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PubMedDate not supplied

Ownership and changes in hospital inefficiency, 1986-1991.

This study examines how ownership affected changes in hospital inefficiency after the introduction of prospective payment by Medicare. Using a national data set, we estimate cost frontiers for 1986 and 1991 to assess hospitals' efficiency relative to best practice in both those years. We then use regression analysis to determine the effect of ownership on the change in hospitals' efficiency. The results indicate that, in both 1986 and 1991, mean inefficiency was highest for for-profit hospitals and lowest for not-for-profit hospitals, with government hospitals falling in the middle. Moreover, between 1986 and 1991, both for-profit and government hospitals had significantly less improvement in efficiency than not-for-profit hospitals, all else equal.

Economic Competition↗
PubMed2005

Nursing home closures, changes in ownership, and competition.

This research examines the relationship of competition among nursing homes and the likelihood of their closure or change in ownership. The study uses nationally representative data from the 1992-1998 Online Survey, Certification, and Reporting system, and is supplemented with several other primary and secondary data sources. It is hypothesized that facilities located in more competitive environments will be more likely to close. Multinomial logistic regression analyses are employed to examine this hypothesis in a model containing organizational and aggregate resident characteristics, and market factors. The Herfindahl index is used as a measure of competition. The descriptive analysis shows that 621 nursing homes closed and 6,471 changed ownership from 1992 to 1998. The incidence rate of closures was .7% of facilities per year. The multivariate analysis shows that facilities located in more competitive environments were significantly more likely to close.

Aged↗
PubMed1996

Church ownership and hospital efficiency.

Using a sample of California hospitals, the effect of church ownership was examined as it relates to nonprofit hospital efficiency. Efficiency scores were computed using a nonparametric method called data envelopment analysis (DEA). Controlling for hospital size, location, system membership, and type of church ownership, church-owned hospitals were found to be more frequently in the efficient category than their secular nonprofit counterparts. The outcomes have policy implications for reducing healthcare expenditures by focusing on increasing outputs or decreasing inputs, as appropriate, and bolstering the case for church-sponsored hospitals to retain the tax-exempt status due to their ability to manage their resources as efficiently as (or more efficiently than) secular hospitals.

California↗
PubMed1998

Ownership of health information in the information age.

The question "Who owns health information?" has no simple answer. The authors examine problems related to traditional ownership in the age of aggregated information and offer suggestions as to how some of these issues can be clarified and resolved. A sidebar examines the traditional view of provider and patient ownership and how these structures are changing.

Abstracting and Indexing↗
PubMed1980

Health Care Financing Administration--Medicare and Medicaid; provider agreements: redesignation and rewrite of Medicare regulations; effective dates; effect of change in ownership. Final rule with comment period.

These regulations revise and redesignate the policies pertaining to provider agreements under the Medicare program to simplify them and to make them easier to read. We have made substantive changes only in the provisions relating to the effective date of the agreement and the effect of a change in ownership. These substantive changes were issued as proposed rulemaking on February 5, 1979, and will also apply to the Medicaid program. The substantive changes make provider agreements effective on the date of the onsite health and safety survey if all Federal requirements are met. If all requirements are not met, the effective date is the date the requirements are met or the date the provider submits an acceptable plan of correction or waiver request. The revised regulations also provide that existing provider agreements be assigned to new owners, subject to the terms and conditions under which they were originally issued. The intent of the substantive changes is to achieve maximum uniformity of policy for the two programs and to provide continuity of coverage for beneficiaries and recipients when there is change of ownership.

Health Facilities↗
PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗
PubMed2002

The effects of hospital ownership on medical productivity.

To develop new evidence on how hospital ownership and other aspects of hospital market composition affect health care productivity, we analyze longitudinal data on the medical expenditures and health outcomes of the vast majority of nonrural elderly Medicare beneficiaries hospitalized for new heart attacks over the period 1985-1996. We find that the effects of ownership status are quantitatively important. Areas with a presence of for-profit hospitals have approximately 2.4% lower levels of hospital expenditures, but virtually the same patient health outcomes. We conclude that for-profit hospitals have important spillover benefits for medical productivity.

Aged↗
PubMed1992

Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics.

