SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Not-for-profit integrated delivery systems require innovative financing mechanisms to compete effectively with expanding for-profit systems. The Massachusetts Health and Educational Facilities Authority (Mass HEFA), in collaboration with Partners HealthCare Systems, Inc., Boston, Massachusetts, developed such a mechanism--a capital asset recycling pool funded through a $150 million bond issue. The recycling pool gives Partners flexible access to tax-exempt capital to fund routine capital expenses across the system and has enabled the system to centralize control of capital resources. Over the pool's 30-year life-span, Partners will be able to issue tax-exempt loans from the pool to any of its affiliates or, with Mass HEFA and insurer approval, transfer the funds to outside organizations. When the loans are repaid, the funds remain available and can be recycled at no additional cost to fund further capital projects. Creation of the pool was made possible by Partners' outstanding credit, strong market position, expanding primary care network, and substantial unrestricted net assets.
All people in the United States have a need for access to comprehensive high quality health care. Such need is so universal and fundamental, not only to personal health, but also to equitable pursuit of all opportunity in a modern and just society, that it is viewed increasingly in the context of rights. Although the current array of health financing programs--Medicare, Medicaid, employer-based medical care insurance benefits, private medical care insurance, and other current insurance methods--have major accomplishments to their credit in providing access to care, the United States falls short in guaranteeing that conceptual right. The result is that 35 to 40 million people in the United States have no insurance coverage at all for medical care expenses, and an unknown number of people have coverage that is grossly inadequate. In addition, our current medical care system is characterized by: significant barriers to equitable access to care, apart from lack of coverage of the direct costs; major deficiencies in services for rehabilitation, long-term care, and home care; extreme variablity in the utilization and quality of care. We also must acknowledge failures in fundamental programs that directly affect the health of our people, such as health manpower, housing, education, and protection against occupational and environmental hazards. However, these matters are outside the purview of this statement. We propose a program, under the leadership of the federal government, with state and local government and the private sector having significant roles to play, that will respond to these shortcomings in our health care system. The program would finance health services comprehensively and equitably, minimize duplication, inefficiency, and the uneven quality of care, and would emphasize health promotion and disease prevention.
Hospitals are facing competition from myriad freestanding players in the outpatient market. It's a fight hospitals can't afford to lose because they often use outpatient profits to cover losses in other service lines. Indeed about 60% of the average hospital's operating margin depends on outpatient revenues. In this session of Straight Talk, we examine how hospitals can build and finance outpatient services with physicians, increasing their competitiveness in increasingly competitive markets.
A state finance authority's recent decision to make a debt payment for a shuttered hospital isn't likely to start a trend industry experts say.
Although factoring transactions involving Medicare (and, in some states, Medicaid) receivables are prohibited by Medicare regulations, a healthcare organization can allow a lender to finance its Medicare receivables and still retain "ownership" of accounts until they are paid. An organization can convert Medicare receivables into cash if: A lender finances between 65 percent and 80 percent of certain "eligible" accounts receivable and takes a security interest in all (or some) of the organization's receivables; Payments on eligible accounts are sent to a designated lockbox account; An amount equal to the amount deposited in the lockbox account is regularly swept into another account (the collateral account); and Legal agreements are drawn up among the healthcare organization, the lender, and any other depository involved. An organization pursuing this financing method should understand the risks involved and prepare legal documents to offset these problems.
American International Hospital in Zion, Ill., doesn't lack support from city hall. In an unusual transaction for an investor-owned hospital, the city recently sold $20 million in taxable debt for the purpose of lending the proceeds to the hospital to help finance a replacement facility. The deal saved the hospital, the area's largest employer, as much as 2.5 percentage points on the interest rate.
