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Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

A simple model is used to evaluate the economic tradeoffs in the design and control of an appointment-based service center that offers a service guarantee. The model, which is based on recursive procedures, is employed in the steady-state and transient analysis of the system to determine the relationship between the departure interval and the scheduling interval and formulate an optimal scheduling plan that will reduce queue.

Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

Byline: Tuvia Horev, Yair M. Babad, Shifra Shvarts Bismarck introduced compulsory health insurance in 1883 as a state system for labourers, based on progressive dues. In Israel, almost a century has passed since the first attempt to establish health services until the present where each citizen receives by law comprehensive health services. We analyse the development of the Israeli system into one based on social principles, discuss advantages, issues and future challenges of the health system and its implementation. The organised health system in Israel started as a single dominant socialistic-political health fund, alongside other funds concentrating on highly educated high earners in metropolitan areas. The 1995 National Health Insurance Law stipulated that health services be provided by the existing health funds to all citizens, and be financed by a salary-based 'health tax'. The state is challenged by its roles as regulator, health provider, and national resource allocator.

This paper provides an algebraic basis of accounting transactions, procedures and bookkeeping activities in a framework that supports various financial and nonfinancial reports and accounting views. The development is based, on a set of accounting matrix operators. This approach, when combined with database technology, provides for a new level of control and security of accounting information, and minimizes the processing required for information distribution on a "need-to-know" basis. The procedural accounting matrix captures the essence of a complete accounting procedure; it is independent of any chart of accounts. Moreover, the order in which matrix operators are combined into the procedural matrix implicitly defines the chart of accounts for the related procedure and the accounts' balances. Consequently, it provides an environment in which alternative charts of accounts, and their financial and accounting implications, can be investigated. This approach, though not yet tested for operational efficiency, thus promotes multiple accounting views, such as GAAP, tax, and managerial accounting, that are all based on the same set of basic accounts, and simplifies their reconciliation. [ABSTRACT FROM AUTHOR]

The literature on physical database design in general, and on rile segmentation in particular, typically ignores any consideration of data security and the cost to enforce it. If records can be physically designed so that all data elements in a given record type have identical security restrictions for a given user, then data element level security enforcement can he transformed into the less costly rile level security enforcement for that user and file. Similarly, If all record types have identical security restrictions, file based security might be sufficient. This paper extends an earlier model for file segmentation to include security considerations. The extended model embeds the security measures into the logical file structure and exploits a four category taxonomy of security restriction types. The model is used to generalize the interaction between element level selective security and physical data- base design. [ABSTRACT FROM AUTHOR]