Employee health insurance decisions in a flexible benefits environment

This study investigates the factors which influence employees' choices among different health insurance options under a flexible benefits plan. Employee-specific selection and demographic data provided by the former National Cash Register (NCR), were used to analyze the effects of employee and plan characteristics on choice of health care plan. Results suggest that employees' health plan choices are influenced by premium, deductible, and coinsurance amounts, and by employees' age, gender, salary, and marital status. The results are considered within an expected utility maximization model. Implications for the design of flex plans as well as future research and theory are discussed. © 1996 by John Wiley & Sons, Inc.     

Quality Competition, Insurance, and Consumer Choice in Health Care Markets

In this model, insurance offering a choice of hospitals is valued because consumers are uncertain which hospital they will prefer ex post. A competitive insurance market facilitates tacit price collusion between hospitals; high margins induce hospitals to compete for customers through overinvestment in quality. Incentives may exist to lock in market share via managed-care plans with less choice and lower prices. As technology becomes more expensive, the market increasingly offers too little choice. A pure managed care market may emerge, with underinvestment in quality. Relative to a pure insurance regime, however, all consumers are better off under managed care.     

Strategic planning for the material management function

Strategic planning and strategic management are essential if a department intends to adapt and survive in the rapidly changing health care environment. Many hospitals require their individual departments to submit strategic plans and annual budgets. This is a sound management practice. In those institutions that do not require strategic plans, I would suggest that the departments take it upon themselves to go through this exercise. The benefits are tangible and long-lasting.     

Why do employees keep choosing the high-premium health care plan? An investigation of the financial consequences and logic of employee health care plan selections

In 1991, Dannon employees had the choice to stay with their current health care plan or switch to a new plan which offered a lower premium and less hospital cost coverage that better fit the needs of most employees. Both plans were the same in all other respects. Only 25% of employees chose the new lower-premium plan over the old plan. This article reports a collaborative effort between The Dannon Company and Cornell University's Center for Advanced HR Studies to identify the patterns of employee choices, and the effects of those choices on the actual costs that employees incurred. The actual decisions of 287 Dannon employees were examined, and the out-of-pocket costs that they actually incurred in the two years after the plan was introduced were calculated. © 1996 by John Wiley & Sons, Inc.     

Strategic Cost Management and Institutional Changes in Hospitals

Accounting research raises the concern that firms in the health care and defence contracting industries, when facing a dual payment system with both cost-based and fixed-rate payments, have an incentive to reallocate overhead costs through increasing inputs used in cost-based operations. However, prior literature reports contradictory empirical evidence regarding such real activity manipulation. Drawing on the institutional perspective, we hypothesise that firms' market power and interorganisational dependence affect their cost-management strategies and choice of overhead allocation in response to dual payment systems. Analysing the data of California hospitals from 1980 to 1991, we find that when facing a dual payment system, dominant (strong market position) hospitals adopt a cost-revenue-enhancing strategy, increasing direct costs for cost-based services without containing costs in fixed-rate services. In contrast, nondominant hospitals choose a cost-reduction strategy and improve operation efficiency on fixed-rate services. We also find that nondominant hospitals shift more overhead costs away from fixed-rate services to cost-based services by reclassifying the allocation bases across services; combining this cost shifting with the cost-reduction strategy, nondominant hospitals demonstrate the compliance with the regulation expectation of cost containment.     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

Tenure choice and the riskiness of non-housing consumption

This paper analyzes a household's choice of housing tenure within a dynamic utility maximization model that yields simple analytical results under uncertainty of income, housing prices, and rents. Given a housing consumption plan, we show that a decrease in the covariance between a household's earnings and housing rents increases the likelihood of ownership. A household who plans to remain in its home over a long period is more likely to own; a household who plans to remain in its home over a short period is more likely to rent. The higher the covariance between the user cost of a home and that of other properties a household is likely to consider in the future, the more likely the household is to own this home. These predictions of our model find support in recent empirical studies.     

Barriers to Entry of a Vertically Integrated Health Insurer: An Analysis of Welfare and Entry Costs

I investigate the reasons why market expansion attempts by vertically integrated health insurers have largely failed. I use an econometric model of consumer demand for hospitals and insurers to simulate entry of an integrated plan into 28 new markets. The results indicate that entry would increase social surplus by over $34 billion per year. I then investigate several potential barriers to entry. Three are particularly important. Integrated plans cannot attract enough enrollees to support their provider networks unless they exceed competitor quality levels and convince consumers of this benefit. Regulatory restrictions on plans building new facilities may also be important.     