The advent of managed care has unleashed market forces on the health care system. One result of these new pressures is a shift from nonprofit to Wall Street-based financing. This report quantifies these trends by comparing health organizations' financial structures in the 1980s and now. The reasons behind this shift and the function of the stock market are examined. A review of Wall Street's key financial measures confirms that health care has shifted to the stock market as its principal means of financing. The stock market works by assigning a current price to a company's stock based on estimates for future earnings. Thus, companies desire predictability in their costs, revenues, and profits. Plastic surgeons can master this system by meeting the challenges imposed by Wall Street financing. Important steps include continuously measuring costs and outcomes of procedures, demanding cost data from hospitals and payers, using these data to improve costs and outcomes, and taking advantage of the system's openness to innovation and easier access to capital. As they seek to protect their role as medical decision makers under the new free-market system, plastic surgeons can benefit from understanding the mechanisms of the stock market.
SBA proposes to amend 13 CFR 108.503--4(c) to limit SBA participation with tax-exempt financing under the program authorized by section 503 of the Small Business Investment Act, 15 U.S.C. 697. Under the proposed rule, SBA would participate in the financing of a project which is also financed by tax-exempt obligations provided the repayment of the proceeds of SBA guaranteed financing is not subordinate to the repayment of the tax-exempt financing. This amendment would be in accordance with existing Federal policy which prohibits Federal agencies from directly or indirectly providing a guarantee to tax-exempt obligations.
This paper provides a practical guide to running preparation courses for postgraduate examinations and is based on the authors' experience. It is intended to be useful to organisers of proposed or existing courses as well as to potential users of courses--people in every specialty preparing for a postgraduate examination. The paper covers the practical aspects of staging and financing a course and recruiting tutors and attracting candidates, in addition to covering the structure, educational content, and evaluation of the course.
Tax-exempt bond financings, inherently complex transactions, can become even more complicated, cumbersome and costly as hospitals come to terms with restrictive policies imposed by some state financing authorities. Executives also find they sometimes get caught in authorities' political machinations that may have little to do with the business of the municipal bond markets.
Medicine and management should be more closely integrated not just at the level of health policy and health services management but also in matters of professional education and training. Learning is a continuous process from entering medical school to retirement and should reflect the transition from learning shaped by the curriculum to learning driven by the needs of the qualified professional in a career service post. The senior clinician does much more than practise clinically. He or she is a leader, a manager, a resource allocator, a teacher and team player. In these roles the values and priorities of the professional and the organization will not always coincide. In postgraduate training and in continuing medical education more joint activity should be developed around 'medicine for non-medical managers' and 'management for doctors'. Much of this shared learning and development will be local and problem-based around local issues of quality, resources and priorities. However, the 'regional' postgraduate dean will play an increasingly pivotal role in maintaining the balance between the needs of the individual and the organization. To achieve this objective of closer integration postgraduate medical education funding should be brought together under a national finance levy against purchasers and allocated through devolved budgets managed by 'regional' postgraduate deans against explicit performance criteria agreed between the professional organizations, universities and health services management.
The potential for big savings through a tax-exempt pooled financing program developed by American Healthcare Systems has other alliances looking on with interest. Such a vehicle can offer savings by consolidating a system's multistate borrowings under one financing authority. While the program's lead banker declined to name the alliances showing interest, SunHealth Corp. is in the early stages of assembling its own program.
The health care industry relies on technological innovation to provide solutions to the ever increasing range of medical problems in the modern world. No industry can survive without financial investment, and some areas of the health care industry have encountered difficulties when trying to attract finance. In this article, the author outlines specific areas that are likely to attract investment funding and the elements that make up an attractive proposition for potential investors.
The unused debt of an Ohio hospital association has caught the attention of the Internal Revenue Service, which has been on the lookout for bogus pools that take advantage of tax-exempt financing to generate professional fees. Bondholders have been told that the federal agency is examining the loan pool, and similar scenarios may soon occur in other states.
Explore the source record for details and available documents.
Financially savvy hospitals are getting aggressive with their investment management strategies, using healthy returns from wisely invested nonoperating dollars to finance construction projects, make acquisitions and expand services. Industry estimates show hospitals have a large nest egg to work with--some $400 billion in assets available for investment.
Explore the source record for details and available documents.