Wait times in Canada.

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.

Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

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.

Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits.

IDS conversions to for-profit status: structuring the deal.

Not-for-profit integrated delivery systems (IDSs) may convert assets to for-profit status in a variety of ways, but typically choose from three basic conversion structures: sale of assets, joint ventures, and lease or management agreements. To select the optimal conversion structure, not-for-profit IDS executives should understand the forces driving their organization's desire or need to effect such a conversion and examine the legal, business, and political implications of each option in light of the organization's particular circumstances.

Federal tax developments affecting health care organizations--Part II: New rulings and court decisions.

Health care providers face numerous federal tax law changes in 1997 legislation, agency rulings, and court decisions. In the conclusion of this article, the author covers agency rulings and court decisions, with particular focus on tax-exempt hospitals forming delivery systems with for-profit entities.

Achieving functional integration: a continuum case study.

Inova Mount Vernon Hospital, a part of the Inova Health System in northern Virginia, has developed a plan to redesign its joint replacement service to better coordinate patient care across the entire continuum. The redesign incorporates services, such as presurgery therapy and patient education, registration and insurance activities, rehabilitation, and home care, into an existing acute care joint replacement clinical pathway to create a continuum of care. To encourage the provider partners to integrate the joint replacement service, Inova Mount Vernon Hospital developed new types of clinical, economic, and service outcome measurements to view episodes of care from a system perspective. These measurements will be used to assess the success of the functional integration effort.

What's in a name?

How should an integrated health care network sell itself? Four very different systems talk it over with the president of the American Hospital Association's Society for Healthcare Strategy & Market Development.

Case study. Columbia/HCA in Florida: a national strategy played out in a $47 billion market.

The world's largest health management company controls a fourth of Florida's hospital beds and is assembling a full-fledged integrated system, including physician investors. HSL looks at Columbia's key strategies, from geographic encirclement to overwhelming purchasing power. And we listen to critics who warn that Columbia "skims the cream" and abandons communities to maximize profits.

The role of private hospitals in South Africa. Part II. Towards a national policy on private hospitals.

This paper reviews some aspects of present state policy on private hospitals and sets out broad policy guidelines, as well as specific policy options, for the future role of private hospitals in South Africa. Current state policy is reviewed via an examination of the findings and recommendations of the two major Commissions of Inquiry into the role of private hospitals over the last 2 decades, and comparison of these with the present situation. The analysis confirms that existing state policy on private hospitals is inadequate, and suggests some explanations for this. Policy options analysed include the elimination of the private hospital sector through nationalization; partial integration of private hospitals into a centrally financed health care system (such as a national health insurance system); and the retention of separate, privately owned hospitals that will remain privately financed and outside the system of national health care provision. These options are explained and their merits and the associated problems debated. While it is recognised that, in the long term, public ownership of hospitals may be an effective way of attaining equity and efficiency in hospital services, the paper argues that elimination of private hospitals is not a realistic policy option for the foreseeable future. In this scenario, partial integration of private hospitals under a centrally financed system is argued to be the most effective way of improving the efficiency of the private hospital sector, and of maximising its contribution to national health care resources.