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PubMed2004

Costs per discharge and hospital ownership under prospective payment and cost-based reimbursement systems in Taiwan.

This study in Taiwan examined the relationships between health care costs and hospital ownership under two financing systems with diametrically opposite incentives, case-payment (a form of prospective payment) and cost-based reimbursement. The universal sample of patients treated in 2000, for three standard care groups under each payment method, was included. The case payment diagnoses were uncomplicated cases of caesarean section, femoral/inguinal hernia operation and thyroidectomy, and the cost-based reimbursement diagnoses were uncomplicated cases of benign breast neoplasm, pneumococcal pneumonia and traumatic finger amputation. Costs per discharge were significantly lower in for-profit hospitals (by 2.8 to 5.7%) compared with public and not-for-profit hospitals for case payment diagnoses, which is consistent with the literature on US hospitals. For the cost-based reimbursement diagnoses, for-profits had 11.5 to 21.8% higher costs per discharge. The opposite direction of associations under the two payment systems validates the assumptions of the property rights theory in Taiwan's health care sector. Three plausible explanations for the study findings are suggested: (1). greater productive efficiency in private hospitals under case payment, (2). cost shifting from case payment diagnoses to cost-reimbursed diagnoses, and (3). patient dumping. Longitudinal studies using detailed hospital-level information with patient tracking facility are needed to clarify these issues.

Adult↗

PubMed2004

Issues of participation, ownership and empowerment in a community development programme: tackling smoking in a low-income area in Scotland.

Founded on community development principles and practice, the 'Breathing Space' initiative aimed to produce a significant shift in community norms towards non-toleration and non-practice of smoking in a low-income area in Edinburgh, Scotland. The effectiveness of Breathing Space was evaluated using a quasi-experimental design, which incorporated a process evaluation in order to provide a description of the development and implementation of the intervention. Drawing on qualitative data from the process evaluation, this paper explores the varied and sometimes competing understandings of the endeavour held by those implementing the intervention. The paper examines the principles that underpin health promotion in the community setting, particularly the concepts of ownership, empowerment and participation, and their differential interpretation and employment by participants. The data illustrate how these varied understandings had implications for the joint planning and implementation of Breathing Space objectives. In addition, the different understandings raise questions about the appropriateness and viability of utilizing community development approaches in this context.

Community Participation↗

PubMed1997

Ownership and governance of university teaching hospitals: let form follow function.

Under the best of circumstances, the complex decision-making and resource-allocation processes of a state university (and often of a variety of state agencies important to the university) significantly hinder the ability of the university-owned hospital to make changes critical to its financial and, hence, its programmatic success. At worst, as was the case for the University of Maryland Hospital a decade ago, the hospital can become capital-starved and operationally deficient under the bureaucratic mantle of the state and university and find itself unable to respond to the fast-changing market, placing its viability in jeopardy. To remedy this situation at the University of Maryland Hospital, in 1984 the state created a separate not-for-profit corporation, the University of Maryland Medical System ("the Medical system"), governed by its own board of directors, with a mandate to assure sound business practices, outstanding patient care, access to patients from across the state for tertiary care, access for the local disadvantaged community for comprehensive care, and attention to the academic mission of the university and its school of medicine. The results include strong financial performance, the ability to recapitalize outmoded facilities and technology, growth of strong programs, and the recruitment of excellent chairs and faculty. The Medical System's success suggests that university teaching hospitals, which necessarily depend on patient care revenues, may best be served by (1) removing them from university governance, thus allowing them to give primacy to their mission of patient care, and (2) removing them from state ownership, thus allowing them to use sound business practices in the competitive health care environment. The challenge under this arrangement is to ensure that the teaching hospitals can still support the educational and research programs that distinguish them. By establishing its independent, actively involved board of directors, the Medical System has successfully responded to this challenge.

Baltimore↗

PubMed2004

Faculty ownership of medical facilities: inappropriate conflict or an opportunity that benefits physicians and patients?

