The determinants of nursing home costs in Nebraska's proprietary nursing homes.

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.     

A health maintenance organization design for long term care under medicaid

The rapid increase in public expenditures for long term care under Medicaid is discussed. The major cause of this increase is identified as the high and often excessive utilization of nursing home care. Health maintenance organizations (HMOs) are considered in terms of their ability to reduce health care costs by curbing unnecessary hospitalization. The HMO structure is extended to long term care, where it is argued that unnecessary nursing home care can be reduced. A health maintenance organization targeted to the Medicaid long term care population is proposed and a detail flow analysis of the HMO is presented.     

Assessing French nursing home efficiency: An indirect approach via budget-constrained DEA models

In this paper, data envelopment analysis (DEA) techniques are applied to the French nursing home industry in order to address two policy issues. The first involves nursing home size and returns to scale, while the second deals with the potential effects of a change in nursing home reimbursement from a flat rate to one based on the severity of case-mix. To accomplish this, our analysis expands on the existing nursing home literature to analyze technical and allocative efficiency along with budget-constrained models rather than the more common direct input-based distance function. Technical efficiency is evaluated via an indirect output distance function while allocative output efficiency is computed with a cost indirect revenue function. The findings suggest that system-wide efficiency and equity may result from coming reforms since payments would more accurately reflect resource use.     

Predicting bankruptcy in the Texas nursing facility industry

Approximately 50% of nursing facilities in Texas petitioned for bankruptcy during the 1998–2004 period. Using a logit regression model tested for robustness, we find nursing facilities that are profit-seekers, chain members, pay higher than average wage rates, accept more intensive-care residents and obtain a larger than average portion of their funding from public sources are highly vulnerable to negative changes in regulatory policy decisions on Medicare and Medicaid reimbursement. Larger facilities having higher than average occupancy rates and quality of care are less susceptible to adverse decisions. The model correctly classifies a facility as either bankrupt or solvent in about 75% of cases. We also examine the duration of bankruptcy using accelerated failure-time models. It appears that the duration of bankruptcy depends on location, out-of-state ownership, length of ownership, volume of resident days supplied, total cost and proportion of revenues from Medicaid.     

如何规范高校会计基础工作

当前高校规模越来越大,资金越来越多,精细化程度越来越高,相应对会计信息的及时和准确提供就非常关键,那如何才能保证会计信息的准确和及时呢?本文针对当前我国高校资金报销及审核中存在的问题进行了全面分析,提出了加强会计基础工作,统一报销审核标准,简化审批流程,规范会计处理,提升会计人员整体素质和业务处理水平等措施,促使高校严守会计法,报销简洁化,效率最大化,工作规范化。     

Modelling the effects of price competition on the utilization of health manpower.

The introduction of diagnosis related groups (DRGs) and resource utilization groups (RUGs) for implementing prospective reimbursement is virtually certain to increase the cost-consciousness of hospital and nursing home administrators. One potential area for cost reduction is in nurse staffing. In this paper, we describe a model which identifies minimum cost nurse staffing patterns subject to constraints on patient needs, mandated staffing requirements, and labor availability, and which is also sensitive to quality considerations. We use the model to predict shifts in nursing patterns at an upstate New York nursing home. To the degree to which this model and this nursing home are typical, we foresee general reductions in the numbers of RNs and LPNs, compensated for by an increase in the number of Aides, and cost savings in the 5-10% range. We also demonstrate that the magnitudes of these changes will depend on the tradeoff between quality and cost considerations, and will certainly vary across facilities.     

A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change

Amidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs.     

六安市某县新农合满意度及其影响因素分析

目的:了解六安市某县居民对新农合的知晓程度、满意度评价及影响满意度的因素。方法:本研究利用方便随机抽样的方法于六安市某县医院调查了57个患者以管中窥豹进行探讨研究。结果:①对新农合起付线、报销比例、报销程度了解的患者比例均不超过50%;②对新农合制度满意度评价尚可,但仍有提升空间,非常满意或者比较满意的患者比例为80%左右;③所有患者表示第二年愿意继续参保,但是参保缴费保守;④随着参合时间的增加,新农合满意度增加,男性对新农合的满意程度高于女性。结论:提高新农合满意度则需要保持现有缴费基础上,完善经办机构管理,提高经办效率,提高报销比例。     

人性化护理排班模式在实际工作中的应用

目的:探讨人性化护理排班模式在实际工作中的应用成效,增加护理人员工作中的协调性和积极性,提高工作效率。方法:按时间顺序将两种不同排班方式分为实验组和对照组,实验组采用男女搭配成组护理弹性排班模式,对照组采用传统排班方式,实验组通过在护士每周耗时、满意度、护理质量、解决问题等方面与传统的排班方式进行比较,两种方法各实行12个月。结果:实验组护士组内矛盾、护理不良事件、病人隐私不满事件明显减少,提高了工作效率及病人抢救成功率,病人满意度提高。结论:在重症监护病房实行男女搭配成组护理弹性排班模式能适应该科的工作特点,可改善由于护理人员缺编及结构不合理对护理工作质量造成的影响,可有效提高工作效率,是一种良好的排班方式,值得在临床推广应用。     

内部资本市场理论综述

内部资本市场理论是研究企业内部资金配置的重要理论之一。在回顾中外学者们的内部资本市场理论的基础上,阐述了内部资本市场产生的实践基础和理论基础,归纳了内部资本市场的定义,列出内部资本市场在配置资源中的优势与劣势,并对内部资本市场的边界进行了分析。     

Management of nursing homes using data envelopment analysis.