Efficiency analysis of emergency departments in metropolitan areas

The demand in the healthcare industry is increasing exponentially due to aging population of the world and this is leading to a rapid increase in the cost of healthcare. The emergency departments of the hospitals are the frontline of health care systems and play an additional critical role in providing an efficient and high-quality response for patients. The overcrowding at the emergency departments due to growing demand results in a situation where the demand for ED services exceeds the ability to provide care in a reasonable amount of time. This has led countries to reconsider their health policies in a way to increase their efficiency in their healthcare systems in general and in emergency departments, in particular. As in many countries, there has been a steady and significant increase in the number of patients that seek health services at the emergency departments of state hospitals of Turkey, due to the significant structural reforms in health services since 2003. While meeting this increasing demand, it is ever more important to provide these critical health services efficiently. Therefore, the efficiency of the emergency departments of seven general hospitals run by Istanbul's Beyoglu State Hospitals Association have been analyzed using categorical Data Envelopment Analysis (DEA) models. The analysis of DEA results is supported by a set of statistical methods to make it easier for the hospital administrators to interpret the analysis and draw conclusions. The analysis shows that less-equipped EDs are supported by better equipped, larger EDs, resulting in a hub-and-spoke type of structure among the EDs where “satellite” EDs serve an important referral function and thus evaluating their efficiency without taking the interoperability among these units into account would not be an accurate assessment of their performance.     

DETERMINANTS OF PUBLIC PENSION PLAN INVESTMENT RETURN. The role of fund value maximization and public choice theory

Public pension plans are a major type of institutional owner during the new era of investor capitalism, yet little is known about them. Based upon fund value maximization (FVM) and public choice theory (PCT), we develop hypotheses on the determinants of plan performance as measured by plan annual investment return. FVM espouses that the plan's fund or investment portfolio will be invested to maximize return for a given level of risk, while PCT holds that agency costs are significant in the public sector, and will have a negative effect on plan return. Using biennial pension plan data for 1992–96 for several hundred plans, we found that fund value maximization has a much greater influence on plan performance, but that plan performance is also subject to agency costs associated with public choice theory.     

Mergers and Exclusionary Practices in Health Care Markets

We evaluate the relationship between insurers (payers) and providers of health care (hospitals) when they each have a nonnegligible share of the market. We focus in particular on their incentives to merge and the existence of equilibria where payers offer preferential treatment to a subset of hospitals. We demonstrate that hospitals are more likely to merge without consolidating their capacities the less competitive they are vis-à-vis the payer's market. Payers are more likely to merge without consolidating their capacities the less competitive either the hospitals' or the payers' market is. A given payer follows an exclusionary strategy when its starting bargaining position vis-à-vis hospitals is weak. At such exclusionary equilibria, payers tend to distinguish themselves from neighboring payers by contracting with a different subset of hospitals.     

Measuring and Evaluating Efficiency of Hospitals Through Total Quality Management

ABSTRACT

The purpose of this study is to measure and evaluate the efficiency of 12 hospitals in Turkey using a multi-criteria Data Envelopment Analysis (DEA) methodology. Number of beds, number of physicians and the critical factors of total quality management in the health care sector were used as inputs of the model. The outputs used in this analysis incorporated financial and non-financial performance of hospitals, number of outpatients and number of patient days. Performance of the hospitals was measured using subjective measures based on executive's perception of how their organization performed relative to the competition. Results provide management with information regarding the relatively best practice hospitals in the observation sets and locate the relatively inefficient hospitals by comparison with the best practice ones. At last some suggestions are made for the least efficient hospital.     

Exclusionary Equilibria in Health-Care Markets

We have demonstrated that when providers of health insurance are perceived to be differentiated by consumers, circumstances may arise under which they find it advantageous to restrict the set of health-care providers that they approve to their customers. Even if all health-care providers are equally qualified and efficient, payers may choose to contract with a selected subset of them in order to secure more favorable contract terms. Moreover, in a concentrated health-care market that consists of two health insurance companies (payers) and two health-care providers (hospitals), both payers may choose to contract with only one of the hospitals while excluding the other completely from the market. When consumers' valuation of an extended choice of providers is small in comparison with the extent of differentiation that exists between the payers, such an exclusionary outcome is the unique equilibrium of the game.     

Fairness perceptions and work attitudes revisited: roles of employee specialty,hospital level and ownership

Compensation is widely acknowledged as an important job element in the eyes of employees. Health care is a special industry in which compensation received by employees differs greatly. This study examines empirically the relationships between hospital employees' perceptions of compensation fairness and their work attitudes, taking into account the roles of employee specialty, hospital level and ownership. Using data from 2,938 employees of thirty hospitals in Taiwan, the results indicate that fairness perceptions and work attitudes differ significantly among hospital employees according to their specialties. Hospital level and ownership exert impacts on employees' fairness perceptions, although not on their work attitudes. A positive relationship is observed between fairness perceptions and work attitudes of hospital employees.     