OBJECTIVE: To evaluate the effects of physician ownership of freestanding physical therapy and rehabilitation facilities on utilization, charges, profits, and three measures of service characteristics for physical therapy treatments. DESIGN: Statistical comparison by physician joint venture ownership status of freestanding physical therapy and comprehensive rehabilitation facilities providing physical therapy treatments in Florida. PARTICIPANTS: A total of 118 outpatient physical therapy facilities and 63 outpatient comprehensive rehabilitation facilities providing services in Florida during 1989. The data from the facilities were collected under a legislative mandate. MAIN OUTCOME MEASURES: Visits per patient, average revenue per patient, percent operating income, percent markup, profits per patient, licensed therapist time per visit, and licensed and nonlicensed medical worker time per visit. RESULTS: Visits per patient were 39% to 45% higher in joint venture facilities. Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians. Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities. Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities. Joint ventures also generate more of their revenues from patients with well-paying insurance. CONCLUSION: Our results indicate that utilization, charges per patient, and profits are higher when physical therapy and rehabilitation facilities are owned by referring physicians. With respect to service characteristics, joint venture firms employ proportionately fewer licensed therapists and licensed therapist assistants to perform physical therapy, so that licensed professionals employed in joint venture businesses spend significantly less time per visit treating patients. These results should be of interest to the medical profession, third-party payers, and policymakers, all of whom are concerned about the consequences of physician self-referral arrangements.

Conflict of Interest↗
PubMed2003

[The indivisibility of the ownership and the running of pharmacy].

The indivisibility of the ownership and the running of a pharmacy is one of the basic principles of the pharmaceutical profession and find its origin in two ancient texts: The Royal Declaration of April 25th, 1777 and some twenty-six years later, the well-know law of 21st Germinal, year XI. The spirit of the law should have done with the competitors, but it did not. The principle was stretched many times until a Court Decision in June 23rd, 1859. Since then the rule was progressively confirmed and many conventions relative to the ownership and the running have been forbidden. Yet certain derogations do exist. Nevertheless, the publication of a law in December 11th, 2001, called " law MURCEF" overthrows deeply the principle because it could allow for reconsideration.

France↗
PubMed2003

Sole hospital commitment to health promotion and disease prevention (HPDP) services: does ownership matter?

Hospitals have been increasingly involved in health promotion and disease prevention (HPDP) in the last two decades. Concurrent with this trend, environmental changes and market pressures have resulted in more hospital consolidations and conversions from not-for-profit (NFP) to for-profit (FP) organizations. The emergence of a large number of sole community hospitals has attracted the attention of policy-makers and community stakeholders because sole community hospitals have more power in the local market and may discontinue unprofitable services to pursue profit maximization. This may be especially true when the sole hospital is a FP organization. On the other hand, sole community hospitals are confronted with a variety of expectations to offer community-oriented services that promote community population health, regardless of ownership. There is relatively little literature that has attempted to examine the behavior of sole community hospitals. This study depicts the profile of sole hospitals' involvement in HPDP services and estimates the possible influence of community constituencies on hospitals with respect to their providing community-oriented services. The results indicate that typically, when there is only one hospital in the community, hospital ownership has no significant influence on hospital HPDP services than their NPD counterparts. Implications for policy-makers and health care leaders are also discussed.

Community Health Planning↗
PubMed2006

Hospital choice by rural medicare beneficiaries: does hospital ownership matter?--a Colorado case.

About 45 percent of rural patients in Colorado bypassed their local rural hospitals during the 1990s. The effect of this phenomenon is a reduction in occupancy rates and a decrease in the competitiveness of rural hospitals, thereby ultimately causing rural hospitals to close and adversely affecting the communities that they were designed to serve. This study tests whether hospital ownership affects hospital choice by patients after controlling for institutional and individual dimensions. A conditional logistic regression is used to analyze Colorado Inpatient Discharge Data (CIDD) on 85,529 patients in addition to hospital data. Rural Medicare beneficiaries are influenced to choose a particular hospital by a combination of hospital characteristics (the number of beds, the number of services, accreditation, ownership type, and distance from patient residence) and patient characteristics (medical condition, age, gender, race, and total charge for services). Increasing rural hospitals' survivability, collaborating with other rural hospitals, expanding the number of available services, making strategic alliance with other providers are possible strategies that may help ward off encroachment by urban competitors.

Choice Behavior↗
PubMedDate not supplied

Proximal impact of Canada on the Move: the relationship of campaign awareness to pedometer ownership and use.

OBJECTIVE: Despite increased participation in leisure-time physical activity, inactivity remains an important public health problem. This study examines the immediate impact of the Canada on the Move initiative to promote walking through pedometer use among adult Canadians. METHODS: Data from a rolling monthly sample were collected via the Canadian Fitness and Lifestyle Research Institute's Physical Activity Monitor between November 2003 and September 2004. Prevalence rates were compared using Bonferroni-adjusted confidence intervals. Correlates of campaign recall and pedometer ownership were estimated using odds ratios adjusted for age, sex, income and education. RESULTS: Message recall and awareness as well as ownership and use of pedometers increased over the campaign and coincided with promotional activity. There was some evidence of a dose response between the number of messages recalled and pedometer use. DISCUSSION: The increased awareness and usage of pedometers among adult Canadians is encouraging; it indicates that these proximal targets are realistic and achievable for health promotion campaigns and contribute to opportunities for increasing physical activity behaviours.

