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PubMed1989

[Approach to the acceptability of the capitation fee system by the population in 3 integrated health centers of the Liège region].

Capitation payment developed rapidly in the Liège area. The 1983 regulations were adopted by an existing health centre (Seraing) and two new health centres financed on capitation basis were created (Ougrée, Liège). It is now possible to distinguish amongst the theoretical factors those who had significant impact on the speed of growth. This is thus a kinetics study. The factors taken into consideration are, on demand side: demographic, sociographic, cultural, economic; and on supply side: quantity, quality of supply (diversity: age, sex, culture), organization of permanent care. The temporary conclusion is that demography of demand and quality of supply seem to be dominant factors for the kinetics. Viability of a health centre depends strongly of growth kinetics. There is a provisional instrument for creation of new health centres and their success.

Belgium↗
PubMed1984

The decision process used for hospital bond rating--and its implications.

Investigation of the process of hospital bond rating related the ratings assigned by Moody's and Standard and Poors to indicators of hospital financial condition (such as debt per bed and peak debt coverage), institutional factors (including size, occupancy, and local market competition), indenture provisions (such as reserves), and contextual factors. The criteria used by Moody's and Standard and Poors to rate hospital bonds were revealed to be similar, but not identical. Criteria used in the bond rating process have several important implications: the rating approach provides strong financial incentives for increases in hospital size and complexity, for example, and hospitals that rely on extensive amounts of public financing appear to be penalized in the rating process.

Bed Occupancy↗
PubMed2005

[The hospital sector in international comparison. An overview].

This article deals with an international comparison of the hospital sector. Its results show that hospitals in Germany are by no means extremely expensive. While Germany is still characterized by a comparatively high level of hospital capacities, these capacities have been reduced noticeably during the last years. In addition, German hospitals are very efficient, because average costs come along with a relatively high number of hospital admissions. Moreover, international comparison shows that most countries still favor public planning of inpatient services and public financing of capital costs as is the case in Germany.

Cost Control↗
PubMed1998

Public/private financing in the Greek health care system: implications for equity.

The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.

Capital Financing↗
PubMed1992

Hospital borrows from position of strength.

Children's Hospital of Philadelphia is nearly debt-free and able to finance much of its own replacement and equipment needs. But rather than avoid debt obligations, it's taking on more than $200 million in new borrowing that capitalizes on the hospital's flush financial profile. Its strong balance sheet and credit ratings will keep capital infusion costs low.

Capital Financing↗
PubMed2000

Some tax-exempt bond issues could become taxable.

The IRS recently launched a new program to audit healthcare mergers-and-acquisition financing arrangements. To date, the IRS has focused on transactions involving IDSs in which tax-exempt bonds issued on behalf of the participants have been used to prepay the outstanding debt of one or both participants. The IRS is concerned that such tax-exempt financing may involve impermissible advance-refunding of the previous debt, in which case the financing would be deemed taxable and the participants subject to penalties.

Capital Financing↗
PubMed2002

Pluralism, public choice, and the state in the emerging paradigm in health systems.

Today in developed nations, the public pays for most medical care, with the state and the medical profession or providers determining its nature, form, and level. But there is no well-defined institutional framework for revealing consumer preferences and enabling client choice about the nature and form of public entitlement. This thwarts the efforts of health system reformers to satisfy their clients and consequently promote equity and control costs--the raison d'être of publicly supported care. Consumers can be empowered in the emerging paradigm, however, in which the publicly financed system also contains competing fund-holding institutions that organize and manage the consumption of care (OMCC), such as HMOs and sickness funds. In a system in which individuals are entitled to health coverage, OMCC institutions can play an essential role in both shaping the entitlement and in expressing members' preferences. To do this, the OMCCs need to be financed through capitation and endowed with appropriate constitutional rights on how to use the funds.

Capitation Fee↗
PubMed1996

Capitation rates. A survival primer for capitated environment--Part 1.

This article is the first of a two-part series designed to provide Michigan physicians with a conceptual framework to approaching capitation. Capitation in financing consists of prepaid risk transfers from insurers to providers for cost and utilization of services. Unfortunately, a number of physician practices are searching for a starting point on capitation processes in these evolving times. The focus of this first article is on primary and specialty subcapitation. Global capitation will be covered in a second article.

Capitation Fee↗
PubMed1988

Merging facility and financial planning: a new approach.

This article seeks to help hospital administrators and boards (especially planning and finance committees) balance facility and financial aspects of a construction project by planning for each concurrently. It recommends that the process start with formal strategic plans, and that facility and capital plans be advanced interactively, thus maintaining flexibility to ensure that the hospital's objectives can be met within manageable financial limits. The authors suggest that the project thus delivered will be the most effective and efficient project possible within defined constraints. And, once planned, the project will be ready for implementation--false starts will be eliminated.

Capital Financing↗
PubMed1995

CFOs take new tack.

To financing integrated delivery systems, healthcare executives are getting creative. Working in many cases without precedent, they're supplementing traditional financing techniques with new ideas and taking risks. A motto: ¿Let's look at all the options,¿ says an adviser.

Capital Financing↗
PubMed1982

Choosing the financing option that's right for your hospital.

THe major debt financing options available to hospitals may be evaluated according to two categories of factors: those involving the financing itself and those involving its subsequent operational impact. Structural considerations include the likely trend in interest rates, the time commitment necessary to complete multiple financings, the institutional operating climate, and the likelihood that a preferable vehicle will be available at a later date.

Capital Financing↗
PubMedDate not supplied

PACS for imaging centers.

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized interfaces such as HL-7, Web access and the choice of view stations.

Administrative Personnel↗