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A new tax-exempt lease financing program in Massachusetts is expected to save the state's hospitals time and money when they acquire medical equipment from GE Medical Systems. GE is looking to expand the program to other states, and it could serve as a model for other equipment manufacturers.
The article provides reasons for decreased activity in the development of market rate senior housing and briefly describes the criteria lenders use to assess risk. It summarizes the various financing options available for nonprofits to finance senior housing projects. Options discussed include tax-exempt bond financing: different supportive senior housing options administered by the Department of Housing and Urban Development, such as Sections 202, 232, and 221 (d)(3) and (4); the HOME Investment Partnership Program (HOME Program); and low-income housing tax credits.
Despite the gains that Philippines posted towards improving the health of the Filipinos, more challenges need to be hurdled to further improve the country's health status i.e. high threat from infectious diseases, increasing degenerative conditions, emerging health problems due to environmental and work-related factors, etc. The development and implementation of the Health Sector Reform Agenda (HSRA) is expected to address these problems through organization/policy changes and financing structure needed to improve health care delivery, regulation and financing: 1. Provide fiscal autonomy to government hospitals; 2. Secure funding for priority public health programs; 3. Promote development of local health systems; 4. Strengthen health regulatory agencies' capacities; 5. Expand the coverage of the National Health Insurance Program. There is a need however to evaluate the implications of the HSRA implementation in the private hospital system as this sector accounts for 67.91% of the total number of hospitals, servicing 48.35% of the country's total bed requirements. Major effects are: 1. Increased competition for patient market; and consequently; 2. for funding/payments; 3. Lesser capital and financing access for service/facility improvement; versus; 4. pressure from consumers/patients to render better quality, high-technology service at a lower cost. Certainly, any adverse effect on their operation will affect the access of a large percentage of the population currently using their services. This paper will provide an in-depth analysis of the implications of the HSRA implementation on private hospitals, major initiatives being undertaken to minimize adverse effect and innovations that can be capitalized to survive/grow in the new health environment. The authors' active participation in the National Health Planning Committee convened to oversee the HSRA implementation, the dialogues and conferences held with hospital sector for the Philippine Hospital Association, and actual involvement in hospital operation will provide a unique perspective and authority for this analysis.
Connie Lee Insurance Co., the newest player in the healthcare bond insurance market, is expanding access to credit enhancements for investment-grade teaching hospitals that may have been overlooked by other insurers. The company, a subsidiary of the College Construction Loan Insurance Association, also has been able to save facilities money over competing bond insurance programs.
This article reviews the long-term care sector of the health care industry, particularly the factors driving sector consolidation and, through the use of four transactions as a platform, discusses key credit issues and risks facing long-term care companies.
Currently in Canada, between $3 and $4 billion of assets are financed annually through various forms of leasing, with the sale and leaseback transaction as the common vehicle for larger value asset financing. Financial theory of sale and leaseback is applied to Canadian hospitals with illustrations of the structure and process of sale and leaseback in practice. The moratorium on sale and leaseback transactions recently imposed by the federal and Ontario governments is also covered.
This paper describes how, against a background of growing financial crisis, pressure for reform is building up in the Lebanese health care system. It describes the various agendas and influences that played a role. The Ministry of Health, backed by some international organizations, has started taking the lead in a reform that addresses both the way care is delivered and the way it is financed. The paper describes the interventions made to prepare reform. The experience in Lebanon shows that this preparation is a process of muddling through, experimentation and alliance building, rather than the marketing of an overall coherent blueprint.
The changing landscape of health care has caused hospitals, health care systems, and other health care organizations to look for ways to finance expansions and acquisitions without "tainting" their balance sheets. This search has led health care executives to a financing technique that has been already embraced by Fortune 500 companies for most of this decade and more recently adopted by high-tech companies: synthetic real estate. Select case studies provide examples of the more creative financial structures currently being employed to meet rapidly growing and increasingly complex funding needs.
Large-scale investment in health care information technology (IT) infrastructure will not take place without leadership by the federal government. But how the federal government supports the financing of health care IT is critical. Health care IT development has multiple aspects, but it is fundamentally a problem of community infrastructure development. A policy approach that has had consistent success in financing our country's essential physical infrastructure in transportation and environmental protection will be well suited to fostering health care IT infrastructure as well. We propose the creation of a health care IT revolving loan fund program to invest public dollars in health care IT infrastructure projects through community-level nonprofit lending agencies.
Lafayette (La.) General Medical Center is trying to raise funds for a $75 million heart hospital by selling bonds to doctors. If the sale is successful, a flood of similar deals could follow. The project's chief architect, Robert Rosenfield, left, says his firm already is working on 25 to 30 additional deals. What effect will this type of financial arrangement have on the healthcare industry?
