中国医疗卫生事业效益分析之系列研究——2005-2009年全国肿瘤、妇产(科)和传染病三类专科医院效益分析

研究2005-2009年全国肿瘤、妇产(科)和传染病三类专科医院,对比发现三类医院在规模、医疗水平上均稳步前进,各项业务指标均向正向发展。肿瘤医院向800张病床规模扩容以满足社会需求;妇产(科)医院中非国有机构迅速增多,应加强对其监管;传染病医院发展仍需依靠国家扶持。提高医疗水平,定期健康检查,送医送药送技术下乡,注重结对扶贫医疗工程。     

Managed Care Incentives and Inpatient Complications

Managed care organizations control costs through restrictions on patient access to specialized services, oversight of treatment protocols, and financial incentives for providers. We investigate possible effects of such practices on the care patients receive by studying frequencies of in-hospital complications. We find significant differences in complication rates between managed care and fee-for-service patients. We investigate the sources of this variation by comparing probabilities of complications among patients with different types of managed care coverage and patients treated in different hospitals. For several patient categories, the differences in outcomes we find appear to arise not from differential treatment of patients within hospitals or from heterogeneity in patients, but from variations in care across hospitals that tend to treat patients with different insurance types.     

Electronic medical record use and efficiency: A DEA and windows analysis of hospitals

We use data envelopment analysis (DEA) to examine the relationship between hospital electronic medical record (EMR) use and efficiency in a national sample of acute care hospitals. Data sources include the American Hospital Association (AHA), Health Information Management Systems Society (HIMSS), and Case Mix Index. Using two research approaches including a retrospective, cross-sectional design and a first differencing repeated measures design, we find limited evidence that EMRs can improve hospital efficiency. Small hospitals may benefit in the area of efficiency through EMR use, but medium and large hospitals generally do not demonstrate such a difference. Likewise, there does not appear to be a significant increase in efficiency over time associated with EMRs when compared to the efficiency of hospitals without such documentation.     

区县级妇幼保健院绩效工资分配的实践与思考

随着医院改革的不断推进,各种改革方案不断出现。在如今的新形势下,区县级妇幼保健院所采用的传统财务管理模式已不再适应社会发展的需要,特别是在绩效工资分配方面。基于此,论文从区县级妇幼保健院绩效工资分配的角度出发,对其实践过程和结果进行了分析和探讨,希望为区县级妇幼保健院的绩效工资分配向更好的方向发展提供一些借鉴。     

Duration of maternity leave in Germany: A case study of nonparametric hazard models and penalized splines

The paper investigates maternity leave behavior in West Germany for females being employed between 1995 and 2006 using data from the German Socio Economic Panel. The observational study focuses on the investigation of individual and family-related covariate effects on the duration of maternity leave following first or second childbirth, respectively. Dynamic duration time models are used in which covariate effects are allowed to vary smoothly with duration of being in maternity leave. The intention of the paper is to demonstrate with state of the art models how effects of covariables change over time and to analyse substantial differences between maternity leaves following first and second childbirth. Particularly the personal income of mothers and the educational attainment influence the decision when to return into employment. The leave period following second birth is influenced by the mothers' attachment to the labour market between their two maternity leave periods. As fitting routine penalized spline smoothing effects is employed using available software in R (http://www.r-project.org).     

Impact of conversion to Critical Access Hospital status on hospital efficiency

This study examines the impact of Critical Access Hospital (CAH) Program on hospital efficiency using a two-stage approach, where data envelopment analysis is used in the first stage to estimate cost, technical, and allocative efficiency scores of a sample of rural hospitals. Densities of efficiency scores of CAHs and prospectively paid rural hospitals are estimated and compared using a nonparametric kernel density estimator and a bootstrap-based test. In the second stage, efficiency scores are regressed on environmental variables using bootstrapped truncated regressions. Density analysis and results from bootstrapped truncated regressions show that CAHs are less cost and allocatively efficient compared to prospectively paid rural hospitals, without being less technically efficient. Relative to their pre-conversion selves, CAHs appear to be slightly less allocatively efficient, while they are slightly more technically efficient and no less cost efficient. Overall, our results suggest that the CAH Program may have decreased the allocative and cost efficiencies of those rural hospitals that converted to CAH status relative to prospectively paid rural hospitals, without significantly increasing their technical efficiency.     

