[Decentralized psychiatry. Evaluation of the first 5 years of psychiatric service based on a general hospital]

In 1977 the state parliament of Berne took the decision to reform the existing psychiatric health care. decentralized, community oriented institutions were to be established with the aim of preventing secondary disabilities due to psychiatric illness, and of enhancing or instigating rehabilitative measures. 4 different psychiatric services based in general hospitals were installed. The present report presents an analysis of statistical data collected during the first 5 years on one of these services. We found a linear increase of admission which appears to be due to several factors: demand, image, manpower, cooperation with other institutions, breadth of the offered service. Furthermore, the distance between the institution and the place of living proved to be an important factor influencing the incidence of psychiatric treatment and the degree of cooperation with other care services--this aspect being consistent with the arguments for a decentralization of care. The degree of consistency in the distribution of diagnoses and the changes of treatment was surprising: an average of 50% of our patients were referred on an out-patient basis, approx. 40% by general hospital wards, 16% remain under the care of the general hospital. Our statistical analysis shows that in an average of 61% of the cases in which a referral to a psychiatric hospital was discussed, this measure could be avoided (although there is a certain degree of subjectivity in this judgement). The psychiatric service does not appear to compete with private practice care: 44% of the patients are referred to general practitioners and practing psychiatrists for after care, while only half as many are referred from private practices.

Emerging contract incentives can add to hospitals' savings

Group purchasing organizations are trying to draw more volume out of their hospital members by offering additional price breaks if purchases meet performance targets, says John Henderson. The purchasing groups see the approach as a way to keep their promise to manufacturers of volume in return for discounts.

Alliances: changing focus for changing times

Alliance networks were supposed to offer members the same buying clout enjoyed by national health care systems and the opportunity to contract with employers as part of a national health care delivery network. But overly optimistic projections about how quickly alliances could reach those goals--and what it would cost to teach them--led to unmanaged growth and disgruntled members. According to our cover story, alliances now are adjusting to changing conditions by adopting strategies to serve the needs of hospitals and systems competing in regional markets.

[Geriatrics in the acute care hospital]

Since 1985, a graded system of medical care has served as a model at the III. Medical Clinic, Antonius hospital, Velbert-Neviges, FRG; Geriatric I (diagnostic, therapeutic, and intensive medicine), Geriatric II (therapy unit), and Geriatric III (day clinic) have not only reflected diagnostic and therapeutic improvements but they have also changed daily hospital operational requirements. Because of the structural adjustment of the hospital geriatric patients receive better care and patient-care costs are reduced.

Group purchasers must take new risks to achieve success

In this article, Henderson shares his perceptions of the group purchasing market and the issues affecting groups and their negotiations with vendors, concentrating on vendors' reactions to changing market forces. He discusses where group purchasing is today and where it is going.

Keeping up with evolution. Choosing strategies as group purchasing gets more complex

The next stage of group purchasing contracts has arrived. Increasing demands of alliances and groups require a more sophisticated response from manufacturers than in the past. Innovative programs, contracts and a thorough knowledge of the group are now required to remain ahead of the competition.