As a result of a confluence of issues, including faculty compensation in an academic health center (AHC), increasing awareness of conflict-of-interest issues, growing interest by faculty in entrepreneurial activities, and the creation of numerous new facilities and buildings associated with the AHC, the Indiana University School of Medicine (IUSM) in Indianapolis addressed the question of whether its faculty or even faculty groups could invest in any of these new entities, either as individuals or as groups. The dean of IUSM appointed a subcommittee of the school's standing Conflict of Interest Committee that included distinct groups of stakeholders and those without any fiduciary interests. As a result of meetings of this subcommittee, a new policy was set forth in a Points to Consider document to meet the emerging needs of the school to deal with such issues. The authors present the policy and the deliberations leading up to it as an example of how to address the issue of faculty ownership of medical facilities.

Academic Medical Centers↗

PubMed1989

The ownership of health facilities and clinical decisionmaking. The case of the ESRD industry.

The growth of investor-owned health care facilities raises questions about the relationship between profit seeking and medical decisionmaking. The authors compared the treatment received by patients with end-stage renal disease in private nonprofit, for-profit, and public facilities. Using data collected by the Health Care Financing Administration in 1981, they found that facility ownership had a significant independent effect on treatment of renal failure. In particular, patients at for-profit facilities were more likely to be dialyzed in the center and less likely to receive kidney transplants, home dialysis, or peritoneal dialysis than were their counterparts in nonprofit and public facilities. These findings persisted after controlling for characteristics of patients, the facility, and the local health care system, suggesting the need for further research and policy initiatives to deal with this issue.

Decision Making↗

PubMed1995

The effects of ownership, operating environment, and strategic choices on nursing home efficiency.

This article reports on a study of the labor efficiency of 461 nursing homes located in Pennsylvania. Data envelopment analysis was used to estimate efficiency scores. Tobit equations were estimated for the entire sample and for subsamples consisting of for-profit (FP) and not-for-profit (NFP) nursing homes. The authors found that the major factors explaining efficiency were managerial and environmental characteristics such as ownership, occupancy rate, size, payment source, wage rate, and per capita income, rather than quality characteristics of nursing homes. Analysis of the FP and NFP subsamples suggests that many NFP homes may respond to environmental pressures by increasing their efficiency, whereas FP homes tend to operate at a high level of efficiency irrespective of environmental and regulatory pressures.

Bed Occupancy↗

PubMed2004

Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia.

BACKGROUND: Whether to hospitalize residents with suspected pneumonia is a complex decision determined both by clinical and financial considerations. The decision to hospitalize may be different in for-profit and not-for-profit facilities and for different payment sources. OBJECTIVE: The objective of this study was to examine the role of proprietary status in the decision to hospitalize residents with suspected pneumonia, controlling for facility- and resident-level factors. DATA AND METHODS: The analysis uses the 1996 Medical Expenditure Panel Survey Nursing Home Component, a nationally representative sample of 5899 nursing home residents in 815 facilities. During the year, 766 elderly residents in the sample were suspected of having pneumonia infections and 224 were hospitalized for them. Logistic regression is used to assess factors affecting the decision to hospitalize among the 766 with pneumonia infections. MAIN OUTCOME MEASURE: Hospitalization for suspected pneumonia. RESULTS: Residents with suspected pneumonia in not-for-profit facilities are hospitalized at a rate half that of for-profit facilities. The difference is most pronounced for residents who are older and more cognitively impaired and those who are covered by Medicare or private funds. Medicaid residents are most likely overall to be hospitalized, with higher rates in not-for-profit than for-profit facilities. CONCLUSION: Risk of hospitalization for suspected pneumonia varies widely by ownership type and resident payer source, with lowest overall risk in not-for-profit facilities. Higher Medicaid hospitalization in not-for-profit facilities is consistent with heterogeneity in the not-for-profit sector, where Medicaid residents are sorted into the lower-quality facilities.

Activities of Daily Living↗

PubMed1991

Ownership of the medical radiograph.

