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Biomedical subjects

R W Broyles

Publications and source records attributed to R W Broyles.

At least 37 records · Page 2Linked to original sources
PubMed1992

Administrative complement and managerial efficiency in South Carolina hospitals.

This article examines the infrastructure and efficiency of administrative personnel employed by hospitals in South Carolina. The analysis suggests that variation in the administrative complement and the efficiency of hospital administrators is related to the scale of operations and related organizational complexity, the occupancy rate, ownership, and affiliation with multihospital systems. The results of the study also indicate that the administrative complement should be regarded as a resource that results in a discretionary rather than a committed cost and might be altered to increase productivity and improve profitability.

Bed Occupancy↗
PubMed1990

Efficiency, costs, and quality: the New Jersey experience revisited.

Focusing on two prospective payment systems that operated concurrently in New Jersey, this study employs the hospital department as the unit of analysis and compares the effects of the all-payer DRG system with those of the SHARE program on hospitals. Relative to the SHARE program, which regulated the revenue derived from Blue Cross and Medicaid, the results indicate that the comprehensive approach to prospective payment induced hospitals to control not only the direct costs of multiple dimensions of patient care per case but also the direct cost per day of nursing care and per unit of ancillary care. The results also suggest that the DRG system reduced the length of stay, the daily use of radiological procedures, and the volume of these services per case. On the other hand, the DRG system was accompanied by an increase in the daily use of laboratory procedures and the volume of laboratory care per case.

Ancillary Services, Hospital↗
PubMed1988

Physicians, patients, and administrators: a realignment of relationships.

The increased reliance on case mix to establish prospective rates of compensation creates an imperative to alter the traditional relationship of physicians to hospitals and to assign the responsibility for the fiscal effects of clinical decisions to the medical staff. This article identifies the physician's admitting policies as an area in which increased cooperation might augment hospital revenues. Conversely, the analysis identifies the physician's prescribing decisions as an area of conflict that must be resolved in order to control costs and preserve the long-term survival of the hospital. Also examined are relationships and organizational arrangements that not only contribute to the resolution of inevitable conflicts but also enhance the beneficial effects of increased cooperation. The article concludes with an examination of the undesirable effects the full implementation of these arrangements might have on the patient.

Conflict, Psychological↗
PubMed1987

Short-term responses of hospitals to the DRG prospective pricing mechanism in New Jersey.

Short-term responses of hospitals to the New Jersey prospective payment system, which uses Diagnosis Related Groups (DRGs) to establish rates of compensation for all payers, were examined in this study. The sample consisted of 84 New Jersey hospitals that were subject to prospective payment and a comparison group of 76 hospitals. Hospitals comprising the comparison group located in eastern Pennsylvania, were reimbursed retrospectively. Regression equations, which included independent variables to control for market supply and demand conditions, were estimated for the cost per admission, cost per day, length of stay; and cases treated. The results indicate that increases in the cost per admission and cost per day were lower (P less than 0.05) in hospitals subject to the all payer DRG system than in those institutions that were reimbursed retrospectively. In addition, the results suggest that most of the cost savings attributed to the New Jersey DRG system are due to a reduction in the average length of stay. The paper concludes with policy implications.

Cost Allocation↗
PubMed1987

The determinants of hospital utilization under a universal public insurance program in Canada.

This study employs the individual as the unit of analysis to examine the relative importance of medical need, sociodemographic and economic factors in determining the use or non-use of hospital care and the volume of service consumed by those who experienced an episode of hospitalization during the study period. The data were derived from the Canada Health Survey which is a stratified, multistaged sample of the entire population. The results of the discriminant and weighted regression analyses indicate that the use or non-use of hospital care and the volume of service consumed are largely determined by medical need and not by income. The findings are supportive of the view that the national health insurance scheme in Canada has resulted in a more equitable distribution of hospital care.

Adolescent↗
PubMed1987

Prospective payment based on case mix: will it work in nursing homes?

This article evaluates the potential efficacy of implementing a prospective payment system based on case mix in the nursing home industry. The analysis of structural differences between the nursing home and hospital industries suggests that the mechanism of compensating long-term care facilities should be based on functional health status rather than on diagnosis and that incentives to improve quality and access should be strengthened. The article assesses several systems of classifying patients that have been proposed as the basis for implementing a prospective payment system in the nursing home industry. The article concludes with a discussion of policy issues related to the appropriate unit of payment and the scope of regulatory authority.

Costs and Cost Analysis↗
PubMed1986

The impact of the New Jersey all-payer DRG system.

Two prospective payment systems that operated concurrently in New Jersey during 1980-1982 created a natural experiment and a unique opportunity to compare the effectiveness of the two systems in restraining cost increases. Our results indicate that during that period, annual increases in the cost per case were significantly less in hospitals that were subject to the all-payer DRG system than in those institutions that were paid under the Standard Hospital Accounting and Rate Evaluation (SHARE) program. We also found that, relative to the SHARE program, the DRG system appears to have increased admission rates and reduced length of stay.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

A qualitative assessment of the Medicare prospective payment system.

This paper employs commonly accepted criteria to evaluate the potential outcomes of the Medicare pricing mechanism. The analysis suggests that the recent revisions in the Medicare payment system have less potential to contain increases in total hospital costs than those embodied in all-payer systems. In addition, this paper also suggests that the pricing mechanism will jeopardize the financial viability of many hospitals while exacerbating inequities that emanate from differential pricing policies. Finally, when viewed from the perspective of insured beneficiaries, it is reasonable to expect that the payment mechanism will reduce not only access to inpatient care but also the use of service once admitted.

Diagnosis-Related Groups↗
PubMed1984

Optimum distribution of diagnostic-specific technology.

Recognizing that the suboptimal allocation of plant assets contribute to the inflationary pressures in the health industry, this paper employs the principles of goal programming to develop a model for distributing diagnostic-specific technology among potential recipients in a given geographic region. The model allocates diagnostic-specific equipment so as to ensure that the provision of the related service satisfies the health needs of the population at risk, the capacity to provide the service in the region and in the hospital is optimal, the service is provided at minimum cost, and access to the equipment is satisfactory. An application and the practical implications of the model are also explored.

Diagnostic Services↗
PubMed1984

Managing patient receivables: a technical note.

This paper focuses on the patient receivables of the hospital and employs a Markov process to estimate the timing of cash receipts, the magnitude of cash receipts, and losses that are attributable to bad debts, courtesy discounts, and the provision of charity care. Further, the usefulness of the model in the day-to-day management of patient receivables is also explored.

Accounting↗
PubMed1984

National health insurance: a new imperative.

When viewed from the perspective of the policy analyst, observed inequities in the access to health services and the rising costs of physician and hospital care are among the most important issues confronting the American health delivery system. Recognizing that publicly financed health insurance programs result in a more equitable distribution of medical services, this paper focuses on the components of a national health insurance scheme that not only offers a comprehensive range of benefits but also employs prospective payment and a set of financial incentives to control the costs of care provided by physicians, hospitals, and other health facilities. The national health insurance program proposed in this paper is designed to eliminate or reduce unwarranted expenditures on plant and equipment; the responsibility for approving and funding capital acquisitions is also regarded as an integral component of the program.

Capital Expenditures↗