Constructing a European healthcare market: the private healthcare company Capio and the strategic aspect of the drive for transparency.

This article analyses the private healthcare company Capio and its participation in the drive for transparency in the European healthcare field. An important point of departure for the paper is that technologies for transparency, such as accounting and auditing, are not neutral devices for increased openness, but carry with them programmatic dimensions that affect our norms and rules of how healthcare is to be organized and controlled. The drive for transparency engages different actors with various motives. To investigate this we carried out semi-structured interviews with 11 persons, mainly management members of Capio. We show that transparency in healthcare has been put forward by a private actor for strategic reasons. We argue that Capio's involvement in the drive for transparency should be seen as a 'second-order strategy' with the aim to create advantageous opportunities in a future European healthcare market. We show that Capio, through its propagation of various transparency technologies, has put forward programmatic ideals of industrialisation, marketisation and Europeanisation in healthcare. The main conclusion is that although Capio has engaged in the drive for transparency for business reasons, the company has also furthered certain political ideals in the field. This study contributes to the literature which problematizes the division between private and public, and between business and politics in healthcare, and is of interest to a broad health policy audience.

Implementing the clinical nurse leader role in a for-profit environment: a case study.

The Clinical Nurse Leader project marks the first time in 35 years that nursing has introduced a new role to the profession. The project has evolved to include partnerships between more than 90 universities and 190 clinical sites. The authors present a case study of how a for-profit medical center created a sense of urgency for change, built a business case, and redesigned professional nursing practice to implement the Clinical Nurse Leader role.

Infection control consultation in a 150-bed acute care hospital: making this unobserved and unmeasured critical job function visible.

BACKGROUND: One qualified infection control director, reporting directly to administration, was responsible for the Infection Prevention and Control Program of a 150-bed acute care, non-teaching, for-profit hospital. To observe for potential trending, questions (consultations) and determinations related to infectious processes were documented. OBJECTIVE: To explore the possibility of measuring the essential although "hidden" function of the infection control consultation (process), which is a role not formerly linked to infection rates (outcomes). METHODS: A 7-year retrospective study was conducted of all infection control consultations requiring more than a 5-minute intervention, as part of routine job responsibilities. The XmR Statistical Process Control charts (XmR Charts) and Pearson's Correlation Coefficient were used to analyze the activity of infection control consultations. RESULTS: From January 1, 1998 to December 31, 2004, there were 770 infection control consultations logged for 375.1 hours. Beginning with 2003, the variation in both the number and duration of infection control consultations in the XmR Charts become more standardized and has a smaller moving range between data points. The Pearson's Correlation Coefficient shows statistical significance (P <.05) between the number and duration of consultations. CONCLUSIONS: Assessment of infection control consultations at this 150-bed hospital illustrates that this essential component can be measured, and should be formerly tracked to document overall assessment of infection prevention and control interdisciplinary interaction. The consultation process became more efficient over the 7-year study period because, as the number of questions increased, the duration required to achieve closure decreased.

An update on safety-net hospitals: coping with the late 1990s and early 2000s.

Recent forces have created new financial stress for hospitals but also some relief. This paper explores hospitals' changing involvement in the safety net between 1996 and 2002. We replicate approaches used in a study of 1990-1997 and thus provide a needed update on the U.S. hospital safety net. Overall, some groups of safety-net hospitals increased uncompensated care, but others did not. Non-safety-net hospitals trimmed certain services commonly used by the indigent; this may point to future reductions in access. We examine the implications of these findings for the future of the safety net.

Uncompensated care and hospital conversions in Florida.

Hospital conversions to for-profit ownership have prompted concern about continuing access to care for the poor or uninsured. This DataWatch presents an analysis of the rate of uncompensated care provided by Florida hospitals before and after converting to for-profit ownership. Uncompensated care declined greatly in the converting public hospitals, which had a significant commitment to uncompensated care before conversion. Among converting nonprofit hospitals, uncompensated care levels were low before conversion and did not change following conversion. The study suggests that policymakers should assess the risk entailed in a conversion by considering the hospital's historic mission and its current role in the community.

Trends in hospital consolidation: the formation of local systems.

During the past decade the hospital industry has made profound organizational changes, including the extensive consolidation of hospitals through merger and the formation of hospital systems. Although the rate of hospital system acquisitions may be slowing, the local presence of hospital systems is growing. Locally concentrated systems have been formed by both for-profit and nonprofit hospitals. Researchers have tended to ignore acquisitions or have portrayed system formation as primarily an issue of hospital ownership conversion, thereby focusing on the expansion of national, for-profit systems. This has left a large gap in policymakers' understanding of how locally concentrated systems may affect patient care and competition.