Sustainable development and financial institutions: Do banks' environmental policies influence customer deposits?

This paper investigates the relationship between the environmental policies taken by financial institutions and the choice of depositors on where to save their money. Prior research has shown that increases in the number of customers making deposits are driven by bank pricing policy and switching costs for depositors. By employing a dynamic panel data model, this study empirically tests how environmental performance influences the depositors' choice on where to put their money in a sample of worldwide financial institutions from 2011 to 2018. The main results suggest that there is a negative relationship between banks' environmental performance and customers' deposits. Furthermore, the banks that are the best at managing carbon emissions and at pursuing sustainable development pay lower interest rates on customer deposits.     

Resilient Growth: Fantasy Plans and Unplanned Developments in India's Flood‐Prone Coastal Cities

Academic and policy literatures on urban climate resilience tend to emphasize ‘good planning’ as the primary means for addressing the growing risk of flooding in Asia's coastal megacities. Cities have come to rely on disaster and climate resilience plans to future‐proof their landscapes and protect vulnerable populations. Yet while data is collected, models are built and plans are drafted, environmentally destructive development practices continue unabated and often unchallenged. This article examines and seeks to explain the contradictions between a growing awareness of the risks of climate‐induced flooding in resilience plans and the continuation of development practices widely acknowledged to exacerbate those risks. It analyzes these contradictions in the context of Mumbai and Kolkata, India's largest coastal cities, which are facing the severest threats from climate‐induced flooding. Based on analyses of key resilience planning documents and both planned and unplanned developments in some of Mumbai's and Kolkata's most ecologically sensitive areas, our analysis reveals that resilience planning, promoted by the central government and international consultants, and presented in locally produced ‘fantasy plans’, fails to address the risks of climate‐change‐related flooding owing to tendencies to sidestep questions of politics, power and the distributional conflicts that shape urban development. We conclude that efforts to reduce urban flood risk would benefit from the research, methods and analytic concepts used to critically study cities, but significant gaps remain between these fields.     

Local government reform between ‘exogenous’ and ‘endogenous’ driving forces

Abstract

Configuration is an appealing concept to help understanding the complex arrangements that guide organizations' actions and contribute to their coherence. Although health care organizations are often described as professional bureaucracy a deep understanding of their structure and systems is still lacking. In this article, we draw on empirical data gathered in a Canadian teaching hospital to expose the nature of interdependencies and themes that drive some of its configurations at health care unit level. Five clinical activities were investigated (ocular surgery, brachytherapy, vascular surgery, rheumatology and geriatrics) using direct systematic observation. Four sub-orchestrating themes emerged. Based on the findings it is argued that the operating core of health care organizations is not homogeneous but rather heterogeneous. Therefore it is our contention that hospitals and other public organizations where professionals control the activities at operating level might be better regarded as ‘diversified professional federation’ than as professional bureaucracy.     

Children's hospitals: specialty hospitals that treat children specially

Any reader who has children will agree that they make special patients, whether at home or in the hospital. These patients have unique requirements for love and compassionate care, and children's hospitals deliver on their promises. The well-run children's hospitals researched for this article have converted their material management operational challenges to opportunities. They have built thoughtful material management strategic plans, reorganized their support services to provide customer service to end users, and they have centered their materiel management efforts around service and quality improvement.     

Team Rewards: How Far Have We Come?

Although many organizations find teams to be important to their success, few have implemented reward systems that encourage team effort. This study examines the practices of 35 firms using team‐based reward programs and identifies some features of these programs that improve their effectiveness. The results indicate that the most valued programs were those associated with (1) high levels of communication to employees about the specifics of the plan, (2) strong worker involvement in the plan's design and implementation, and (3) team members' perceptions that the pay system was fair. HR managers considered more complex plans more beneficial than simple plans. © 2001 John Wiley & Sons, Inc.     

Competition Among Health Plans: A Two‐Sided Market Approach

We set up a two‐sided market framework to model competition between a Prefered Provider Organization (PPO) and a Health Maintenance Organization (HMO). Both health plans compete to attract policyholders on one side and providers on the other. The PPO, which is characterized by a higher diversity of providers, attracts riskier policyholders. Our two‐sided framework allows us to examine the consequences of this risk segmentation on the providers' side, especially in terms of remuneration. The outcome of the competition depends mainly on two effects: a demand effect, influenced by the value put by policyholders on the providers access and an adverse selection effect, captured by the characteristics of the health risk distribution. If the adverse selection effect is too strong, the HMO receives a higher profit in equilibrium. On the contrary, if the demand effect dominates, the PPO profit is higher in spite of the unfavorable risk segmentation. We believe that by highlighting the two‐sided market structure of the health plans' competition, our model provides a new insight to understand the increase in the PPOs' market share as observed in the USA during the last decade.