Frank Markel - Academia.edu (original) (raw)
Papers by Frank Markel
Journal of Algebra, Jul 1, 1973
Groups with Many Conjugate Elements 'I'his paper studies two classes of groups in which certain e... more Groups with Many Conjugate Elements 'I'his paper studies two classes of groups in which certain elements are necessarily conjugate. M'e consider only finite groups. Let G be a finite group with Y conjugacy classes. Choose coniugacy class representatives <?I ,.,..g, numhercd so that G ~-:~ C(gl) ... '; ~ C:(g,). In this paper WC present a partial classification of those groups wlkh satisfv the restraint C(g,)' " "' ' ~ C(&).
Healthcare Management Forum, Dec 1, 1991
En 1989 était lancée l&amp;amp;amp;#39;initiative de financement transitoire des hôpitaux... more En 1989 était lancée l&amp;amp;amp;#39;initiative de financement transitoire des hôpitaux, qui incorpore des mesures de groupements de cas dans le mécanisme de financement hospitalier. Cette initiative marque le début d&amp;amp;amp;#39;un principe nouveau, plus objectif, pour calculer le financement des hôpitaux. Aux premiers stades, la croissance progressive et les ajustements d&amp;amp;amp;#39;affectations inter-hospitalières sont apportés aux budgets globaux. Nous décrivons au document le lancement de l&amp;amp;amp;#39;initiative et les formules de financement issues de la première phase. Nous abordons ensuite la question des effets incitatifs et, puisque c&amp;amp;amp;#39;est une initiative en évolution ou transitoire, nous formulons des observations sur plusieurs questions économiques qui découlent de cette nouvelle tentative.
PubMed, 1988
More competition for finite resources and increasing regulation have led many hospitals to consid... more More competition for finite resources and increasing regulation have led many hospitals to consider a strategic reorganization. Recently, one common reorganization strategy has been"product line management." Product line management can be broadly defined in terms of centralized program management, planning, and marketing strategies. In Canada, while strategic driving forces may be different, a product line management alternative has arisen in one of the most potentially complex product lines, cancer services. This article compares and contrasts the theoretical model for product line management development, with special reference to cancer services, to the experience of one Canadian medical center and cancer center.
PubMed, 1992
In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of... more In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Canadian Medical Association Journal, Apr 2, 2013
M any eligible patients never receive an organ transplant because of biological or psychological ... more M any eligible patients never receive an organ transplant because of biological or psychological human factors that contribute to shortfalls in organ availability. 1,2 Immune suppression and surgical complications, for example, require that transplant recipients receive centralized care at hospitals staffed by highly specialized clinicians. 3,4 However, the subtleties of patient preferences, community support and maximizing available organs require that donors be identified from a wide range of general hospitals. 2 Ultimately, these practices can mean that hospitals responsible for identifying potential donors do not always encounter the patients who received the suc cessful transplantations. A request for organ donation after death requires initiative, appropriate referral, consent, formal declaration of brain death and maintenance of donor viability at a time when other patients may also require attention. 5,6 The time pressure is substantial, because incidents often arise on weekends or at night when clinicians are short staffed, sleep deprived and uncertain about diagnosing brain death. 7,8 The diversity of cultural preferences and distraught emotions in relatives of potential donors can also cause wellintentioned requests to be misunderstood and followed by negative conflict. 9,10 Hence, the ongoing rates of deceased organ donation represent substantial efforts both in the community and in hospitals. 11 Decision science research suggests that clinical behaviour does not always follow the standard model of rational thought. 12 Self-identity, for example, can sometimes influence decisions by shaping people's preferences and defining institutional norms. 13-15 We questioned whether the difference between hospitals that observe gratifying recipient outcomes and hospitals that initiate
Medical Care, Jun 1, 1986
Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of... more Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of Ontario called a strike of house staff in Ontario's teaching hospitals. The authors obtained data concerning utilization of laboratory tests and radiology procedures during that period and for the same days 2 weeks before and after the strike. During the strike period, the number of tests performed per patient day decreased by only 8.3%. After accounting for proportional changes in emergency and nonemergency admissions, there was no significant change in the number of tests or relative value units performed per patient day as a result of the strike. These results suggest that the volume of tests performed in teaching hospitals is more likely related to the case mix and severity of illness of patients admitted to these institutions than to a pure "teaching effect."
