Impacts of health maintenance organization growth on community health care costs.

The paper presents a model of health maintenance organization (HMO) growth, traditional health delivery system response, and total community health care costs. Simulations using a range of assumptions about the response of government and the traditional sector to HMO growth suggest three conclusions. First, HMO growth reduces total community health costs, but a substantial fraction of HMO subscribers' savings is added to the cost of other sector subscribers. Second, HMO cost savings depend as much on HMO control of inflation rates as on control of hospital utilization. Third, while HMOs can have significant impact even when they share hospital resources with the traditional sector, HMOs must control captive hospitals in order to achieve all of their potential savings, growth, and community impact.     

试论上海某10所医院管办分离及效益分析

目的:研究上海10所医院管办分离前后效益对比分析。方法:收集2004～2010年连续7年数据报表,以比率分析法和环比法进行数据分析。结果:投入产出及成本管理总值逐年持续增长,业务收支结余率年均增长0.43%;固定资产投入增长快速,年均增长率在20%以上;无形资产产出保持增长。门急诊次数、出院人数年均增长率分别为12.54%、12.47%;平均住院日、病死率逐年下降,诊疗费用、药占比逐年上涨,环比增长超过上海市人均生产总值。结论:加强资产运营效率,规范医院经营管理自主权,降低医院管理、医疗成本,提高医疗资源利用率,发挥社会效能。     

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.     

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.     

对政府投资项目工程量清单控制价编审的分析

财政部门是政府投资的出资人,投资控制是财政部门在项目投资管理工作中的重要内容,工程量清单控制价编审又是投资控制中控制造价、节约财政资金最有效的方式方法。通过对当前政府投资项目工程量清单控制价编审的分析,提出了政府投资项目工程量清单控制价的编审要点,为政府部门做好投资项目的造价管理和提高投资效益提供一些参考。     

Managing under pressure: HRM in hospitals

Health reforms in the last 25 years focused largely on structural change, cost containment and the introduction of market mechanisms, and the importance of the management of HR has often been overlooked. Pressures for efficiency and effectiveness are particularly pronounced in the hospital sector, which is the most resource-intensive component of the health care system. One important aspect of improving and maintaining service delivery in hospitals is to better manage the HR function. This paper highlights the importance and complexities of HRM in hospitals throughout the world.     

Health care reform or more affordable health care?

This article investigates the impact on the U.S. economy of making health care more affordable. We compare health care cost reductions with the Patient Protection and Affordable Care Act (ACA) using a rich life cycle general equilibrium model with heterogeneous agents. We evaluate a wide range of cost reductions ranging from 0.64% (realistic and feasible) to 29.5% (equivalence with OECD). Our results show that the ACA is more effective in reducing uninsured population than all cost reductions considered. This result holds throughout the life cycle and for the most fragile part of the population: the poorest, the less educated, and those with bad health. Realistic and feasible cost reductions are less welfare improving than the ACA. The increase of welfare induced by the reform is around 7.8 times higher than the increase provided by cost reductions. Besides, the poorer are more benefited than the richer after the reform, while the opposite occurs after cost reductions. Finally, to obtain the same welfare increase of the ACA, medical costs have to decrease by 5.21%, a very hard task. These results provide support for the ACA against opponents who might present cost reductions as alternatives.     

Federal Health Care Leadership Skills Required in the 21st Century

The purpose of the current study was to identify and describe the skills required of future health care leaders in the U.S. Department of Defense, Department of Veterans Affairs, and the Department of Health and Human Services. The identified skills should also be relevant to leaders of nonfederal agencies or nonmedical disciplines, such as education, human services, and similar public sector‐oriented disciplines, where the leaders are challenged to engage with a multitude of local, state, federal, and not‐for‐profit entities. The study employed a focus group methodology during a 2‐day leadership summit. The participants were 47 senior health care leaders representing various federal agencies and the private sector. During facilitator‐guided sessions, six focus groups consisting of seven or eight randomly selected participants identified 165 skills that are required of leaders. Subsequent to the summit, content analysis was used to group the skills into 12 overarching skill sets. The 12 skill sets were the ability to build partnerships, develop trust, thrive in complex and ambiguous environments, listen actively, think with agility, create conditions for success, assert aspirational future‐based leadership, develop present moment awareness, create an interagency learning network, develop network leadership, develop network goal setting, and maintain resilience. It appeared that only the first six skills were noted in the literature. Further research is recommended to validate the findings including further investigation into the leadership competencies that are most effective at driving health and non health outcomes in communities.     

Recent initiatives in U.S. hospital supply management

A variety of health care industry changes affect hospital/system materiel management directors as never before. Among them: the switch to patient care in alternative sites, system integration, new health care partnerships, and evolving technology and benchmarking needs. The key drivers for management include total product cost, compliance, standardization, utilization, and long-term partnering.     

南京市老年人养老服务需求研究

本文通过对南京市老年人口养老服务需求的调查研究,发现:在健康状况和生活自理能力弱化的预期下,选择机构养老的老年人口比例增加;高收入老年人的机构养老的意愿明显高于低收入或没有收入的老年人;市区老人在各项居家养老服务的知晓率上明显高于郊区老人;空巢老年人的居家养老服务需求率明显高于非空巢老人;老年人对水电气维修服务、医疗咨询和保健服务、精神慰藉等居家养老服务的需求比例较高。最后,针对上述结论提出完善南京市养老服务体系建设的对策。     

Making tough decisions about telemetry monitoring

Telemetry monitoring, when used effectively and appropriately, is beneficial and plays an important role in enabling primary caregivers to provide optimum care for their patients. However, it is frequently used ineffectively and inappropriately, which can be extremely costly for hospitals. In this era of health care reform, careful review of this technology and analysis of telemetry utilization can avoid unnecessary expenditures or abuse.     

