The learning curve and the health care industry

This article will examine the learning curve and its potential impact on the health care industry. Although the learning curve has traditionally been applied to the manufacturing industry, a labor-intensive industry like health care is a prime candidate for the benefits of the learning curve. Specifically, we will look at past research on the learning curve and discuss what effects learning might have on health care costs and outcomes in the current health care environment.     

Enhanced ABC costing for hospitals: directed expense costing

Space limitations do not allow a complete discussion of all the topics and many of the obvious questions that the preceding brief introduction to directed expense costing probably raised in the reader's mind. These include how errors in accounting practices like posting expenses to the wrong period are handled; and how the system automatically adjusts costs for expenses benefiting several periods but posted to the acquisition month. As was mentioned above, underlying this overtly simple costing method are a number of sophisticated and sometimes complex processes that are hidden from the normal user and designed to automatically protect the integrity and accuracy of the costing process. From a user's viewpoint, the system is straightforward, understandable, and easy to use and audit. From a software development perspective, it is not quite that effortless. By using a system that is understood by all users at all levels, these users can now communicate with each other in a new and effective way. This new communication channel only occurs after each user is satisfied as to the overall costing quality achieved by the process. However, not all managers or physicians are always happy that the institution is using this "understandable" cost accounting system. During one of the weekly meetings of a hospital's administrative council, complaints from several powerful department heads concerning the impact that the use of cost data was having on them were brought up for discussion. In defending the continued use of the system, one vice president stated to the group that cost accounting does not get any easier than this, or any less expensive, or any more accurate. The directed expense process works and works very well. Our department heads and physicians will have to come to grips with the accountably it provides us to assess their value to the hospital.     

A question of community: at not-for-profit hospitals health is a local affair

For-profit hospitals' entrepreneurial status, big business climate, and adherence to market discipline mandate that their services be considered akin to any other market commodity, to be bought and sold at the highest margin to the largest audience. Investor owned healthcare's primary allegiance must be a reasonable return to its stockholders and as a result it must avoid unprofitable services and unprofitable patients, by displacing their costly burdens onto the rest of the healthcare system.     

Collectively bargained public health benefit plans

The marketplace for health benefits for public sector employees is large and complex with a great variety of approaches for providing care and a difficult patchwork of regulatory and collective bargaining regulation to deal with in designing a plan. Public sector workers' plans are subject to an additional constraint provided by the political nature of the process. The products sold to public sector plans are not regulated as ERISA plans, given the exclusion of government plans and the differential regulation of collectively bargained plans under the HMO act. This article attempts to guide the reader through some of the difficulties of this marketplace, pointing out pitfalls and opportunities where they appear.     

The “Iron Law of Paternalism” in Employee Grievances and Arbitration? A Comparison of Disciplinary and Nondisciplinary Cases

In the criminology literature, the iron law of paternalism suggests that women receive less serious sanctions in the judicial system. This examination of three years of grievance outcomes (n= 1216) and arbitration outcomes (n= 1146) tests this iron law in the context of organizational disciplinary and dispute resolutions. These data, across several levels of outcomes (win, lose, compromise), controlling for the severity of grievances (disciplinary/nondisciplinary) and arbitrations (termination/nontermination) provide no support for the paternalistic thesis. Moreover, we find no support for the paternalistic thesis with regard to either the incidence or length of suspensions as a function of gender.