Poor eating habits, a sedentary life style, and smoking have made acute coronary syndrome a disease characteristic of modern life. Although the widespread appearance of coronary heart disease has been delayed by 10 years, it is expected to be the primary cause of death in the world by the year 2020, in spite of the development of reperfusion therapy and the use of defibrillators. The incidence of coronary heart disease is spreading to more depressed areas and affecting an increasingly larger number of persons over 70, who are generally poorly represented in clinical studies and respond less favorably to treatment. Detaining the advance of this epidemic demands the development of a competitive research policy that includes rigorous training of researchers and scientific programs based on cooperation and teamwork. The success of this scientific strategy rests on public and private fund-raising to finance the anticipated priority areas of cardiovascular research in the coming years: vascular immunobiology, genome studies, tissue transplantation, and organogenesis. Advances in research complemented by the implementation of preventive measures based on a unified scientific approach and community educational campaigns could act effectively against the spread of cardiovascular disease in the world, thus avoiding otherwise inevitable social and economic consequences.
On December 30, 1994, the Internal Revenue Service (IRS) published proposed regulations (Proposed Regulations) that if enacted would significantly change the climate and rules of federal income tax law controlling the issuance and maintenance of tax-exempt bonds for governmental and 501(c)(3) health care borrowers. This article (1) summarizes the aspects of the Proposed Regulations dealing with private activity tests, management contracts, allocation and accounting rules, change in use of financed facilities, and antiabuse rules, and (2) summarizes the possible interrelationship of the IRS's audit program for tax-exempt bonds and the Proposed Regulations. The article reviews features of the Proposed Regulations that will affect either the costs or administrative burdens of managing the federal tax compliance of future tax-exempt health care borrowings.
It's not known how many hospitals are selling their receivables for cash, but the potential market is enormous. Providers will charge more than $800 billion for healthcare services this year. At any one time, the nation's hospitals are awaiting payment on $14 billion in receivables. Many say hospitals would be better off attempting to improve their own billing and collection systems; others are more than sold on the programs.
A trust finance director argues that doctors are best placed to win the debate on better health care for all, but first must understand the realities of being part of central government and the financial consequences of this. Change will best be achieved by facing up to the financial issues and moving the system from within; clinical audit could prove to be the most powerful weapon.
PACE--the Program of All Inclusive Care for the Elderly--provides integrated comprehensive healthcare services to the frail elderly on a capitated basis. Begun in the early 1970s in San Francisco's Chinatown, PACE today comprises many individual programs across the nation. PACE's goal is to provide participants with the healthcare services they need for the highest possible level of functioning and autonomy. A typical PACE program is divided into sites, each of which serves 120 to 150 participants. Most participants come several times a week to the site's adult day care center, where they see members of an interdisciplinary team that includes physicians, nurses, social workers, therapists, and others. Home care is provided to participants unable to attend the center. PACE is financed by capitated payments from Medicare and Medicaid, which put providers at full risk for the services used by participants. The flexibility provided by this funding enables PACE to offer a wide variety of services, including supportive housing, which help keep participants out of institutions. Estimates of Medicare savings attributed to PACE are 12 percent and higher.
The Heavily Indebted Poor Countries (HIPC) Initiative, which was launched in 1996, is the first comprehensive effort by the international community to reduce the external debt of the world's poorest countries. The Initiative will generate substantial savings relative to current and past public spending on health and education in these countries. Although there is ample scope for raising public health spending in heavily indebted poor countries, it may not be advisable to spend all the savings resulting from HIPC resources for this purpose. Any comprehensive strategy for tackling poverty should also focus on improving the efficiency of public health outlays and on reallocating funds to programmes that are most beneficial to the poor. In order to ensure that debt relief increases poverty-reducing spending and benefits the poor, all such spending, not just that financed by HIPC resources, should be tracked. This requires that countries improve all aspects of their public expenditure management. In the short run, heavily indebted poor countries can take some pragmatic tracking measures based on existing public expenditure management systems, but in the longer run they should adopt a more comprehensive approach so as to strengthen their budget formulation, execution, and reporting systems.
In various countries in Africa, community financing has become the main source of finance for health services. In Benin, the "Bamako Initiative" experiment started in 1988 for many health structures and has subsequently been greatly expanded. After three years experience, the authors try to answer some important questions about community financing: To what extent does payment of fees have an influence on the use of health services? How are the funds collected and used and is embezzlement a serious problem? The question of equity is also considered as well as cost recovery, allowing an economics-based assessment of the Bamako Initiative which suggests that it has a promising future in Benin.
OBJECTIVES: Since 1997, members of the International Network of Agencies for Health Technology Assessment (INAHTA) have collaborated on a Joint Project to track the diffusion, evaluation, and clinical policy of positron emission tomography (PET). Part 2 of this updated Joint Project report summarizes HTA-based strategies for directing the clinical use of PET and a discussion on the value of HTA in managing the diffusion of high cost diagnostic technologies, which were presented at an INAHTA-sponsored workshop at the Health Technology Assessment International Annual Meeting in 2004 on strategies for managing high cost diagnostic technologies. METHODS: A summary of the workshop proceedings is presented. CONCLUSIONS: Sharing assessment work, universal agreement in assessment conclusions, stakeholder input, and modeling techniques help manage the uncertainty in the evidence base while targeting clinical use of PET toward the most promising indications. Emphasis on HTA findings, linkage between financing of clinical PET and outcome evaluation, and targeted dissemination of scientific findings empower providers to reduce unnecessary utilization and contain costs within a quality improvement framework. Above all, a trustworthy source of HTA information and a process that is conducive to using scientific evidence as the basis for decision making are essential for managing the diffusion of complex and costly diagnostic technologies in patient care.