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PubMed1984

Capital financing in prospective payment.

In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.

Capital Financing↗
PubMed1999

A cost construction model to assess the cost of a family practice residency program.

BACKGROUND AND OBJECTIVES: This study uses a cost construction approach to evaluate the cost of training family practice residents in a university-based residency program. The approach calculates the cost of the educational program from a global institutional perspective, including all monetary and nonmonetary costs, independently of how they are financed. METHODS: Cost construction analysis is used to compute the instructional cost, which includes the cost of faculty and resident time directly related to teaching and the support of the teaching program. The value of the clinical care and supervision provided by the family practice residents is assessed as a replacement cost. Sensitivity analysis examines a range of assumptions concerning residents' productivity, replacement costs, and the cost allocation of activities that jointly produce clinical care and education. RESULTS: For a junior resident, the instructional cost is $94,835 per year, and the replacement cost is $65,052 per year. The value of the teaching and clinical services provided by senior residents, $124,247 per year, exceeds the cost of the resources used to educate them, $98,364 per year. CONCLUSIONS: The cost construction model can be used as a tool to allocate resources, negotiate for funding, and estimate variations in cost due to changes in curriculum and in the health care environment.

Costs and Cost Analysis↗
PubMed2006

QOLLTI-F: measuring family carer quality of life.

BACKGROUND: The primary goal of palliative care is to optimize the quality of life (QOL) of people living with a life-threatening illness and that of their families. While there have been important advances in measurement of the QOL of palliative care patients, little attention has been paid to the QOL of their carers (family caregivers). To develop and deliver the most effective services to these carers, their QOL needs to be measured with acceptable and psychometrically sound instruments that have content validity. METHODS: This study reports three phases of the development and testing of such a measure: QOLLTI-F, Quality of Life in Life Threatening Illness--Family Carer Version, simultaneously in English and French. Participants were carers from 12 Canadian palliative care services who were asked to complete QOLLTI-F on three occasions. RESULTS: The final version of QOLLTI-F consists of 16 items. It was deemed acceptable by the vast majority of carers and a longer, 24-item version was completed in a median of 12 min. Content validity was assured by inclusion of all domains reported by carers to be important to their QOL: state of carer, patient wellbeing, quality of care, outlook, environment, finances and relationships. Construct validity was demonstrated, as principal components analysis indicated that the 16 items did indeed reflect these seven domains. Furthermore, the seven domain scores predicted 53% of the variance in global QOL, although the QOLLTI-F Total score predicted less well (43%). The test-retest reliability for the QOLLTI-F Total score was 0.77-0.80 and ranged from 0.50 to 0.79 for the seven domain scores. All QOLLTI-F scores were shown to be significantly different between days the carers considered bad, average and good, demonstrating responsiveness to change, with the exception of the Financial Concerns submeasure, which did not distinguish between average and good days. CONCLUSIONS: QOLLTI-F is unique in that in measuring one person's QOL (the carer's) it includes their perception of the condition of another (the patient). This attests to the close relationship between the two. It is also unique in that its content is derived from a qualitative study asking carers what is important to their own QOL, rather than focusing on the changes or burdens related to caregiving. QOLLTI-F also has the advantage of being briefer than other carer QOL measures. It contains measures of seven different domains that are determinants of carer QOL, in addition to a summary score. All these measures are valid, reliable and responsive to change in QOL.

Adult↗
PubMed1990

Drug use patterns and demographics of employed drug users: data from the 1988 National Household Survey on Drug Abuse.

This paper has identified some characteristics of full-time working populations who are at higher risk to be substance abusers. In summary, employed people who use drugs are generally between the ages of 18 and 34. Heavy drinkers fall mainly between 18 and 25 years of age. Males are much more likely than females to use marijuana, cocaine, or other illicit drugs and alcohol on a frequent basis. For males, past month use of any illicit drugs and marijuana was higher among those with the lowest personal incomes. For females, past year use of cocaine was higher among those with the highest personal incomes. Females and males with high personal incomes were also more likely than their low income counterparts to use alcohol on a weekly basis. Industries with high percentages of male substance abusers were: construction, wholesale trade, finance, repair services and professionals. Industries with substantial numbers of female drug abusers were manufacturing, retail trade and professionals.