Current hospital policies controlling original diagnostic radiographs do not serve the best interests of either the patients or the institutions. A survey of 200 randomly selected hospitals shows that approximately 40% of the hospitals would not release the original radiograph directly to the patient. Even more important, hospitals will destroy original radiographs without prior notification of the patient. Although statutes and case law support the institutional ownership of the x-ray film, there is a strong legal trend allowing the patient the use of the film. There are potential problems with patient control of the original radiographic image, but there is no evidence that these problems would develop if current hospital policies were changed to allow the patient physical possession of the films. Because there are economic incentives for hospitals to destroy the original radiographs, hospital policies should be liberalized to allow patients to acquire and maintain possession of their own original radiographic images.

Copying Processes↗

PubMed2002

Cost and care quality between licensed nursing homes under different types of ownership.

In Taiwan, there is some uncertainty and concern regarding the quality and safety of unlicensed nursing homes, as they are typically crowded and poorly equipped. There are data insufficient regarding the quality of care in licensed nursing homes for the government to reliably assist unlicensed facilities to become licensed. The purpose of this study was to examine the relationship between the different nursing home ownership types and the following dependent variables: (1) operating cost per resident day, (2) RN to resident ratio, (3) facility size, (4) occupancy rate, and (5) quality of care amongst licensed nursing homes nationwide. The descriptive study used a survey design. Data were obtained from 28 licensed nursing homes using self-administered questionnaires, on-site interviews and record reviews. Data were analyzed by Kruskal-Wallis test, Mann-Whitney U test and Spearman s correlation. A positive and significant relationship existed between nursing home quality and the RN ratio per resident day. Chain/For-profit and Chain/Non- profit nursing homes tended to have higher operating costs and a better quality of service. Secondary research is still needed to examine the results by detailed cost analysis or by research oriented toward outcomes of residents care. These findings provide basic reference for the government for planning the operation of nursing home facilities and also to assist the many unlicensed nursing homes to ultimately become licensed. The results also present important data for developing reimbursement policies.

Aged↗

PubMed2004

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

BACKGROUND: The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. METHODS: Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. RESULTS: In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). CONCLUSION: The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Female↗

PubMed2005

Embedding organisational quality improvement through middle manager ownership.

PURPOSE: To strengthen the middle manager role in a hospital quality improvement (QI) program, with a view to increasing and sustaining organisational QI implementation. DESIGN/METHODOLOGY/APPROACH: Case study based action research project, combining pre- and post-action quantitative and qualitative data collection, relating to a QI program intervention in an Australian metropolitan specialist teaching hospital. A model for enhancing the middle manager role in QI was developed and then implemented as the action over a 12-month period. FINDINGS: Middle manager understanding and ownership of the QI program and organisational QI implementation significantly increased, although their perceived enjoyment of being involved in QI decreased. RESEARCH LIMITATIONS/IMPLICATIONS: This case-study based action research project was limited to one organisation of a specific type - a large specialist metropolitan teaching hospital. The composition of the middle manager group, therefore, is necessarily limited to particular specialties. It is acknowledged that findings from case study and action research methodologies are limited in their generalisability, but assist in the development of knowledge and principles that can be adapted to different settings. PRACTICAL IMPLICATIONS: This QI implementation model can increase levels of organisational QI implementation by effecting a positive change in middle manager attitude to and involvement in QI. ORIGINALITY/VALUE: There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

Hospital Administrators↗

PubMed1997

The impact of ownership on health care services in HMOs.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider-owners who substitute towards production of their own goods.

Catchment Area, Health↗

PubMed2006

Disputes over memory ownership: What memories are disputed?

The ownership of memories is sometimes disputed, particularly by twins. Examination of 77 disputed memories, 71 provided by twins, showed that most of the remembered events are negative and that the disputants appear to be self-serving. They claim for themselves memories for achievements and suffered misfortunes but are more likely to give away memories of personal wrongdoing. The research suggests that some of the memories in which we play a leading role might in fact have been the experiences of others.

Adolescent↗

PubMed2001

Effect of gender on ownership and income in veterinary practice.

