The Effects of Managed Care on Medical Referrals and the Quality of Specialty Care

This paper analyzes the role of referrals in the provision of surgical services. Primary physicians in managed care control patient access to specialists, while referrals in traditional insurance plans are less constrained. The traditional, fee–for–service insurance market is shown to achieve appropriate incentives for high quality care. In contrast, physicians with bad reputations may not lose HMO's referrals, owing to differences in incentives to cut costs. Empirically, we find that managed care may protect a physician whose reputation has been damaged by providing a source of referrals when shunning occurs in the FFS sector following a malpractice claim.     

Prospective payments and hospital efficiency

This paper examines the effects of the Prospective Payment System on the behavior of hospitals with respect to their capital allocations and the efficiency with which they produce in-patient care. A theoretical model adapted from Pope [1989] yields the testable hypotheses that as a hospital's Medicare population increases the hospital will supply greater levels of capital and produce in-patient care using less technically efficient methods. A two stage test of these hypotheses is run on a sample of US non-federal hospitals. Results from patient demand functions and a stochastic profit frontier are consistent with the theoretical model.     

Managing customer relationships: Account manager turnover and effective account management

Managing relationships with customers and clients is a critical task for industrial sales organizations. This paper reports on research that focuses on improving client relationships through effective handling of account manager turnover and improved account management. Even in situations where account manager turnover is high, the relationship between the company and the SME client does not suffer if the account management turnover process is well managed. When account manager turnover is not well managed, customer satisfaction suffers. The research also identifies eleven specific management activities that are highly related to supplier satisfaction with both the account manager and the supplier financial institution.     

Time-driven activity-based costing for health care provider supply chains

ABSTRACT

Health care providers currently operate in an environment of complex supply chains and increasing costs where approximately one third of hospital operating expenses are related to supplies. It is pertinent that health care providers have a clear understanding of their supply chain process costs. Knowing how these costs are driven and where opportunities for cost reduction exist can support health care provider supply chain (HPSC) efficiency. In this article, we present a time-driven activity-based costing (TDABC) supply chain cost methodology for health care providers. A TDABC management system can provide health care providers with valuable product and process supply chain cost information by investigating logistics activities, resource consumption, and time drivers. Our HPSC TDABC methodology is demonstrated in a case study conducted for the supply chain department of a 200-bed, not-for-profit hospital.     

Performance implications of outsourcing for technological innovations: managing the efficiency and adaptability trade‐off

We explore how increasing efficiency compromises adaptability when a firm outsources during the emergent stages of a technological innovation. Since efficiency ‐related problems differ in complexity and structure from those associated with adaptability, their optimal governance differs. While the former benefits from outsourcing, the latter is better off managed within organizational boundaries. In addition, a firm's ability to engage in complex problem solving buffers the efficiency‐adaptability trade‐off that occurs with increasing levels of outsourcing. In this study, we find support for our theses. Although outsourcing yields efficiency gains up to a certain point, it hurts adaptability. However, a firm's absorptive capacity mitigates this trade‐off. Our data on outsourcing for Internet banking is both archival and based on two surveys conducted with 100 U.S. banks. Copyright © 2011 John Wiley & Sons, Ltd.     

The impact of the Medicare Rural Hospital Flexibility Program on patient choice

This paper seeks to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on rural resident hospital choice. The program created a new class of hospital, the Critical Access Hospital (CAH), which receives more generous reimbursement in return for limiting its beds and services. The program's goal is to maintain access to hospital care. Estimates from a patient choice model show that patient utility from visiting a hospital was negatively affected by conversion. While the lower bed capacity appears to play a minor role, the reduction in services results in a 28% drop in admission rates.     

A Management Capacity Constraint? Obstacles to the Development of the Overseas Chinese Family Business

Overseas Chinese family business (OCFBs) have gained a reputation for cost efficiency, responsiveness, and flexibility as original equipment manufacturers (OEMs) and as pioneers of the mainland's industrialization. This success is based upon a relatively simple ‘personally managed’ organization operating within a network of kin and ethnic relations. To what extent are mid-sized OCFBs now able to develop the capacity to compete in new strategic domains and manage more complex value chains? The paper examines competing views of the OCFBs organizational and competitive capabilities. The strategies of 50 mid-sized Hong Kong based manufacturing firms are used to provide insight into the questions of capabilities upgrading and long-term competitiveness in personally managed enterprises. In contrast to prevailing cultural and institutional accounts of OCFB behavior, the paper suggests that current (western) theory of the family firm and of organizational networks provides an alternative explanation of observed investment strategies and organizational structure.     

