Workplace and workforce 2000+ -the future of our work environment.

OBJECTIVES: Research in the Human Resource Department at the University of Mannheim is directed towards the exploration of future work structures and design, and their effects on employees and employment relations. METHODS: The main methods applied are trend extrapolation and simulation in combination with delphi research methodology. The trends observed during the last decade suggest that the workplace and workforce in the new millenium will primarily be affected by flexibilization, decentralization, and globalization. RESULTS AND CONCLUSIONS: Flexibilization will lead to a core group with unlimited full employment and an increasing larger group of short-term limited and/or part-time employees who face severe employment risks, ultimately resulting in stress. Flexibilization will also affect the workplace. Information technologies will dissolve social entities. The virtual company suppresses social interaction and will as a consequence create new forms of alienation. Decentralization will increase the responsibility for business processes. Employees will be regarded as business process owners and will be held responsible for their results, a situation which again creates new stress factors. Globalization enhances competition, which in turn will encourage competitive attitudes at the workplace. Internal market mechanisms will take the place of performance appraisals by management. Market evaluation will substitute leadership styles and communication, which stand for the human side of enterprise. The psychosocial problems arising from these developments will produce new challenges for occupational health professionals.

[Costs-proceeds calculation for radiotherapy; comment]. / Kosten-Erlös-Rechnung für die Strahlentherapie.

BACKGROUND: The Health Care Structure Bill (Gesundheitsstrukturgesetz) and the Federal Health Care Tariff Regulation (Bundespflegesatzverordnung) pose new challenges for the chief physician in charge, which he has to face on account of hospital management control with department-specific internal budgeting of services, expenditure and remittance. In view of the impending establishment of care-related lump sums (Fallpauschalen) and special allowances for radiation therapy (Sonderentgelte) as well as the introduction of an appropriate internal budget plan, we resolved to draw up the service-cost ratio for 11 tumor entities, implementing calculation based on process evaluation, and to match this calculation to the actual proceeds from outpatient treatment covered either by general health insurance or private care insurance. MATERIAL AND METHODS: The following 11 tumors were included in the analysis: Glioblastoma multiforme, squamous cell carcinoma of the head and neck, lung cancer, oesophageal cancer, breast cancer, rectal and prostate cancer, cancer of the anal canal and the uterine cervix, Hodgkin's disease and bone metastases. For the description of the services rendered and for the calculation of actual cost, the complex treatment regime was divided into the following steps: administration, medical radiation planning, radiation planning by physicist, workmanship, radiotherapy treatment and medical service. The calculation of costs was made either in- or excluding the cost of teatment facilities and basic investment. The proceeds were calculated according to the regulations of the EBM (dated 1. 10. 1994) for general health insurance patients (median point value 9.35 DPF) and the GOA (dated 1. 7. 1988) for private patients (point value 11 DPF). RESULTS: 1. Calculation by EBM standards: Excluding the cost of facilities and basic investment, there is a profit margin for the following tumor entities amounting to +1.6% (103.18 DM) for ENT tumors, +9.2% (671.90 DM) for carcinoma of the anal canal and +35.8% (1637.84 DM) for bone metastases. All other tumor entities cannot be treated cost-effectively. With the exception of glioblastoma, median loss comes to -20% (-14% to -27.4%, i.e. -809.48 to -1812.84 DM). Including in the calculation the cost of the facilities and investment, only bone metastases can be treated with a profit margin. For all other tumors, the mean loss amounts to -33% (-14.1% to -44.7%) or else -1308.26 to -4550.51 DM. 2. Calculation by GOA standards: Comparing cost and actual proceeds, there is a loss for all tumor entities. Excluding the cost of treatment facilities and investment, median loss amounts to -44% (-33.3% to -53.5%, or -1752.64 DM to -3488.18 DM), including both, mean loss comes to -56% (-47.8% to -53.3% or -3156.33 DM to -6332.43 DM). 3. Calculation of comprehensive cost and of the proceeds: For our own department, considering the cost-proceeds ratio for 1994, we ran up a deficit of 673,767.10 DM for outpatient care. This deficit can mainly be traced back to non-operational hours of the linear accelerator due to machine impairment, maintenance and dosimetric measurements by the physicists, leading to the loss of 53 work-days (14 hours each) amounting to 498,771.34 DM plus general costs of 271,000 DM added to the bill by hospital administration. CONCLUSIONS: As to the reviewed tumor entities, modern standard radiotherapy cannot be administrated cost-effectively. A considerable degree of under-funding is especially evident with the inclusion of cost of investment and of the facilities. The cost-proceeds ratio is most unsatisfactory as regards GOA calculation, which is obsolete as far as service description and service payment is concerned. As it in no way measures up to the required standard of modern radiotherapy, reform is therefore urgently needed.