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Hospital ownership and the care of uninsured and Medicaid patients: findings from the National Hospital Discharge Survey 1979-1984.

From 1980 to 1984 Americans with no health insurance increased from 13.9% to 17.1% of the non-elderly population. Non-elderly persons covered by Medicaid declined from 6.2% to 5.6%. Previous studies of the share of the burden of uncompensated care borne by various provider groups present opposing findings. The National Hospital Discharge survey data presented here demonstrate that for-profit hospitals serve significantly lower percentages of uninsured discharges than secular or church-affiliated non-profit hospitals and public hospitals. The same pattern of differentials is observed with respect to Medicaid. On the whole the results of the survey tend to support the argument that private non-profit hospitals do indeed render greater public services in treating indigent patients than do for-profit hospitals. It must also be emphasized, however, that the results show all private hospitals falling somewhat short of the standard set by public hospitals in treating indigents. Thus, the continued shrinkage of the public hospital sector has serious policy implications.

Data Collection↗

Medicare upcoding and hospital ownership.

Many hospitals in the 1990s many hospitals were accused of "upcoding" patient diagnostic related groups (DRGs) to increase Medicare reimbursements. We find that between 1989 and 1996, the percentage point share of the most generous DRG for pneumonia and respiratory infections rose by 10 points among not-for-profit hospitals, 23 points among for-profit hospitals, and 37 points in hospitals converting to for-profit status. Not-for-profit upcoding was also higher in markets with a larger for-profit hospital share. Upcoding appears to reflect both risk-taking by administrators and a closer alignment between the goals of the administration and the behavior of the clinical staff.

Aged↗

On complexity, process ownership and organisational learning in manufacturing organisations, from an ergonomics perspective.

The paper discusses some characteristics and implications of the complexity approach as applied to manufacturing organisations and their supply chains. It then discusses the acquisition of process capability within organisations, one of the essential processes for maintaining the organisation's ability to compete in a complex environment. The paper then discusses the concept of the Process Owner, as a means of preserving and evolving the organisation's knowledge under such circumstances, and discusses the consequences of this role. Finally, the knowledge lifecycle management implications are discussed, since these are among the resources that a Process Owner will require to maintain the effectiveness of the role. Throughout the paper the point is made that complexity demands more of an organisation than technical excellence; technology alone will not overcome the effects of complexity and the organisation's people must be included in the response to its challenges.

Ergonomics↗

The ownership difference in relative performance of rehabilitation specialty hospitals.

Despite the rapid growth in the number of rehabilitation specialty hospitals in recent years, there is little knowledge of the performance of these facilities. The recent growth in the number of for-profit rehabilitation providers and increasing competition among for-profit and not-for-profit rehabilitation hospitals have raised questions about differences in performance. This study analyzed differences in financial and operational performance between for-profit rehabilitation specialty hospitals and not-for-profit rehabilitation specialty hospitals for fiscal years ending in 1989 through 1992. Because rehabilitation hospitals are exempted from Medicare's Prospective Payment System, but subject to cost limits established under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), this study controlled for the influence of TEFRA by grouping hospitals into "new" and "existing" categories. The findings show significantly higher net revenue and profits in existing for-profit rehabilitation hospitals. In addition, existing for-profit rehabilitation facilities served a larger percentage of Medicare patients and had fewer employees than existing not-for-profit facilities. It was concluded that existing for-profit rehabilitation hospitals maximized their charges to increase their revenues. These findings have important policy implications for reimbursement alternatives under consideration for inpatient rehabilitation programs.

Financial Management, Hospital↗

Waste, ownership and bodily products.

This paper considers the extent to which bodily parts and products can be legitimately regarded as "waste" in law and what are the legal consequences of regarding them in this manner. First, what is the approach of English law to bodily parts as property? Secondly, why is this an important legal issue? Thirdly, what do we mean when we say that something is "waste" and can bodily products/parts be classified as "waste"? Fourthly, if the English courts are prepared to recognise bodily parts and products as property, then what are the legal consequences of regarding bodily products as "waste" and what problems may arise from such a legal conceptualization? It is argued that these issues require a more measured considered approach to regulation than simply leaving them to ad hoc determination in the courts.

Bioethics↗

Regulation, ownership and efficiency in the Swiss nursing home industry.

Switzerland is a federal State where policy decisions regarding long-term care regulation are by rights incumbent upon regional and local governments. This situation is in part responsible for the large number of small nursing homes operating in Switzerland. Moreover, long-term care for the elderly is supplied by public, private for-profit and non-profit nursing homes, respectively. The paper presents an econometric estimation of a stochastic cost frontier using cross-section data for a sample of 886 Swiss nursing homes operating in 1998. The results of this analysis are used to examine the relationship between cost efficiency, the alternative institutional forms and the different regulatory settings.

Aged↗

Changes in hospital quality after conversion in ownership status.

This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes.

Aged↗

The impact of ownership conversions on HMO performance.

Recently, several Blue Cross plans that sponsor Health Maintenance Organizations (HMOs), among other insurance products, have sought regulatory approval to convert from a not-for-profit to a for-profit entity. We examine the impact of not-for-profit HMOs converting to for-profit status in a fixed-effects framework using HMO level data from InterStudy. Our findings indicate conversions to for-profit status do not significantly impact HMO prices, profit margins, use of hospital days or ambulatory visits, and the provision of Medicare and Medicaid products.

Ambulatory Care↗