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PubMed1993

Making the case to fund networked access to electronic information services.

The establishment of a local area network can greatly widen access to an organization's electronic information services, create improved conditions for staffing the delivery of these services and improve training and user support. Such a project is, however, expensive to fund. This article describes the approach taken at the Royal Free Hospital School of Medicine to secure funds for networking MEDLINE on hard disk and other information services. The importance of close collaboration between library and computer departments in planning and promoting a project of this nature is emphasized.

Budgets↗
PubMed2004

The place of research and the role of academic surgeons in cardiac surgery.

The development of the discipline of cardiac surgery was, to a large extent, guided by the vision and research of its pioneers. On the basis of their efforts, all the different areas of cardiac surgery were able to evolve including coronary artery bypass grafting, heart valve surgery, surgery of the aorta, congenital heart surgery, surgery for rhythm disorders including the implantation of pacemakers and defibrillators, and surgical treatment of advanced heart failure (for example, heart transplantations and mechanical circulatory support). The continued existence of cardiac surgery and its role in medicine in general will depend, to a significant extent, on the future research activities of its protagonists. Cardiac surgeon-scientists will play a pivotal role since they combine clinical experience with scientific knowledge and intuition which make them able to direct research to topics which will matter in the future. However, research costs money, and state or national funds will be not sufficient to support research as much as is necessary. Funding from third parties such as industry will increasingly be required. Due to this, however, the cardiac surgeon-scientist faces various challenges such as the evaluation of his skill in acquiring funds, conflicts with current ethical standards, conflicts of interest when receiving money from industry, and, as a result of the tough competition in this field, the temptation to commit fraud. The head of a department of cardiac surgery holds an important function as his initiative is decisive for the development of visions for the future and for the employment of surgeon-scientists who pursue visionary research. It will take the combined efforts of surgeon-scientists and departmental heads not only to maintain but to extend the position of cardiac surgery in medicine and society even further.

Biomedical Research↗
PubMed2004

[New forms of remuneration and care delivery: their impact on rehabilitation].

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.

Budgets↗
PubMed1986

The comparative economic performance of investor-owned chain and not-for-profit hospitals.

We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

Capital Financing↗
PubMed2002

An integrated approach to diagnosis and therapeutic management of patients with systolic heart failure in the Copenhagen metropolitan area.

BACKGROUND: Studies on the effect of heart failure clinics have been encouraging and convincing with respect to reduced hospitalizations, improved quality of life, and reduced cost. However, previous results have been derived from patient populations either recently discharged and with specific exclusion criteria or from heart transplant lists. We here report the establishment of a heart failure clinic that offers an integrated approach to both diagnosing and managing heart failure patients, the baseline characteristics of the first 283 patients treated, and the impact on heart failure hospitalizations during establishment. METHODS: Since September l, 1999, a heart failure clinic has been in operation at Frederiksberg University Hospital. The clinic was designed with both a diagnostic and a therapeutic unit. The diagnostic unit offers open access to all patients with suspected heart failure, either through referral from general practitioners or from the medical departments of the hospital. In the case of confirmed systolic heart failure, the patient is referred to the therapeutic unit for (1) uptitration and optimization of medical therapy and thorough information and education. In addition, the unit offers a rapid access track and the possibility of intravenous diuretic treatment. RESULTS: During the 21 months of operation, a total of 460 patients were referred to the clinic. Of these, 320 (70%) were found to have clinical evidence of heart failure, and 283 (88% of the patients with heart failure) had left ventricular systolic dysfunction (defined by an ejection fraction of < or =45%). These patients were seen in the clinic for education, control of fluid retention, and uptitration of medications. These patients with left ventricular dysfunction were predominantly elderly (aged 72.7 +/- 10.7 y) and most often male (73%). Ischemic heart disease was the most common etiology (55%). Before referral, most patients with left ventricular dysfunction had been treated with none or only low-dose angiotensin-converting enzyme inhibitor (55%), and fewer than one third received beta-blockers (29%). During the first year of operation of the clinic, there was a 23% decline of heart failure-related hospital admissions to the department of cardiology (from 396 to 306). CONCLUSIONS: Patients with systolic heart failure are not always optimally treated. The establishment of a heart failure clinic, which offers the combination of diagnosing and managing congestive heart failure, appears to be efficient both in terms of therapy optimization and with respect to a concomitant decline in hospitalization for heart failure.

Adolescent↗
PubMed2001

Increasing the efficiency and flexibility of capital funding for public and private hospitals.

This paper outlines the recent history of capital funding in the health sector in Australia. It focuses on the trends in capital expenditures and the roles of the public and private sectors. The demand for future capital funding will depend upon a number of factors, including the state of the current capital stock and uncertain future impacts of technology and changes in patient demands. Because of these uncertainties, capital funding for the future must be flexible to meet any changes in operations and demand. The paper highlights the possible use of joint ventures between various public and private organisations, based on the principles of competition and cooperation.

Australia↗
PubMed2002

Capital investment in public hospitals.

Capital investment is a major concern for public hospitals. Relative to operating expenditures, it has been almost constant for 40 years, despite great changes in technology and patient throughputs. Research studies during the last decade suggest that over that time almost all investment has been on simply replacing existing assets. Per person, the total capital stock has actually declined. However most replacement outlays are predictable. Although major building outlays may still need some central supervision, equipment replacement can be projected with enough confidence to fund it through operating grants. Using data from several surveys, some capital-weighted DRGs have been developed and a funding system suggested.

Australia↗