Accidents, Occupational↗
PubMedDate not supplied

Are black Americans entitled to equal health care? a new research paradigm.

This paper analyzes the health, economic and legal implications of most major health systems' reform initiatives in the 20th century and, briefly, the 19th century. The paper suggests that models of analysis grounded in science deter the development of claims for racial equality in health care. Because race is a legal construct, the paper suggests that the 14th Amendment's Equal Protection Clause is an analytical framework that better accommodates the complexity of the health system, is at the heart of our national laws and ethos, and has political rhetorical power to further the political and policy debate. Major components of the health care system, including professional training, hospital construction, and health care financing, are analyzed for racially discriminatory purpose or impact and the extent of government participation. The paper gives particular attention to: the Flexner Report and the limited number of black physicians; the Hill-Burton program and the disproportionate assistance it gave to white controlled hospitals; and, efforts to expand health insurance coverage that also disproportionately favored the needs of the white community. Given the compounding effects of numerous policy decisions made over many years, there should not be any great wonder that such gross disparities in morbidity and mortality exist between black and white Americans. Further research and analysis of the policy decisions that have constructed the current health care system as well as framing those analyses as claims for racial fairness will better develop the policy debate than more narrowly focused analytical models from biomedical science or epidemiology. The law produced slavery and segregation, which usually determined where you lived, where you went, what work you could do, and what you learned. That legally constructed system significantly determined what you earned and what health you had. The biomedical models of analysis of our health system are too narrowly focused and temporally limited to identify the broad systemic barriers to equal health and health care. An analytical framework from law more easily accommodates the complex dynamics of our health care system. The equal protection clause of the 14th amendment has been used to analyze complex social and economic models, such as housing and education and has moved those systems to greater racial equality. The equal protection clause is at the heart of our national laws and ethos and, as a claim for fair treatment from government, has considerable rhetorical power. Menefee presents an analysis of major health policies dealing with training of physicians, construction of hospitals, and financing of personal health care. He suggests it demonstrates a health system rooted in racial discrimination and perpetuating racial discrimination in education, employment and housing. The history of successes using this analytical framework in other areas of social policy validates its consideration by health policy analysts for further research.

Black or African American↗
PubMed1979

Hospitals should finance medical office buildings.

After the decision to build a medical office building on the hospital campus has been made, a new set of considerations must come to the fore. Although the best decision may be for the hospital to undertake financing of the building, this decision must be made in light of a number of important financial and legal considerations.

Certificate of Need↗
PubMed1998

Using real-estate-based financing to access capital.

One strategy employed by healthcare organizations to increase their market presence is the construction of new facilities. Accessing capital to fund such construction, however, has become more of a challenge. One relatively untapped source of building capital is real-estate-based financing. Nonrecourse mortgages, turnkey net leases, and synthetic leases can provide several advantages to healthcare organizations seeking capital, assuming issues related to building ownership, debt and balance sheet effects, and tax-exempt status have been thoroughly explored first.

Capital Financing↗
PubMed1988

Decree No. 44 approving the Regulations of the Unified General System of Housing Subsidies, 14 March 1988.

This Decree provides that the Chilean Government will confer a housing subsidy under the following conditions: 1) each beneficiary is entitled to only one subsidy; 2) the subsidy is to be a supplement to money saved and at the immediate disposal of the beneficiary; 3) in general, the subsidy is to be used to finance the acquisition or construction of new housing; and 4) the housing must be intended as the permanent residence of the beneficiary. Two kinds of subsidies are to be granted: a direct subsidy in specific amounts not to exceed 75% of the house value and an indirect subsidy to subsidize mortgages. Under the Decree, single or married persons who have reached the age of majority and minors who are married and employed are eligible for subsidies. Applicants awarded subsidies are to be determined on a regional basis according to the particular conditions of the applicants, such as the amount saved by the applicant, lot availability, number of family members, length of time of savings, and the amount of credit needed. Once housing is acquired, a beneficiary may not for five years sell, transfer, rent, or use the housing for any purpose other than living there permanently. Provisions of this Decree were amended by Decree No. 114 of 8 July 1988 (Diario Oficial, No. 33.140, 6 August 1988) and Decree No. 135 of 2 August 1988 (Diario Oficial, No. 33.146, 13 August 1988).