Optimal productive size of hospital's intensive care units

Authors of past studies focusing on returns to scale in hospitals proffered mixed results. These seemingly contradictory findings have probably arisen due to different methodological approaches (parametric or non parametric), different aggregation levels of analysis (hospital/department/units), nature of data (quantity data or economic values) and also due to technological improvements operating in hospitals and case mix adjustment to account for the severity of patients' conditions.In this paper, we apply a new approach to determining returns to scale for single and multi-output homogenous technologies, which is different from traditional DEA models. Our approach is characterized by (1) a non parametric approach based on quantity data that allows us to avoid assumptions on cost minimization or profit maximization behavior of hospitals, on relevancy of economic values for hospitals (costs, revenues and prices) and on a priori specification of the health care production function, and (2) an analysis of optimal productivity size at both the disaggregated level of intensive care units and at the aggregated hospital level. The methodological advantage is that we can unambiguously define increasing returns to scale, which is lacking in more traditional non-parametric approaches because of the convexity assumption imposed earlier. We apply the methodology to intensive care units (cardiac care (CICU), medical/surgical care (MSICU), pediatric care (PCIU) and neonatal care (NICU), which are operating in 235 general short term hospitals of Florida state in 2005. We also consider the hospital level by analyzing the general activity of the hospitals in our population.To summarize our findings, we find that 60% of intensive care units are operating at increasing returns to scale, 10% are operating at optimal productive size and 30% are characterized by decreasing returns to scale. In average intensive care units operate 40% under the optimal size. The policy implication of this result should be an increase of the size of all types of intensive care units to meet productivity gains. The picture is completely reversed at the aggregate hospital level. Here decreasing returns to scale prevail for 65% of hospitals while only one fourth are operating at increasing returns to scale. In average hospitals' number of beds should decrease by 40% to reach the optimal productivity size. One policy solution may include reallocating resources from general beds to the more specialized beds.     

What really goes on in your doctor's office?

Hate managed care? It's no picnic for doctors either. The big question is whether medicine's new order is making your doc treat you better or worse.     

Hospitals: The Market for Health Care Facilities

Health care facilities include hospitals and nursing homes. Demand for beds and occupancy depends on income, prices and insurer restrictions. The supply of beds is limited by regulatory certificates of need. The implied equilibrium vacancy leads to a trade-off with rate increases. Rate increases establish an asset price for a hospital bed. If prices of health care rise faster than income and nonhealth prices, patients demand less bed availability and occupancy. Rising vacancy and rising prices occur, consistent with the empirical observations for U.S. health care facilities. For 1980–2001, the equilibrium vacancy rate for U.S. hospitals is between 27% and 36% depending on capacity adjustments, bed availability and price expectations. Equilibrium vacancy is near the actual rate after 2000, but that rate is 11 percentage points higher than in the early 1980s when the number of beds was nearly one-third higher. Usually rent regulation leads to excess demand. But in a general equilibrium model with income, relative prices, expectations, supply and capital markets, price regulation can coexist with excess supply.     

Advertising efficiency and profitability: Evidence from the pharmaceutical industry

B2B firms spend considerable sums of money on promotional activities to promote their products and to build brand equity. An increasing proportion of this spending is being devoted to direct to end-user (DTE) advertising in an effort to pull end-users towards their products as a complement to their push promotional activities. This is particularly true for US-based pharmaceutical firms following the deregulation of DTE advertising. This trend suggests the necessity to investigate how efficiently DTE advertising expenditure is being managed, and to ascertain whether the level of efficiency has any impact on profitability. This study examined the level of DTE advertising efficiency for a sample of US-based pharmaceutical firms and went on to investigate the impact of the efficiency level on firm profitability. The findings of the study demonstrate that DTE advertising efficiency does vary between firms and, furthermore, that the higher the level of efficiency, the better is firm profitability. These results are robust to alternative measures of firm profitability, specifically, return on assets (ROA), return on equity (ROE), gross profit margin (GPM) and net profit margin (NPM).     

Understanding ERP system implementation in a hospital by analysing stakeholders

Implementing enterprise resource planning (ERP) systems requires significant organisational, as well as technical, changes. These will affect stakeholders with varying perspectives and interests in the system. This is particularly the case in health care, as a feature of this sector is that responsibility of services is shared between many autonomous units. In these and similar settings, it is essential to analyse stakeholders and to understand their expectations and attitudes towards the system. Such an understanding will help implementers to address stakeholder interests and to encourage acceptance. Therefore, the purpose of this paper is to develop a theoretically based model to analyse how stakeholder attitudes and behaviours in a hospital setting affect the outcome of ERP implementation. This model is applied in an empirical study of a project to introduce an ERP system in medium‐sized hospital in The Netherlands. The study shows how the ERP implementation impacts the interests of stakeholders such as physicians and administrators, which caused tensions. The paper examines the reasons of these tensions. In doing so, it contributes to our understanding of ERP implementation in health care and any other similar sectors from a stakeholder perspective, and it may help implementers to manage this more effectively.     