Healthcare quarterly, Mar 15, 1998
The publication of Case Mix Tools for Decision Making in Health Care represents a landmark achiev... more The publication of Case Mix Tools for Decision Making in Health Care represents a landmark achievement for the field of utilization management in Canadian healthcare. This coming of age can be seen in several ways. First, we find, at long last, through the development of the Complexity Measure, a response to the continual complaint of physicians, managers, and hospital administrators, when they are faced with an unfavorable utilization comparison, namely "My patients are sicker than those to whom I am being compared," and as a result, " I have been inappropriately made to look inefficient." Many of us remember a time when the combination of weak analytic tools, and weaker managerial resolve prohibited the effective employment of utilization-management techniques, both within hospitals and between them. Those were the days when to question physician-utilization practise was to intrude on the private relationship between doctor and patient, and to link hospital funding to performance was to risk political suicide. A reading of Case Mix Tools provides convincing evidence that those days are now behind us. In their stead, we find ourselves in a world where physicians have taken on the challenge of working within admitted fiscal constraints, and have responded with an increased attention to achieving better utilization practices. As well, Ministries of Health have turned to Case Mix Measures as a necessary component of hospital-funding decisions. This fundamental change has been made possible by a combination of tighter fiscal constraints, an introduction of
Healthcare Management Forum, Dec 1, 1991
In 1989, the hospital transitional funding initiative, which incorporates case mix measurement in... more In 1989, the hospital transitional funding initiative, which incorporates case mix measurement into the hospital finding process, was started in Ontario. This initiative is the beginning of a new, more objective basis for determining hospital finding. In its initial stages, incremental growth and interhospital equity adjustments are made to the global budgets. In this paper, we describe the launching of this initiative and the funding formulas that emerged from its first phase. The issue of incentive efsects is then discussed and, as this is an evolving or "transitional" undertaking, we comment on several economic issues arising as a result of this new venture.
and the hospitals to modify Ontario's global budgeting system. The goals are to achieve grea... more and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Many eligible patients never receive anorgan transplant because of biologi-cal or psychological h... more Many eligible patients never receive anorgan transplant because of biologi-cal or psychological human factors that contribute to shortfalls in organ availabil-ity.1,2 Immune suppression and surgical compli-cations, for example, require that transplant recipients receive centralized care at hospitals staffed by highly specialized clinicians.3,4 How-ever, the subtleties of patient preferences, com-munity support and maximizing available or-gans require that donors be identified from a wide range of general hospitals.2 Ultimately, these practices can mean that hospitals respon-sible for identifying potential donors do not always encounter the patients who received the suc cessful transplantations. A request for organ donation after death requires initiative, appropriate referral, consent, formal declaration of brain death and mainte-nance of donor viability at a time when other patients may also require attention.5,6 The time pressure is substantial, because incidents often arise on we...
Healthcare Quarterly, 2006
In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of... more In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Healthcare Quarterly, 1998
Healthcare Management Forum, 1991
Healthcare Quarterly, 2002
The notion of uniform terms and conditions speaks to equity of access--that fair rules apply in o... more The notion of uniform terms and conditions speaks to equity of access--that fair rules apply in obtaining medically necessary services. However, when demand for medical services outweighs the supply of these services, the issue of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fair rules&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; concerning who comes first or who is most in need is a hotly debated subject. This debate has focused not just on how long patients may have to wait for access, but also on the question of how caregivers decide the priority of providing care. Central to this discussion is the need to develop a transparent methodology that fairly prioritizes patients based on urgency; timely access to services and acceptability to all stakeholders.
