RESUMO
This study compares graduate medical education (GME) payments between nonprofit and for-profit hospitals between 2011 and 2020 to assess how hospitals value GME.
Assuntos
Economia Hospitalar , Educação de Pós-Graduação em Medicina , Financiamento Governamental , Administração Hospitalar , Educação de Pós-Graduação em Medicina/economia , Hospitais , Internato e Residência/economia , Estados Unidos , Economia Hospitalar/organização & administração , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Administração Hospitalar/economia , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/organização & administração , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Governo FederalAssuntos
Hospitais com Fins Lucrativos/organização & administração , Número de Leitos em Hospital/estatística & dados numéricos , Preços Hospitalares/estatística & dados numéricos , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/estatística & dados numéricos , Humanos , Estados UnidosRESUMO
BACKGROUND: South Africa essentially has two health care systems-the public and private ones. While much is known about how the public system operates, little work has been conducted on the private sector, perhaps not surprisingly in a profit-oriented, proprietary system. But it is a massive system with its own agenda, interests, and organizations. In this paper, we address the place of private care governance issues, one seen by government as maldistributed, costly, and controlled by few groups and the medical search for profit. METHODS: Using qualitative in-depth interviews, 10 top executive managers of the hospital were asked about its functionality in terms of patient care, profitability, and the practice of governance. Data were analyzed based on themes using NVivo 10 software. RESULTS: The study demonstrates that private hospital functionality finds meaning in board structure, composition and functions, purposeful governance practices as evidenced in well-designed management structures and roles, systematizing governance through the planning of activities, and devising appropriate strategies to deal with both internal and external pressures in the health care environment. CONCLUSION: The study findings establish that shareholders and managers goals converge resulting in the institutionalization and consolidating of relational governance practices in the hospital. Yet other stakeholders appeared to be sidelined.
Assuntos
Atenção à Saúde/organização & administração , Setor Privado/organização & administração , Conselho Diretor/organização & administração , Hospitais Privados/organização & administração , Hospitais com Fins Lucrativos/organização & administração , Humanos , Entrevistas como Assunto , África do SulRESUMO
A significant barrier to accessing healthcare in Canada is long waiting lists, which can be linked to the way that Medicare was structured. After significant pressure, provincial governments began to address wait times. An example of a successful strategy to reduce wait times for elective surgery is the Saskatchewan Surgical Initiative, which saw wait times in the province change from being among the longest in Canada to the shortest.
Assuntos
Listas de Espera , Canadá , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais com Fins Lucrativos/organização & administração , Hospitais com Fins Lucrativos/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , SaskatchewanAssuntos
Eficiência Organizacional , Hospitais com Fins Lucrativos/organização & administração , Sistemas Multi-Institucionais/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Hospitais com Fins Lucrativos/economia , Humanos , Sistemas Multi-Institucionais/economia , Estados UnidosRESUMO
This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance.
Assuntos
Grupos Diagnósticos Relacionados/economia , Sistema de Pagamento Prospectivo/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos Diagnósticos Relacionados/organização & administração , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Economia Hospitalar/organização & administração , Economia Hospitalar/estatística & dados numéricos , Feminino , Política de Saúde , Custos Hospitalares/estatística & dados numéricos , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Sistema de Pagamento Prospectivo/estatística & dados numéricos , Taiwan , Adulto JovemRESUMO
BACKGROUND: Little is known about the relationship between operative care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy--a newer and more expensive modality--as well as overall RT. METHODS: We conducted a retrospective study of female Medicare beneficiaries who received breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT by using hierarchical generalized linear models. RESULTS: The sample consisted of 35,118 women, 8.0% of whom had breast-conserving operations at for-profit hospitals. Among patients who received RT, those who underwent operation at for-profit hospitals were more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; odds ratio [OR] for for-profit versus not-for-profit: 1.50; 95% confidence interval [95% CI] 1.23-1.84; P < .001). Among women aged 66-79 years, there was no relationship between hospital ownership status and overall use of RT. Among women ages 80-94 years of age--the group least likely to benefit from RT due to shorter life expectancy--undergoing breast-conserving operations at a for-profit hospital was associated with greater overall use of RT (OR 1.22; 95% CI 1.03-1.45, P = .03) and brachytherapy use (OR 1.66; 95% CI 1.18-2.34, P = .003). CONCLUSION: Operative care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women who are least likely to benefit from RT, operative care at a for-profit hospital was associated with greater overall use of RT, with this difference largely driven by the use of brachytherapy.