Maternity rights and mothers' return to work

This paper uses a cohort of 12,000 births to examine the effect of maternity rights on mothers' post-birth return to employment decisions. It uses a discrete hazard model to disentangle the effects of the terms of maternity rights entitlements from other factors that influence the timing of a mother's return to work. Mothers with rights have an underlying (but unobserved) stronger attachment to the labour market that prompts earlier return than on average. We take this into account by estimating a counterfactual distribution of return times using a sample of women who failed to qualify for maternity rights but who have similar levels of labour market attachment. Even when differential attachment is taken into account there remains a substantial impact of maternity rights on behaviour.     

The effect of state maternity leave legislation and the 1993 Family and Medical Leave Act on employment and wages

In 1993, President Clinton signed the Family and Medical Leave Act (FMLA). Similar to the 12 states that already had maternity leave mandates, the FMLA guarantees 12 weeks of unpaid leave for eligible mothers. I evaluate the effects of maternity leave legislation on employment and wages, taking advantage of variation created by state legislation and the FMLA. My results show that maternity leave legislation has small and statistically insignificant effects on employment and wages. Maternity leave legislation may have little effect because the mandated leave is short and unpaid and many employers provided maternity leave benefits prior to the statutes.     

Work and family practices in Japanese firms: their scope,nature and impact on employee turnover

Using firm-level data from Japan, this study examines the effects of four commonly used work and family practices on employee turnover: flextime, maternity leave, child care leave, and nursing care leave. Overall, we find statistically significant associations between work and family practices and female employee turnover in Japan. In stark contrast, we do not find such a statistically significant linkage between work and family practices and male employee turnover. As such, this study highlights the potential moderating effect of individual characteristics such as gender on the relationship between work and family practices and employee attitudes and behaviours.     

The impact of PPS legislation on the systematic risk of hospitals

In 1983 the government passed legislation implementing a new method of paying hospitals for Medicare inpatient services, the Prospective Payment System (PPS). Under this system the changes in economic incentives to hospitals affected the market conditions under which hospitals operate. This article investigates the impact of PPS on the financial riskiness of hospitals. Using the capital asset pricing model (CAPM), this study analyzes the systematic risk of a portfolio of four publicly traded acute care hospitals in the pre-PPS and post-PPS periods, as well as four control portfolios. It covers a pre-PPS period from 1976 to the passage of the Tax Equity and Fiscal Responsibility Act (TEFRA) and a post-PPS period through 1988. The systematic risk for publicly traded acute care hospitals increased significantly in the post-PPS period. However, the control groups also showed significant changes in systematic risk.     

新医改背景下对实现公立医院公益性的路径探讨

实现和维护公立医院的公益性是新医改的基本出发点,面对医改不断的深化,各种问题也不断出现。在此背景下,如何有效实现和维护好公立医院的公益性是我们应该首要解决的问题。文章对新医改背景下实现公立医院公益性路径进行了探讨。     

The Sorting of Female Careers after First Birth: A Competing Risks Analysis of Maternity Leave Duration

A number of contributions have found evidence that motherhood is a critical life event for women's employment careers. This study presents a detailed analysis for the duration of maternity leave in which young mothers can make a transition into different types of employment, unemployment as well as the next birth. We provide a comprehensive picture of the sorting mechanisms that lead to the differentiation of women's employment careers after birth. Our empirical evidence is derived from large‐linked administrative individual labour market data from Germany for a period of three decades. We obtain unprecedented insights into how women's skills, the quality of the previous job match, firm level characteristics, labour market conditions and leave legislation are related to the length of maternity duration. Expansionary leave policies, e.g. are found to be a key factor for the rising share of women who have their second child out of inactivity.     

The welfare effects of restricted hospital choice in the US medical care market

Managed care health insurers in the USA restrict their enrollees' choice of hospitals to within specific networks. This paper considers the implications of these restrictions. A three‐step econometric model is used to predict consumer preferences over health plans conditional on the hospitals they offer. The results indicate that consumers place a positive and significant weight on their expected utility from the hospital network when choosing plans. A welfare analysis, assuming fixed prices, implies that restricting consumers' choice of hospitals leads to a loss to society of approximately $1 billion per year across the 43 US markets considered. This figure may be outweighed by the price reductions generated by the restriction. Copyright © 2006 John Wiley & Sons, Ltd.     