Adolescent↗
PubMed1990

Physician ownership-referral arrangements in the United States.

Physician ownership-investment arrangements are increasingly being subjected to public and professional scrutiny. One view is that some of these arrangements may have distinct beneficial, legitimate effects, possibly including increased availability of health care services and state-of-the-art technology. A contrasting view is that such practices are unethical and may result in excessive utilization of services and concommitant increases in medical costs. Legislation has been proposed in the United States Congress which may severely curtail or prohibit various physician ownership-investment relationships. A serious need exists for the collecting of further quantitative data on this subject.

Ethics, Medical↗
PubMed1990

The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

Black or African American↗
PubMed1985

The effects of ownership and system affiliation on the economic performance of hospitals.

We investigated differences among five types of hospitals, defined by ownership (investor-owned or not-for-profit), system affiliation (system-affiliated or freestanding), and government sponsorship on 24 measures of economic performance. Using multivariate analysis of 1980 Medicare cost report and other data from a national sample of 561 hospitals, we found that investor-owned chain hospitals charged significantly more, and were more profitable, than all other types of hospitals except freestanding for-profits; there were no differences in productive efficiency that could be attributed to ownership or affiliation; the investor-owned hospitals had higher debt-to-asset ratios, less-capital-intensive plants, and greater capital costs as a percentage of operating costs than the not-for-profits; and there were no consistent case-mix differences among the hospitals.

Capital Expenditures↗
PubMed1990

Attitudes toward bicycle helmet ownership and use by school-age children.

To identify attitudes toward bicycle helmet ownership and use, questionnaires were sent to parents of 2178 third-graders; 1057 (48.5%) returned valid responses. Of 931 children who had bicycles, 24% owned helmets, but only 56% of children who owned helmets wore them. Helmet ownership, but not use, was associated with higher parental education. Fifty-one percent of 704 parents of bicycle owners who had not purchased helmets said they had never thought of it, 29% thought helmets were too costly, and 20% felt their children would not wear them. Of 792 children who did not wear helmets, 25% said they did not wear them because their friends did not; 22% never thought about wearing helmets; and 16% found them uncomfortable. Efforts to increase the wearing of helmets should address helmet design, awareness, peer pressure, and cost.

Attitude to Health↗
PubMed2000

Self-reported weapon ownership, use, and violence experience among clients accessing an inner-city sexually transmitted disease clinic.

Little is known about the extent to which people who access public health care settings own/carry weapons and experience/perpetrate acts of violence. The purpose of this study was to describe weapon ownership and violence experiences of persons attending an inner-city sexually transmitted disease clinic. Face-to-face interviews were administered to 245 clients to assess weapon ownership, types of weapons carried, and experiences as victims or perpetrators of violent acts. Overall, 43.7% reported experience of carrying a weapon at some point in their lives. More men chose to carry guns; more women chose to carry knives or mace. Participants reported experiencing alarming levels of violence in the previous year: 30.5% experienced beatings, 23.9% reported being threatened with a gun, and 18.9% reported forced, unwanted sex. Persons with a history of carrying weapons were significantly more likely to report being both victims and perpetrators of violence. Persons who experienced violence in the previous month were significantly more likely to be diagnosed with an STD. Results show that STD clinics represent yet another setting wherein interventions to curb the extent of violence might be appropriate, and strategies to assist and protect those experiencing violence are needed.

Adolescent↗
PubMed2005

Hospital ownership, reimbursement systems and mortality rates.

This paper analyses the effect of ownership and system of reimbursement on mortality rates. From the statistical results we could conclude that the incentive created by fee-for-service reimbursement yields a four-point reduction in the mortality rate. However, this ranking of hospital quality is completely dependent on the characteristics and illness severity of patients. To take this difficulty into account, we use an innovative duration model applied to panel data: a duration model with both patient and hospital unobserved heterogeneity. No distributional assumptions are made regarding the latter. By this way, we control the fact that patients admitted to the private sector can be different in terms of disease severity from patients admitted to the public sector. The capacity to perform innovative procedures has more effect on the mortality than the system of reimbursement and/or ownership. As such, private sector hospitals that perform more innovative procedures provide a better quality of care, measured by the probability of dying. Nevertheless, heterogeneity within hospitals is greater in for-profit hospitals than in other types of hospital. This suggests that, by choosing a for-profit hospital, patients have on average a lower instantaneous probability of dying but are less sure about the quality of the hospital.

Adult↗