Americas↗
PubMed2002

Endoscopic ambulatory surgery centers in the academic medical center. We can do it too!

A freestanding ambulatory surgery center (ASC) at an academic institution is an exception rather than the rule. It is a major challenge to the concept of the traditional academic medical center. Advantages and disadvantages are discussed, as well as the detailed planning process beginning with a well executed feasibility study, the hiring of consultants, and financing of the facility. Construction, opening of the facility and operation are not different from other ACSs. However, the integration of teaching and research presents new opportunities. Lessons learned and advice to others are detailed on how the ASC benefitted one specific institution and how it may add value and revenue to other academic medical centers.

Academic Medical Centers↗
PubMed2001

An overview of experiences of Wisconsin dairy farmers who modernized their operations.

Wisconsin dairy producers who modernized their operations between 1994 and 1998 had positive feelings about their expansion experiences, accompanied by increased production and improved profitability and quality of life. The average herd in this survey experienced increased production during the 5-yr period studied. Nearly all producers were satisfied with their expansion experience. The negative effect on milk production normally associated with expansion was minimal for most years and did not exist if all herds were summarized together. Managing labor appeared to be the most daunting challenge facing producers following expansion. Respondents who built all new facilities observed higher production, greater labor efficiency, and satisfaction with measures of profitability and quality of life than respondents who modified facilities or added no new facilities. As herd size increased, milk production, labor efficiency, and satisfaction with herd performance, profitability, and quality of life increased. Producers who built all new facilities spent less time on farm work, more time managing employees, and had less difficulty finding, training, supervising, and keeping farm employees than producers who modified facilities or added new facilities to existing operations. Larger herds were associated with an increased reliance on nonfamily labor. Managing labor appears to be an easier task for managers of larger herds. The most difficult challenges for producers who modernized their operations were with labor management, financing, and loan procurement, construction and cost overruns, and feet and leg health. Difficulties with expansion differed little between expansion types (same type, some new, or all new facilities) or herd sizes.

Animal Husbandry↗
PubMed1993

Capital update factor: a new era approaches.

The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals.

Capital Expenditures↗
PubMed1985

Analysis of nationwide pharmacy charges per DRG.

The national hospital data used by the Health Care Financing Administration (HCFA) to construct the DRG-payment weights for the Medicare prospective-pricing system are analyzed and evaluated. The database represented a 20% sample of all Medicare hospital bills in 1981. Each record contained 96 bytes of data in 28 field elements, including DRG assignment, Standard Metropolitan Statistical Area code, length of stay (LOS), pharmacy charges, and total hospital charges. There was considerable variation in the relative weight of pharmacy charges to total ancillary charges among DRGs; however, the degree of variation appeared to be similar for both rural and urban hospitals. Examination of the pharmacy charges for the top-10 Medicare DRGs revealed that the median pharmacy charge per DRG was consistently less than the average pharmacy charge per DRG. Average pharmacy charges per DRG were generally 50% greater for urban hospitals than rural hospitals. Average and median LOS per DRG also differed substantially, and the LOS for urban hospitals was approximately 20% longer than it was in rural hospitals for all DRGs. The standards derived from the pharmacy-charge and LOS data used by HCFA in developing the DRG-payment weights should be used cautiously. The heterogeneity of these data confirms the imprecision in constructing these weights and the need to use median rather than average statistics as standards in use-review programs.

Costs and Cost Analysis↗
PubMed1994

Smoking restrictions in private workplaces in Singapore.

This survey aims to determine the number and profile of private workplaces in Singapore which have a smoking restriction policy. The response rate was 43%. Of the companies which responded, 59% had some form of smoking restriction. Private companies are more likely to have a smoking restriction policy: (a) where smoking poses inherent fire risks, such as those dealing with inflammable chemicals or gases; (b) where smoking poses inherent detrimental effects to the quality of the products, such as those dealing with precision electronic microcomponents, where a smoke-free and dust-free environment is essential; (c) are larger companies; and (d) have strong management support in initiating and enforcing smoking restriction. Future programmes should give more emphasis to the service industries such as construction, insurance, banking and finance, and smaller companies (with fewer than 100 employees). They should involve the management who play an important role in implementing smoking restriction at their workplace.

Air Conditioning↗
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↗