A new approach to optimal selection of services in health care organizations.

A new reimbursement policy adopted by Medicare in 1983 caused financial difficulties for many hospitals and health care organizations. Several organizations responded to these difficulties by developing systems to carefully measure their costs of providing services. The purpose of such systems was to provide relevant information about the profitability of hospital services. This paper presents a new method of making hospital service selection decisions: it is based on an optimization model that avoids arbitrary cost allocations as a basis for computing the costs of offering a given service. The new method provides more reliable information about which services are profitable or unprofitable, and it provides an accurate measure of the degree to which a service is profitable or unprofitable. The new method also provides useful information about the sensitivity of the optimal decision to changes in costs and revenues. Specialized algorithms for the optimization model lead to very efficient implementation of the method, even for the largest health care organizations.     

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.     

Botswana's Macroeconomic Management of Its Mineral-Based Growth: It Used Mining Revenues for Development and Services but Must Now Broaden the Beneficiaries

Abstract . The economic performance and the political history of Botswana during 1974-84 contrasted significantly with the experience of virtually every other African country. The South African republic, immediately north of the Republic of South Africa, achieved steady real economic growth with improved social services and provision for its people's basic needs. This was achieved in spite of world recession and drought because its mineral wealth Was reserved for the people and mining companies had to pay for the privilege of extracting that wealth through a tax program limited to appropriating its surplus, while assuring the investors and entrepreneurs an adequate long-term return on capital and enterprise. But sound macroeconomic policies failed to provide even reasonably equitable benefits for the majority of the people. Sound micropolicies are needed to widen access to employment and earned income and to asset accumulation.     

PROPRIETORIAL CONTROL IN FAMILY FIRMS: SOME FUNCTIONS OF 'QUASI-ORGANIC' MANAGEMENT SYSTEMS

The purpose of this paper is to investigate the strategies of managerial control which are used by the proprietors of family-owned business enterprises. Interviews with the proprietors and senior managers of businesses in the building industry illustrate the ‘quasi-organic’ nature of management structures. These grant some autonomy to senior managers without threatening proprietorial decision-making prerogatives. Although the family firm has certain distinctive features, similar control strategies designed to ensure that delegated decisions are ‘reliable’ and ‘responsible’ are evident in various types of business enterprise. There is, then, scope for further comparative research within a conceptual framework which does not entirely divorce the family firm from other business organizations.     

Deriving benefits from conflict resolution: A macrojustice assessment

Effective conflict resolution procedures serve to minimize dysfunctional effects of conflict and maximize functional effects. In the literature on conflict resolution procedures, the effectiveness of procedures has been evaluated primarily from the perspective of the individual. This article suggests that a system-level analysis of the pattern of outcomes resulting from different conflict resolution procedures is a necessary component in formulating a comprehensive framework for the design and evaluation of conflict resolution systems in organizations. The analytic questions addressed by this study concern associations between resolution procedures and outcome patterns in a system created specifically for conflict resolution within organizations: the grievance system. The pattern of outcomes was found to vary with the conflict resolution procedure. It is suggested that this has important implications for effective conflict resolution systems.     

A child health production function estimated from longitudinal data. Cebu Study Team

Collaborating researchers used a multi equation model to analyze 3080 mother-infant pairs living on the island of Cebu in the central Philippines and to estimate a child health production function. The econometric methods used eliminated obstacles such as heterogeneity and endogeneity of significant explanatory factors. They also maximized the longitudinal quality of the data. The results showed that morbidity in 1 period reduced infant weight in following periods. For example, diarrhea and febrile respiratory infection reduced growth in the time period following the illnesses. Further effects of some contributing factors were great near birth not diminished with age. For example, breast feeding promoted growth and protected against infection, especially diarrhea and febrile respiratory infection, more substantially near birth than it did later. Further, in urban areas, preventive health care positively affected growth independently of its indirect influence on reducing respiratory infection. Yet it had little effect on diarrhea. Diarrhea had a strong adverse effect on growth. Exposure of the infant to enteric pathogens had the greatest influence on production of diarrhea. In urban areas, exposure included water supply contamination, exposure to feces, a more pathogenic diet, and community crowding. In rural areas, however, exposure included community crowding and increased rainfall which presumably washed feces into the water supply. Household crowding in both urban and rural areas and irritation from smoke in urban areas only tended to bring about febrile respiratory infection.     

Hospitals and material management in the coming decade

The 1990s will be a decade of increasing dramatic and traumatic change for hospitals. Reimbursement, technology, and consumers, either alone or in concert, will be the forces that will shape hospitals in the future. At the end of the 1990s we will have hospitals that offer technology to the critically ill, outpatient surgical services, and comforting care for those in the late years of life. Material management will be important to hospitals because expense control will be as important as ever. However, I believe the role of a material manager will diminish as the services provided change and as the role is folded into the responsibilities of those who manage one of the three critical business areas hospitals will be in. This new hybrid of today's manager will still apply all of the concepts to the distribution of supplies in a hospital as today's material managers do but will use them as only a part of their overall management responsibility.     

A different perspective on operating leverage: Comments

A recent article in this journal by Dran (1991) suggests that the usual treatment of degree of operating leverage (DOL) is misleading because it improperly attributes the DOL to the ratio of fixed to total costs rather than the closeness of the firm’s output to breakeven. Managerial economics texts are clear in identification of DOL as an elasticity concept which varies with the nearness to break-even. Examples associating DOL with the relative level of fixed cost arise from association of higher fixed costs with higher breakeven points, and this appears to be the normal economic relationship.