Data envelopment analysis (DEA) is used to evaluate the relative technical efficiency and assist in the management of a chain of nursing homes. As with any DEA model, variables chosen are particularly important. The study looks at two possibly critical issues. The first is the appropriateness of models that include only financial and economic measures to evaluate administrators when quality care is an expected output. The second issue is the appropriateness of using noncontrollable variables, in this case operating income, to evaluate administrators. We show how efficiency scores differ when quality variables and/or operating income are included. We also demonstrate the usefulness of DEA information to both the home administrator and chain managers for improving operating efficiency.     

Some observations on greater competition in the West German health-insurance system from a US perspective

This article argues that greater competition could result in improved performance and greater efficiency in the West German health-care system, much as more extensive competition has reduced the growth rate in the United States. Two special impediments to greater competition are discussed: (1) geographical limits in size of sickness funds which limit economies of scale, and (2) the tax-like financing of individual sickness funds which may actually offer incentives to increase health-care costs and which violates the most generally accepted principle of tax equity, that of horizontal equity.     

Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains

Over the past 10 years, merger activities in the private for-profit nursing home industry have been increasing in Europe. In this paper, we investigate chain affiliation’s influence on the performance of lucrative nursing homes. We measure performance using a cost frontier estimated by stochastic analysis on a sample of 370 French for-profit nursing homes. We find that cost efficiency decreases with the number of facilities in a chain. We also identify different external actor types in nursing homes’ institutional environment and test their influence. We show that nursing home chains’ cost efficiency improves when local governments and shareholders exert pressure. Our results are robust to alternative model specifications and another definition of costs. Overall, our findings inform researchers, as well as standards setters, of the relevance of chain affiliation and of the role of institutional pressures regarding cost containment at the nursing home level.     

护理管理中绩效考核的应用价值探讨

目的:观察探讨绩效考核在护理管理当中的应用价值。方法:就我院外科科室的18名护理人员进行分析,观察绩效考核制度引入前后的护理人员的从业素质、护理质量、教学指标和患者满意度进行观察。结果:我院在引入绩效管理进入之后,护理人员的从业素质、护理质量、教学指标和患者满意度得到了明显地提高。结论:绩效考核制度能够切实有效地提高医院护理管理的水平,帮助护理人员自身素质、护理专业技能和知识的提高,可以督促护理人员不断学习,而且可以提高患者的满意度,减少医患纠纷的发生。     

Pricing a contract of linking home reversion plan and long-term care insurance via the principle of equivalent utility

Home reversion plans allow homeowners to tap into the value of their house and live in it until their death. The article considers a contract linking home reversion plan and long-term care insurance, which could better prepare seniors for their retirement and long-term care needs. Here, we assume the product exposes an insurer to two risks: the uncertainty of nursing care cost from disable, and the home value decreasing in real estate markets at the time of sale. Because the market is incomplete, we apply the principle of equivalent utility to price the contract under exponential utility.     

Public and Private Provision of Health Care

One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states.     

麻醉恢复室护理工作程序化管理的探讨

目的:研究经过麻醉之后在恢复室进行程序化护理的效果。方法:选取我院2010年1月至2012年1月麻醉恢复室进行护理的患者资料进行回顾性分析。结果:经过在麻醉恢复室程序化护理,成功复苏率高达97.9%,并利于并发症及时的发现,提高围麻醉期的安全性。结论:通过程序化护理保证了患者接受系统治疗以及护理,护士对病情的观察和护理水平有很大提升,保证了护理质量,使管理更有效。     

如何提升财政投资评审效能的研讨

随着我国国民经济的快速发展和财政收支水平的不断提高,我国政府财政投资资金增长的速度也逐年加快,这样才能更好地推进和实施财政投资评审制度,有效地加强对财政性建设资金的管理,以此促进财政资金的使用效益的发挥。由于,财政投资评审的工作还处于起步探索阶段,在实施过程中还面临一些亟待解决的问题。本文在分析目前政府财政投资评审工作现状及存在问题的基础上,对提升政府财政投资评审效能提出合理化建议。     

居家养老模式下的社区护理

随着我国老年人口的快速增长,空巢或纯老家庭已成为我国越来越多家庭的写照,对老人进行健康上的专业护理照料,已取代生活上的吃饱穿暖而上升为急需解决的社会老龄问题之一。文章分析了我国社会老龄化速度加快的现状,说明了国外比较成熟的居家养老护理服务形式,阐述了我国居民养老护理服务中存在的问题,进一步提出了居民养老模式下的社区护理服务对策。