High Performance Work Systems and Employee Experience of Work in the Service Sector: The Case of Aged Care

In spite of the growing body of research on high performance work systems (HPWS), there is little evidence on their application in the service sector. It is commonly argued, however, that occupational segmentation in services is a barrier to HPWS. Analysis of data from aged‐care workers indicates that: HPWS have positive outcomes for workers; highly skilled nurses are no more likely than lowly skilled personal care workers to be subject to HPWS; and in some cases, HPWS are associated with more positive outcomes for low‐skilled than high‐skilled workers. These findings suggest that HPWS may well be widely applicable in service settings.     

转型时期的卫生问题与健康公平

中国在如何建立与社会主义市场经济体制相适应的卫生事业等公共服务方面的改革还没有取得相应的成果。近年来．卫生改革的效率和公平性在某种程度上甚至出现了下降的状况。医疗费用快速上涨引发的看病贵、看病难问题已经成为人们普遍关注的经济和社会热点问题。本文在叙述经济转型过程中的卫生事业面临的挑战和问题的基础上，着重探讨问题的成因和根源，在完善社会主义市场经济体制的背景下对如何增强卫生发展的公平与效率、充分发挥医疗卫生和健康保障在建设和谐社会中的作用提出一些意见和建议。     

U.S. High‐Performance Work Practices at Century's End

This study examines the incidence, industry differences, and economic environment of work practices in the United States in 1994 and 1997 using census data from a nationally representative random sample of establishments. Self‐managed work teams were used by a majority of workers in some sites. Work‐related meetings had higher incidence. A high‐performance work organization is used in about 1 percent of establishments. There were significant industry differences associated with globalization, namely, imports and exports.     

The Economics of Teams among Technicians

This paper examines the economic logic of organizing field technicians into self‐managed teams, an approach to work organization that shifts the division of labour from a hierarchical to horizontal one. Economic efficiencies arise through the integration of direct and indirect labour tasks and the alignment of'the organizational structure with the occupational logic of communities of practice among technicians. Self‐managed teams absorb the monitoring and co‐ordination tasks of supervisors, substantially reducing indirect labour costs but without adversely affecting objective measures of quality and labour productivity. For technicians, team membership means longer work hours, but higher wages through overtime pay.     

ICTs quality and technical efficiency: An empirical analysis

In 1987, Robert M. Solow hinted at the computer age and productivity statistics puzzle. While this puzzle persisted for many years, a growing literature has picked it up to examine the effect of ICTs on technical efficiency. However, this literature has focused mainly on quantity-based ICTs measures, which have come under severe criticism in recent times. We advance this literature in this paper by shifting the focus of analysis to quality-based ICTs measures; in this case, Internet quality. We also extend the literature by examining how the envisaged relationship between ICTs quality and technical efficiency is conditioned by a country's unique attributes. Our results show a significantly positive effect of ICTs quality on technical efficiency. We also find that the technical efficiency gains associated with ICTs quality are higher in skill-abundant countries, countries that engage more intensively in cross-border trade, have stronger contracting institutions, and are endowed with well-functioning and well-developed financial markets that ensure greater efficiency of capital allocation. We find a network effect in the nexus between ICTs quality and technical efficiency. That is, the marginal effect of ICTs quality on technical efficiency increases as the number of Internet users expands. We discuss the policy implications of our findings.     

需求量速增的抗肿瘤药物

目的了解近年来上海市医院抗肿瘤药物的临床应用,为生产、营销和使用等部门提供参考.方法上海市样本医院提供2004～2006年用药数据,结合临床应用进行分析。结果抗肿瘤药物需求量增长迅速,常用品种有奥沙利铂、紫杉醇、紫杉特尔、卡培他滨、吉西他滨、表柔比星、长春瑞宾等.结论高效低毒的抗肿瘤药物需求量速增,前景看好。     

The 18C's model for a successful long-term outsourcing arrangement

The purpose of this paper is to identify the factors that contribute to a successful long-term outsourcing arrangement, particularly in the facilities management area. Organisations expect to achieve many benefits from outsourcing, despite the fact that there are significant risks associated with unsuccessful outsourcing. The paper analyses a successful multiple activity outsourcing case study. Six managers and team leaders, who have initiated and managed the sixteen outsourced activities during an eight year period, were interviewed. In order to complement and confirm the interviews, the observation of four monthly performance review meetings was conducted. Eighteen key success factors for a long-term outsourcing arrangement have been identified and approved by the interviewees. They have been used to construct the 18C's model.     

Neglected elements in vertical integration analysis: The case of retail price preticketing

The “conventional wisdom” with respect to the advantages to be gained through vertical integration are highly overrated. That associated with increased efficiency tops the list. Also, those advocating vertical integration have tended to ignore the preticketing phenomenon. In these cases the best that can be said is that there may exist a neutral effect. On the other hand, empirical analysis shows that, at the worost, negative effects may prevail.