Journal of Algebra, Jul 1, 1973
Groups with Many Conjugate Elements 'I'his paper studies two classes of groups in which certain e... more Groups with Many Conjugate Elements 'I'his paper studies two classes of groups in which certain elements are necessarily conjugate. M'e consider only finite groups. Let G be a finite group with Y conjugacy classes. Choose coniugacy class representatives <?I ,.,..g, numhercd so that G ~-:~ C(gl) ... '; ~ C:(g,). In this paper WC present a partial classification of those groups wlkh satisfv the restraint C(g,)' " "' ' ~ C(&).
Healthcare Management Forum, Dec 1, 1991
En 1989 était lancée l&amp;amp;amp;#39;initiative de financement transitoire des hôpitaux... more En 1989 était lancée l&amp;amp;amp;#39;initiative de financement transitoire des hôpitaux, qui incorpore des mesures de groupements de cas dans le mécanisme de financement hospitalier. Cette initiative marque le début d&amp;amp;amp;#39;un principe nouveau, plus objectif, pour calculer le financement des hôpitaux. Aux premiers stades, la croissance progressive et les ajustements d&amp;amp;amp;#39;affectations inter-hospitalières sont apportés aux budgets globaux. Nous décrivons au document le lancement de l&amp;amp;amp;#39;initiative et les formules de financement issues de la première phase. Nous abordons ensuite la question des effets incitatifs et, puisque c&amp;amp;amp;#39;est une initiative en évolution ou transitoire, nous formulons des observations sur plusieurs questions économiques qui découlent de cette nouvelle tentative.
PubMed, 1988
More competition for finite resources and increasing regulation have led many hospitals to consid... more More competition for finite resources and increasing regulation have led many hospitals to consider a strategic reorganization. Recently, one common reorganization strategy has been"product line management." Product line management can be broadly defined in terms of centralized program management, planning, and marketing strategies. In Canada, while strategic driving forces may be different, a product line management alternative has arisen in one of the most potentially complex product lines, cancer services. This article compares and contrasts the theoretical model for product line management development, with special reference to cancer services, to the experience of one Canadian medical center and cancer center.
PubMed, 1992
In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of... more In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Canadian Medical Association Journal, Apr 2, 2013
M any eligible patients never receive an organ transplant because of biological or psychological ... more M any eligible patients never receive an organ transplant because of biological or psychological human factors that contribute to shortfalls in organ availability. 1,2 Immune suppression and surgical complications, for example, require that transplant recipients receive centralized care at hospitals staffed by highly specialized clinicians. 3,4 However, the subtleties of patient preferences, community support and maximizing available organs require that donors be identified from a wide range of general hospitals. 2 Ultimately, these practices can mean that hospitals responsible for identifying potential donors do not always encounter the patients who received the suc cessful transplantations. A request for organ donation after death requires initiative, appropriate referral, consent, formal declaration of brain death and maintenance of donor viability at a time when other patients may also require attention. 5,6 The time pressure is substantial, because incidents often arise on weekends or at night when clinicians are short staffed, sleep deprived and uncertain about diagnosing brain death. 7,8 The diversity of cultural preferences and distraught emotions in relatives of potential donors can also cause wellintentioned requests to be misunderstood and followed by negative conflict. 9,10 Hence, the ongoing rates of deceased organ donation represent substantial efforts both in the community and in hospitals. 11 Decision science research suggests that clinical behaviour does not always follow the standard model of rational thought. 12 Self-identity, for example, can sometimes influence decisions by shaping people's preferences and defining institutional norms. 13-15 We questioned whether the difference between hospitals that observe gratifying recipient outcomes and hospitals that initiate
Medical Care, Jun 1, 1986
Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of... more Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of Ontario called a strike of house staff in Ontario's teaching hospitals. The authors obtained data concerning utilization of laboratory tests and radiology procedures during that period and for the same days 2 weeks before and after the strike. During the strike period, the number of tests performed per patient day decreased by only 8.3%. After accounting for proportional changes in emergency and nonemergency admissions, there was no significant change in the number of tests or relative value units performed per patient day as a result of the strike. These results suggest that the volume of tests performed in teaching hospitals is more likely related to the case mix and severity of illness of patients admitted to these institutions than to a pure "teaching effect."