Evolving Electric Utility Regulatory Policy

A bstract . Current electric utility pricing methods understate the marginal social casts of electricity. Electricity prices are set to cover the utility's average cost rather than the higher marginal social cost. This mispricing hides from consumers the true cost their consumption imposes on society and, thereby, encourages them to ignore efficient conservation opportunities. Additionally, the conservation market suffers from a number of imperfections such as barriers to the acquisition of information, high upfront capital costs and the lack of conservation equipment availability. The electricity and conservation multimarket equilibrium is not achieved. The result is that society overconsumes (excess demand) electricity, overinvests in electric generating plants and underinvests (excess supply) in conservation resources. The large, yet uncertain, level of foregone conservation investment offers new opportunities for regulators and electric utility managers to improve economic efficiency with regulatory and planning policies that appropriately encourage the cost effective use of conservation resources. In the absence of the most efficient policy, marginal social cost pricing, integrated resource planning (IRP) is being adopted as a potential second-best regulatory policy and utility resource planning framework to improve energy efficiency. IRP uses mathematical optimization methods to search among many alternate resource portfolios of electricity creating and saving technologies. These methods identify the mix that best meets society's needs with the least social cost , where the social external costs and benefits of generating plant and conservation, respectively, are considered. Such a goal requires the choice of a resource portfolio that optimizes a complex objective function. As a result, the solution offers a resource action plan for electric utilities that may be Pareto-improving.     

Assessing the effects of power grid expansion on human health externalities

Generation expansion planning is the framework under which power grid capacity expansions are made. Under this framework, mathematical optimization tools are used to determine the type of generation technology to invest in, and when and where these investments should be made in order to minimize market costs such as investment costs, fixed and variable operating & maintenance costs, and fuel costs over a long term planning horizon. Given the current infrastructure and policies, fossil fuels (such as coal, oil, and natural gas) are among the most economical sources of electricity. Thus, under these assumptions, these energy sources dominate the resulting expansion plans. However, fossil fuel combustion creates by-products contributing to ground-level ozone, particulates, and acid rain, which have harmful health implications such as premature death, respiratory-related illnesses, cardiovascular injuries, pulmonary disorders, and autism leading to lost days at school or work on a daily basis. In this research, we formulate a linear program to solve a multi-period generation expansion planning problem minimizing market costs for a centrally dispatched power system. We can then assess the human health externalities of the resulting expansion plan by studying the model output with an Environmental Protection Agency (EPA) screening tool that determines the human health externalities from the electricity sector. Results with and without emission limits and other policies can then be evaluated and compared based on predicted societal costs including human health externalities. This research enables policy makers to directly assess the health implications of power grid expansion decisions by explicitly estimating the total societal costs by quantifying externalities as part of the investment strategy.     

Foreign direct investment,labour relations and sector effects: US investment outflows to Europe

This paper analyses the impact of national labour relations on foreign direct investment (FDI), with emphasis on macro-markets and sector properties. Since there are sector-specific differences between industries in transferability, labour-relations effects on FDI probably vary across sectors. The paper finds that labour costs dampen FDI, while the impact of national market potential remains inconclusive. Collective labour institutions have a significantly adverse impact on FDI in manufacturing, and a relatively beneficial one on FDI in services. While investment in manufacturing seeks to minimize labour costs at given skill levels, investment in services maximizes skills at given levels of cost.     

A low quality–high cost–low satisfaction trap in public health care: a model and an efficiency-quality-welfare improving stochastic resolution

This paper develops an applied stochastic model of public health care and shows that the public health care sector in Turkey is plagued by a low quality–high cost–low satisfaction trap which has been persistent over time. The values in question are shown to be stochastically stable. We formulate an efficiency-quality-welfare improving stochastic policy rule, which helps the sector to reach a selected target and which stabilizes quality, cost and welfare around that target.     

Materiel management reengineering: value creation through innovation

By reengineering their department's core processes, materiel managers can expand their role in the health care setting while realizing significant cost savings. Using a team model, Inova Health System materiel management staff integrated their processes for vendor selection, purchasing, inventory reduction, and utilization across three hospitals and ancillary services. An integrated approach at all levels of the organization gained buy-in from administrators and staff systemwide.     

The ‘postcode lottery’ of the Italian public health bill analysed with the hierarchy Stochastic Multiobjective Acceptability Analysis

Over the last two decades, due to strong decentralization and widespread budget constraints, the Italian co-payment for health care has become a way to finance public health. This phenomenon has provoked a continuous increase of private costs of public health and an evident regional heterogeneity. As a result, a pervasive spatial inequality of access to public health care is becoming increasingly clear. The aim of this paper is to measure this inequality, mainly determined by the differences among regional co-payment prices. Access, equity, and needs are all part of the phenomenon ‘inequality of access’, and they are difficult to define and measure in health care. For this reason, most of the previously proposed measurement methods have inherent limitations and have prompted us to use an innovative approach focused exclusively on the supply side. In particular, we focus only on the cost of health benefits (co-payment). From a methodological perspective, we use a recent new version of the Stochastic Multiobjective Acceptability Analysis (SMAA), which is a methodology mainly used to build composite indicators of multidimensional phenomena out of the market. In order to deal with the hierarchical structure of the Italian health care system, we use the Hierarchy Stochastic Multiobjective Acceptability Analysis (HSMAA), which takes into account the uncertainty with respect to the weights assigned to the considered criteria, as in the standard SMAA, but also the uncertainty with respect to the weights assigned to the considered sub-criteria. Applying for the first time HSMAA to measure inequality allows us to create a unique index for each region and then to make a classification among them. The results show that, since there are different prices for the same health benefits among different regions, there are strong spatial inequalities in the cost of the Essential Levels of health care in Italy.