Deconstructing the Columbia/HCA investigation.

Every issue raised by the current investigation into the business practices of Columbia/HCA serves as a signpost for the progress and problems inherent in market-driven health care reform. Actions against Columbia/HCA by regulators reveal deeply rooted resistance to the profit-motivated reforms embodied in the company's philosophy: the public's reluctance to accept necessary reductions in excess hospital capacity; the legal and cultural obstacles to the overdue alignment of physician and hospital economic interests; and the myriad reimbursement and accounting problems involved in the vertical integration of health care delivery. The investigation also underscores the antiquation of the reimbursement mechanisms and control systems in place for financing the delivery of care to Medicare beneficiaries.

On the commodification of medicine.

The author reviews key themes of medicine and medical education in the 20th century, such as the revolution in therapies and the consequent and continuing changes in the economics of health care; workforce issues, including the controversy over the optimum number of residency slots; and the impact of managed care on teaching hospitals and medical schools. This impact is part of "the commodification of health care," in which health care is beginning to be bought and sold in a market, where prices determine outcomes, and where the not-for-profit, service orientation of health care providers is threatened. He discusses in detail the pressures this new health care environment places on medical schools and teaching hospitals, and recounts the first Senate Finance Committee hearing in April 1994 on the subject of academic health centers under health care reform. Soon after, the Committee approved legislation to create the Graduate Medical Education and Academic Health Center Trust Fund, to be financed by a 1.5% tax on private health care premiums in addition to Medicare Graduate Medical Education payments. The provision was later dropped from a similar bill that came before the full Senate, but has since been introduced as the Medical Education Trust Fund Act of 1997. The author concludes by cautioning that matters will grow more difficult in the near future, since the threats to academic medicine's institutions have not yet become part of the national political agenda.

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.

Japan's clinic physicians and their behavior.

The paper examines the behavior of the Japanese general practitioner or clinic physician. Clinic physicians in Japan are entrepreneurs who own and operate their own clinics with either no beds or less than 20 beds. They have been the prime providers of Japan's health care, and they are represented by the politically powerful Japan Medical Association. General practitioners are reimbursed basically on the basis of fee-for-service with fees determined by the authority. Japan has universal health insurance. The paper modeled the general practitioner as a maximizer of his own utility and explored its theoretical and empirical implications. The maximization of his own utility which is a function of his income and leisure time should reflect the fact that the physician's conscientious behavior is relied upon for the effective delivery of medical care in Japan. Our empirical results found that revenues and net profits of clinics are critically related to the quantity of drugs used, the age of physicians and the size of clinics. This finding gives some support to the oft-heard allegation in Japan that physicians maximize their income by prescribing more drugs and examinations.

For profits: a look at the bottom line.

This paper examines the expansion of for-profit health care organizations, focusing on hospitals. It argues that much of the support of for-profits derives from American market ideology and the assumption that the search for profits leads to efficiency in production. In the health field, there is no evidence, however, that such gains in efficiency exist or that, if they do, they are shared with patients in the form of lower costs of care or with employees in the form of higher wages. The paper presents a number of reasons for concluding that for-profits would not serve the needs of patients, care deliverers, local communities, or the health care system. Potential efficiency gains, even if realized, would be far outweighed by the damage that for-profits would cause.

The future of the pathologist in the hospital setting.

The future of the pathologist in the hospital setting can be speculated on in light of contemporary and predictable trends occurring in hospitals. From five of these trends--downsizing, restructuring, diversification, hospital-physician relations, and for-profit hospitals--eight implications for the practice of pathology are identified.

For-profit hospitals for Europe: the case of Britain and France.

The paper first describes the structural characteristics of the for-profit private sector in Britain and in France. In Britain, the recent growth of the for-profit private hospital's sector, although still a small sector, is related to the growth of private insurance. Cost-containment however coupled to rapid increases in premiums is slowing down the momentum. Moreover, the NHS starts charging private hospitals for such services like blood banks. In France the private sector has always been strong, although living in a highly regulated and dependent symbiosis with the public sector. In a second part, speculations are made on the crucial question whether for-profit hospitals are a legitimate alternative for Europe. In the end, an in-between solution is opted for by which the public sector would sub-contract certain functions like data processing, management and others, from the commercial sector.