Healthcare quarterly, Mar 15, 1998
The publication of Case Mix Tools for Decision Making in Health Care represents a landmark achiev... more The publication of Case Mix Tools for Decision Making in Health Care represents a landmark achievement for the field of utilization management in Canadian healthcare. This coming of age can be seen in several ways. First, we find, at long last, through the development of the Complexity Measure, a response to the continual complaint of physicians, managers, and hospital administrators, when they are faced with an unfavorable utilization comparison, namely "My patients are sicker than those to whom I am being compared," and as a result, " I have been inappropriately made to look inefficient." Many of us remember a time when the combination of weak analytic tools, and weaker managerial resolve prohibited the effective employment of utilization-management techniques, both within hospitals and between them. Those were the days when to question physician-utilization practise was to intrude on the private relationship between doctor and patient, and to link hospital funding to performance was to risk political suicide. A reading of Case Mix Tools provides convincing evidence that those days are now behind us. In their stead, we find ourselves in a world where physicians have taken on the challenge of working within admitted fiscal constraints, and have responded with an increased attention to achieving better utilization practices. As well, Ministries of Health have turned to Case Mix Measures as a necessary component of hospital-funding decisions. This fundamental change has been made possible by a combination of tighter fiscal constraints, an introduction of
Healthcare Management Forum, Dec 1, 1991
In 1989, the hospital transitional funding initiative, which incorporates case mix measurement in... more In 1989, the hospital transitional funding initiative, which incorporates case mix measurement into the hospital finding process, was started in Ontario. This initiative is the beginning of a new, more objective basis for determining hospital finding. In its initial stages, incremental growth and interhospital equity adjustments are made to the global budgets. In this paper, we describe the launching of this initiative and the funding formulas that emerged from its first phase. The issue of incentive efsects is then discussed and, as this is an evolving or "transitional" undertaking, we comment on several economic issues arising as a result of this new venture.
and the hospitals to modify Ontario's global budgeting system. The goals are to achieve grea... more and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Many eligible patients never receive anorgan transplant because of biologi-cal or psychological h... more Many eligible patients never receive anorgan transplant because of biologi-cal or psychological human factors that contribute to shortfalls in organ availabil-ity.1,2 Immune suppression and surgical compli-cations, for example, require that transplant recipients receive centralized care at hospitals staffed by highly specialized clinicians.3,4 How-ever, the subtleties of patient preferences, com-munity support and maximizing available or-gans require that donors be identified from a wide range of general hospitals.2 Ultimately, these practices can mean that hospitals respon-sible for identifying potential donors do not always encounter the patients who received the suc cessful transplantations. A request for organ donation after death requires initiative, appropriate referral, consent, formal declaration of brain death and mainte-nance of donor viability at a time when other patients may also require attention.5,6 The time pressure is substantial, because incidents often arise on we...
Healthcare Quarterly, 2006
In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of... more In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.
Healthcare Quarterly, 1998
Healthcare Management Forum, 1991
Healthcare Quarterly, 2002
The notion of uniform terms and conditions speaks to equity of access--that fair rules apply in o... more The notion of uniform terms and conditions speaks to equity of access--that fair rules apply in obtaining medically necessary services. However, when demand for medical services outweighs the supply of these services, the issue of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fair rules&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; concerning who comes first or who is most in need is a hotly debated subject. This debate has focused not just on how long patients may have to wait for access, but also on the question of how caregivers decide the priority of providing care. Central to this discussion is the need to develop a transparent methodology that fairly prioritizes patients based on urgency; timely access to services and acceptability to all stakeholders.