OBJECTIVE: To estimate the effect of gender on ownership and income in veterinary practice in Australia. METHODS: Questionnaire completed by private veterinary practitioners, and analysed using the SAS System for Windows 7.0. RESULTS: More than three-quarters (78%) of male but 36% of female private practitioners were partial or sole owners of practices. The median annual income for all male practitioners working more than 40 hours/week was $70K, but that for females was $43K. These disparities existed in both city and country practices, and in the case of income it increased with increasing time in the workforce. Male practice owners also reported higher incomes than female owners. CONCLUSIONS: Female veterinary practitioners are less likely to own practices, and more likely to earn low incomes than males. These differentials do not appear to be due to location, hours worked or years since graduation or, in the case of income, to whether they are owners or employees. The evidence points to a lower interest by women than men in the business aspects of veterinary practice.

Female↗

PubMed1990

The effects of for-profit multihospital system ownership on hospital financial and operating performance.

The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities. Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent.

Costs and Cost Analysis↗

PubMed1994

Ownership differences in the provision of outpatient substance abuse services.

The authors examine the assumption of the 1980s that the provision and costs of substance abuse services, among others, could best be met by expanding programs in the private sector. The study presents a comparison of public and private substance abuse services, based on data drawn from a national sample of outpatient units, and develops a profile of treatment and financing within three auspice (ownership) categories--private nonprofit, private for-profit, and public. An input-throughput-output framework was used to assess the public-private differences within a wide range of organizational characteristics.

Cost-Benefit Analysis↗

PubMed2006

Effect of hospital ownership status and payment structure on the adoption and use of drug-eluting stents for percutaneous coronary interventions.

BACKGROUND: The impact of the use of drug-eluting stents in percutaneous coronary intervention (PCI) on cardiac care is still uncertain. We examined the influence of systemic factors, such as hospital ownership status, organizational characteristics and payment structure, on the use of drug-eluting stents in PCI and the effect on cardiac surgery volume. METHODS: We conducted a cross-sectional analysis of drug-eluting stent use in 12 993 patients undergoing PCI with stenting (drug-eluting or bare-metal) and time-series regression analyses of the monthly number of cardiac surgery and PCI procedures performed using data collected from 1998 to 2004 at 13 public and private hospitals in the Emilia-Romagna region of Italy. RESULTS: Public hospitals used drug-eluting stents more selectively than private hospitals, targeting the new device to patients at high risk of adverse events. The time-series regression analyses showed that the number of PCI procedures performed per year increased during this period, both in public (slope coefficient 36.4, 95% confidence interval [CI] 30.2 to 43.1) and private centres (slope coefficient 6.4, 95% CI 3.1 to 9.2 ). Concurrently, there was a reduction in the number of isolated coronary artery bypass graft (CABG) surgeries, although the degree of change was higher in public than in private hospitals (coefficient -16.1 v. -6.2 respectively ). The number of CABG procedures associated with valve surgery decreased in public hospitals (coefficient -5.0, 95% CI -6.1 to -3.8) but increased in private hospitals (coefficient 4.1, 95% CI 2.0 to 6.1). INTERPRETATION: Public and private hospitals behaved differently in adopting drug-eluting stents and in using PCI with drug-eluting stents as a substitute for surgical revascularization.

Cardiovascular Surgical Procedures↗

PubMed1991

Motorcycle licensure, ownership, and injury crash involvement.

The interrelationships among motorcycle licensure, ownership, and injury crash involvement were investigated in a sample of 2,723 motorcycle drivers severely or fatally injured in California in 1985-86. Owners of motorcycles in such crashes ("driver-owners") were less likely to have valid licenses than a random sample of motorcycle owners who had not been in crashes (42 vs. 57 percent). Thirty-three percent of the crash-involved drivers had valid motorcycle driver's licenses; 39 percent were operating motorcycles they did not own ("driver-nonowners"). Driver-nonowners were less likely to be validly licensed than driver-owners (20 percent vs. 44 percent). The licensing rate of crash-involved driver-nonowners was 15 percent if the owner was also unlicensed. Rates of valid licensure were lowest among the youngest drivers. Virtually no crash-involved driver-nonowners under age 21 were licensed in cases in which the owner was also young and unlicensed.

Accidents, Traffic↗