Assuntos
Braquiterapia/estatística & dados numéricos , Neoplasias da Mama/terapia , Hospitais com Fins Lucrativos/economia , Hospitais Filantrópicos/economia , Mastectomia Segmentar , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/economia , Terapia Combinada , Feminino , Custos de Cuidados de Saúde , Custos Hospitalares , Hospitais com Fins Lucrativos/organização & administração , Hospitais Filantrópicos/organização & administração , Humanos , Modelos Lineares , Medicare/economia , Propriedade/economia , Propriedade/organização & administração , Estudos Retrospectivos , Estados UnidosAssuntos
Economia Hospitalar/organização & administração , Eficiência Organizacional/economia , Sistemas Multi-Institucionais/economia , California , Fechamento de Instituições de Saúde/história , História do Século XX , História do Século XXI , Hospitais com Fins Lucrativos/história , Hospitais com Fins Lucrativos/organização & administração , Hospitais Religiosos/organização & administração , Estudos de Casos OrganizacionaisRESUMO
Are independent hospitals still viable? Yes, but partnerships can provide important support.
Assuntos
Comportamento Cooperativo , Hospitais com Fins Lucrativos , Modelos Teóricos , Eficiência Organizacional/economia , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/organização & administração , Idaho , Relações Interinstitucionais , Autonomia ProfissionalRESUMO
Independent hospitals should take six steps when considering the viability of maintaining independence: Evaluate the links between independence and organizational mission. Assess market factors. Analyze the organization's financial status. Perform a strategic assessment. Evaluate the potential benefits of partnership. Assess the organization's ability to implement strategy.
Assuntos
Hospitais com Fins Lucrativos/economia , Autonomia Profissional , Reforma dos Serviços de Saúde , Instituições Associadas de Saúde/economia , Hospitais com Fins Lucrativos/organização & administração , Técnicas de Planejamento , Estados UnidosAssuntos
Relações Hospital-Médico , Hospitais com Fins Lucrativos/legislação & jurisprudência , Patient Protection and Affordable Care Act , Autorreferência Médica/legislação & jurisprudência , Hospitais com Fins Lucrativos/organização & administração , Humanos , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Propriedade/legislação & jurisprudência , Estados UnidosRESUMO
Leveraged buyout (LBO) arrangements are a reorganization strategy whereby a firm assumes a substantial amount of debt to buy back its publicly held stock to become privately held. LBOs offer a firm several advantages and have the potential to increase efficiency. In the past 20 years, several healthcare firms have engaged in LBOs, but the literature on performance changes in healthcare organizations as a result of an LBO is limited. In this article, we report on a study that examined the performance of Hospital Corporation of America (HCA) hospitals before and after the LBO that was initiated in 2006. We used data from the Medicare Hospital Cost Report Information System and analyzed data from 130 HCA hospitals and 490 comparison hospitals. Findings show that HCA hospitals reduced expenses and their number of full-time equivalents (FTEs) relative to local competitor hospitals. HCA hospitals' cash-flow-margin ratio was substantially higher when adjusted for its local competing hospitals at the beginning of the LBO as well as at end of the LBO. When compared to local hospitals, HCA hospitals had a significant decrease in their capital investment in fixed assets from 2006 to 2009. These findings underscore the effectiveness of HCA's management strategies to repay debt and increase the value of the company, and they are informative for healthcare firms and their managers who are considering LBOs.
Assuntos
Administração Financeira de Hospitais/métodos , Instituições Associadas de Saúde/economia , Hospitais com Fins Lucrativos/economia , Medicare/economia , Gastos de Capital , Competição Econômica , Eficiência Organizacional , Administração Financeira de Hospitais/economia , Hospitais com Fins Lucrativos/organização & administração , Humanos , Medicare/estatística & dados numéricos , Melhoria de Qualidade/economia , Melhoria de Qualidade/organização & administração , Estados UnidosAssuntos
Hospitais com Fins Lucrativos/tendências , Hospitais Filantrópicos/tendências , Medicaid/economia , Patient Protection and Affordable Care Act/economia , Administração Financeira de Hospitais/legislação & jurisprudência , Administração Financeira de Hospitais/normas , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/organização & administração , Hospitais Filantrópicos/economia , Hospitais Filantrópicos/organização & administração , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Relações Interinstitucionais , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act/normas , Estados UnidosRESUMO
In the face of increasing health care costs, taxing not-for-profit hospitals may be seen as the right choice to increase government revenues if not-for-profit hospitals are not different from their for-profit counterparts. This study investigates how hospital ownership type affects treatment choices to show whether ownership type and teaching status are correlated with choosing a procedure as the treatment and how these choices relate to patient insurance type. Not-for-profit hospitals significantly differ from for-profits in terms of treatment choices of less profitable patients and all hospitals are more likely to accord the procedure when the patient is privately insured than uninsured though teaching government hospitals are the most likely to accord the procedures for all insurance types. Considering treatment choices, not-for-profit hospitals have different objectives than for-profit and government hospitals and in terms of profit-seeking behavior, not-for-profit hospitals seem to lie between for-profit and government hospitals.