The disaster response performance of hospitals in Taiwan: evaluation and classification

Hospitals need disaster response plannings and temporary shelters to rescue victims in disasters. In Taiwan, there are 82 emergency medical service (EMS) hospitals are requested to possess guildlines of preparedness and responses to mitigation the damage and recovery the pre-event status in a disaster. A measurement chart including three major factors??facility, manpower, and disaster plan and drill mode??was created to evaluate the performance of disaster management of these EMS hospitals. Based on the expert opinions, some hospitals were selected as a reference set prior to the accreditation. Data envelopment analysis (DEA) is applied to classify each of the remaining hospitals into qualified or unqualified classes. Then, each unqualified hospital was recommended to improve its practice of disaster preparedness and responses into the qualified level. We also find that, on average, private hospitals perform better than public hospitals and medical centers perform better than the regional hospitals. But, the differences are not statistically significant.     

Does corporatisation improve organisational commitment? Evidence from public hospitals in Indonesia

This study aims to investigate the consequences of corporatisation on organisational commitment and to explain the relationship between work values, job satisfaction and organisational commitment. The research was carried out in 54 public hospitals in East Java, Indonesia, applying a multilevel structural equation model to survey data on 1282 workers in those hospitals. Analysis suggests that the longer a hospital has been corporatised, the greater the organisational commitment of its employees. Incentives have positive and substantive association with organisational commitment, while training and resource availability do not. We found that employees in larger hospitals are more committed than those in smaller hospitals and that work values and job satisfaction have a positive and significant relationship with organisational commitment. Our findings shed light on the debate on corporatisation as a lever for improving organisational commitment in public hospitals in developing countries.     

Modeling and prediction of surgical procedure times

Accurate prediction of medical operation times is of crucial importance for cost-efficient operation room planning in hospitals. This paper investigates the possible dependence of procedure times on surgeon factors like age, experience, gender and team composition. The effect of these factors is estimated for over 30 different types of medical operations in two hospitals, by means of ANOVA models for logarithmic case durations. The estimation data set contains about 30,000 observations from 2005 to 2008. The relevance of surgeon factors depends on the type of operation. The factors found most often to be significant are team composition, experience and time of the day. Contrary to widespread opinions among surgeons, gender has nearly never a significant effect. By incorporating surgeon factors, the accuracy of out-of-sample prediction of case durations of about 1250 surgical operations in 2009 is improved by up to more than 15% compared with current planning procedures.     

Hospital ethics committees and the future of health care decision making

In an era of increased patient decision making and limited resources, the solving of ethical dilemmas requires more than the traditional top-down approach. This article examines the use of ethics committees in hospitals located in Alabama. A significant minority of the hospitals do not have committees, despite increasing calls for ethics committees in the literature and by regulatory and accreditation agencies. The article also describes the typical composition of a hospital ethics committee as well as the means by which hospitals without committees solve ethical problems.     

Patient Admission Patterns and Acquisitions of "Feeder" Hospitals

Acquiring outlying community hospitals is one approach commonly used by large tertiary care hospitals to increase referrals. Sophisticated acquirers may also seek to selectively increase referrals of more profitable patients. To explore these issues, we study vertical hospital acquisitions. Using a treatment and control framework, we find that roughly 30% of vertical acquisitions lead to a significant increase in referrals. Very few result in decreases. We find that increases are concentrated among patients undergoing more profitable procedures and with more generous insurance. However, we find no evidence that hospitals shun patients with higher expected costs of care.     

基于DEA-Tobit模型的上海医疗资源整合效率分析

本文以2007年至2010年上海市39家二级医院为样本,利用数据包络分析(DEA)和Tobit回归模型分析参与整合对医院效率变化的影响及其主导因素。结果发现在2010年整合组医院和非整合组医院的纯效率值产生显著差异。从投入要素的作用机制角度考虑,以2010年各医院效率值为因变量,高级职称医师比例、10万元以上设备比例以及是否整合为虚拟变量作为自变量,通过Tobit回归模型认定高级职称医生的比例提高是其效率提升的关键因素。     

Enticing the Stork: Can we Evaluate Pro‐Natal Policies Before Having Children?

Aside from immigration, the only meaningful demographic lever available to policymakers attempting to moderate the rate of ageing is the birth rate. This article departs from previous analyses of pro‐natal policies by studying determinants of pro‐natal options ex ante, which represents an advantage for policymakers looking to craft policies with prior knowledge of whether or not a demographic policy will have a significant effect. Our multinomial regression model for a US sample involving college students shows that the preferred choice of pro‐natal incentive is dependent on gender, economic class, number of planned children and migrant status. We find that females are more likely than males to choose any pro‐natal incentive over no incentive. The highest odds for increasing planned number of children are for maternity leave and parental leave options. Respondents associating themselves with the poorest economic class are more likely to choose daycare or government grant as pro‐natal options.