology we proposed to use to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1993, beginning October 1, 1992.     

Medicaid program; state allotments for payment of Medicare Part B premiums for qualifying individuals: federal fiscal year 2006 and fiscal year 2007. Final rule

This final rule sets forth the methodology and process used to compute and issue each State's allotments for fiscal years (FY) 2006 and FY 2007 that are available to pay Medicare Part B premiums for qualifying individuals. It also provides the final FY 2006 allotments and the preliminary FY 2007 allotments determined under this methodology. We are also confirming the April 28, 2006 interim final rule as final.     

Medicare program: data, standards, and methodology used to establish fiscal year 1994 budgets for fiscal intermediaries and carriers--HCFA. Final notice

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards, and methodology used to establish budgets for Medicare intermediaries and carriers. In this notice, we respond to the comments received in response to our notice of October 5, 1993 and we announce the adoption of the proposed data, standards, and methodology that we used to establish the Medicare fiscal intermediary and carrier budgets for fiscal year (FY) 1994, beginning October 1, 1993, as final and without revision.