Assuntos
Hospitais com Fins Lucrativos/organização & administração , Hospitais Públicos/organização & administração , Hospitais Filantrópicos/organização & administração , Propriedade/estatística & dados numéricos , Comportamento de Escolha , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino/organização & administração , Humanos , Seguro Saúde/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: A leveraged buyout (LBO) is a type of corporate reorganization and acquisition practice whereby private investors borrow a substantial amount of debt to acquire a firm by buying back its publicly held stock to go private. The Hospital Corporation of America, Inc. (HCA), went through its second LBO in July of 2006. A prior study on the performance changes of the first LBO found no significant changes in revenues, expenses, or profitability. PURPOSES: In this study, we evaluated the changes in performance measures for HCA hospitals during the second LBO period. We looked at the effect of the LBO on financial and operational performance indicators, controlling for market and hospital characteristics. METHODOLOGY: We identified 121 urban HCA hospitals that consistently reported data over a 4-year window from 1 year pre-LBO to 3 years post-LBO and evaluated their study performance changes during the period. Primary data for operational and financial measures are derived from Health Care Cost Report Information System data sets. FINDINGS: On the basis of this study, the LBO led to significant increases in cash flow margin, net patient revenues, and total asset turnover ratio. It also increased operating expenses significantly. However, it was not associated with changes in labor costs, staffing, and capital investment. PRACTICE IMPLICATIONS: The management of publicly traded hospitals that consider an LBO should develop operating strategies to maintain a strong cash flow performance and find ways to boost patient volume. It also needs to determine if it would be able to continue investing in its facilities to keep physicians and patients loyal and to keep investing in the training and retention of employees, which ultimately improves the quality of care and enhances operational efficiency.
Assuntos
Eficiência Organizacional , Instituições Associadas de Saúde/economia , Hospitais com Fins Lucrativos/organização & administração , Hospitais Urbanos/economia , Corporações Profissionais/economia , Sociedades/organização & administração , Gastos de Capital/tendências , Competição Econômica , Administração Financeira de Hospitais , Pesquisa sobre Serviços de Saúde , Hospitais com Fins Lucrativos/economia , Humanos , Admissão e Escalonamento de Pessoal/economia , Corporações Profissionais/estatística & dados numéricos , Análise de Regressão , Análise de Sistemas , Estados UnidosAssuntos
Administração Financeira de Hospitais/economia , Hospitais com Fins Lucrativos/economia , Hospitais Filantrópicos/economia , Controle de Custos/métodos , Administração Financeira de Hospitais/organização & administração , Administração Financeira de Hospitais/tendências , Hospitais com Fins Lucrativos/organização & administração , Hospitais com Fins Lucrativos/tendências , Hospitais Filantrópicos/organização & administração , Hospitais Filantrópicos/tendências , Humanos , Renda/tendências , Estados UnidosAssuntos
Hospitalização/economia , Hospitais com Fins Lucrativos/organização & administração , Hospitais Públicos/organização & administração , Medicare/economia , Alta do Paciente/normas , Idoso , Comunicação , Feminino , Hospitais com Fins Lucrativos/economia , Hospitais Públicos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
Hospitals operate in markets with varied demographic, competitive, and ownership characteristics, yet research on ownership tends to examine hospitals in isolation. Here we examine three hospital ownership types -- nonprofit, for-profit, and government -- and their spillover effects. We estimate the effects of for-profit market share in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals' medical service provision systematically varies by market mix. We find no significant effect of market mix on the operating margins of nonprofit hospitals, but find that for-profit hospitals have higher margins in markets with more for-profits. These results fit best with theories in which hospitals maximize their own output.