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Mental health services in Asia: international perspective and challenge for the coming years.

In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.

Asia↗

Sources of project financing in health care systems.

Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

Capital Financing↗

A guide to taxable debt financing alternatives.

The 1986 Tax Reform Act placed new restrictions on the use of tax-exempt financing for certain healthcare projects, and policymakers are considering further restrictions. In light of these developments, financial managers should become familiar with the available taxable debt financing options. These include commercial paper, taxable variable rate demand notes, floating rate notes, medium-term notes, long-term domestic public offerings, and domestic private placements.

Capital Financing↗

Capitated payment approaches for Medicaid-financed long-term care services.

In the following analysis, the authors examine the capitated payment approaches for long-term care (LTC) services of five programs: the Program of All-Inclusive Care for the Elderly (PACE), the Arizona Long-Term Care System (ALTCS), the Texas STAR + PLUS, the Minnesota Senior Health Option (MSHO), and the Monroe County Continuing Care Networks (CCNs) in New York. The authors describe key aspects in the design of these programs, with an emphasis on Medicaid reimbursement, and discuss differences and commonalities in the approaches taken by the programs in setting capitation rates.

Aged↗

Selling accounts receivable can improve cash flow.

New financing programs especially geared to accounts receivable allow healthcare organizations to convert these assets into cash literally overnight and at costs below the prime interest rate. Certain pooled versions of the financing strategy include non-recourse features that guard against sharing bad debts among the participants. These pooled programs generally allow hospitals to continue managing and billing their own accounts.

Accounting↗

Primary market derivatives: satisfying investor appetites.

This article discusses various financing techniques utilized by municipal entities in their debt structures. These financing structures include inverse floaters, embedded swaps, embedded caps, and synthetic fixed-rate debt. The article explores the advantages and disadvantages of each structure to both the borrower and the investor and its mechanics.

Capital Financing↗

Financing medical office buildings.

This article discusses financing medical office buildings. In particular, financing and ownership options from a not-for-profit health care system perspective are reviewed, including use of tax-exempt debt, taxable debt, limited partnerships, sale, and real estate investment trusts (REITs).

Accounting↗

Ten popular health economic fallacies.

Important decisions about the financing, determining priorities in and provision of health services depend on beliefs about facts and relationships. It is argued in this paper that many popular beliefs are either logically wrong or are not supported by the evidence. Important errors exist in the beliefs about the effects of technology and ageing populations on health care costs, affordability of care, capital resources, financing mechanisms, efficiency and economies of scale, the growth of litigation, priority setting and the importance of getting people back to work. This paper aims to correct some of these fallacies and suggest alternative beliefs that better match the theory or fit the evidence.

Attitude to Health↗

CEOs: keep capital fold-in out of budget politics.

Hospital CEOs don't want to see Medicare capital reimbursement fall victim to budget politics. Yet, that's likely to happen if the Health Care Financing Administration folds capital reimbursement into the prospective pricing system (PPS), CEOs say. Moreover, the majority of CEOs say that no fair method of including capital payments in PPS rates can be developed.

Attitude of Health Personnel↗

Financing medical education.

As more health care services are being diverted from hospitals to the ambulatory setting, funding for student and resident training in this setting becomes a problem. This paper details the causes of this problem and proposes some financial solutions.

Ambulatory Care↗

Occupational and environmental medicine in the United States.

The history and the current status of occupational and environmental medicine (OEM) research, educational resources, clinical practice patterns, and regulatory framework in the United States are reviewed. Current or anticipated changes in health-care financing, clinical practice patterns, occupational safety and health regulations and enforcement, and funding for research and medical education at the national level are already having an impact on OEM activities in this country.

Capital Financing↗

Hospitals in New York state may have easier time raising cash with tax-exempt bonds.

New York state hospitals considering the sale of tax-exempt bonds as early as next year might find it easier to get to market, said the new executive director of the New York State Housing Finance Agency, which oversees the organization that acts as a conduit for not-for-profit hospitals wanting to issue bonds. Among the new exec's priorities is the streamlining of the state's cumbersome bond-pricing process.

Capital Financing↗

Using corporate finance to engineer an organizational turnaround.

Georgia's Southern Regional Medical Center used a proven corporate finance approach to dramatically improve its financial position and integrate its strategic and financial planning. Managers throughout the organization were educated about principles of corporate finance. Reliable cash-flow projections were used to create a multiyear glide path to financial stability. Initiatives were tied to specific time frames and quantifiable financial goals and underwent a standardized review process.

Budgets↗

Compare benefits before entering receivables financing.

Financing accounts receivables is becoming a popular strategy in the healthcare industry. Factoring and securitization are two financing methods available to hospitals. Patient accounts managers who understand the programs' structures, incentives, and costs will be able to achieve the maximum benefit for their hospitals when choosing one of these transactions.

Accounts Payable and Receivable↗

Tax-exempt private placements: a new opportunity for not-for-profit providers.

Tax-exempt private placements offer an attractive financing alternative for not-for-profit healthcare providers for which the public debt market is no longer a viable option. They offer the following advantages: Greater flexibility Lower fees. Less paperwork. Fewer players. Shorter time to complete.

Capital Financing↗

Hospital finance.

This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed.

Accounts Payable and Receivable↗

Caveats for physicians in the financing of practice networks.

There are advantages for physicians to affiliate in networks with other practitioners in order to contract with third party payers and to achieve economies of scale. However, doctors must assure themselves of the viability of the organization they may be joining in terms of long-term financial stability and managerial expertise.

Capital Financing↗