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At least 1,171 records · Page 65Linked to original sources
PubMed1998

Teaching hospital costs: implications for academic missions in a competitive market.

CONTEXT: As the managed care environment demands lower prices and a greater focus on primary care, the high cost of teaching hospitals may adversely affect their ability to carry out academic missions. OBJECTIVE: To develop a national estimate of total inpatient hospital costs related to graduate medical education (GME). DESIGN: Using Medicare cost report data for fiscal year 1993, we developed a series of regression models to analyze the relationship between inpatient hospital costs per case and explanatory variables, such as case mix, wage levels, local market characteristics, and teaching intensity (the ratio of interns and residents to beds). SETTING AND PARTICIPANTS: A total of 4764 nonfederal, general acute care hospitals, including 1014 teaching hospitals. MAJOR OUTCOME MEASURES: Actual direct GME hospital costs and estimated indirect GME-related hospital costs based on the statistical relationship between teaching intensity and inpatient costs per case. RESULTS: In 1993, academic medical center (AMC) costs per case were 82.9% higher than those for urban nonteaching hospitals (actual cost per case, $9901 vs $5412, respectively). Non-AMC teaching hospital costs per case were 22.5% higher than those for nonteaching hospitals (actual cost per differences in case, $6630 vs $5412, respectively). After adjustment for case mix, wage levels, and direct GME costs, AMCs were 44% more expensive and other teaching hospitals were 14% more costly than nonteaching hospitals. The majority of this difference is explained by teaching intensity. Total estimated US direct and indirect GME-related costs were between $18.1 billion and $22.8 billion in 1997. These estimates include some indirect costs, not directly educational in nature, related to clinical research activities and specialized service capacity. CONCLUSIONS: The cost of teaching hospitals relative to their nonteaching counterparts justifies concern about the potential financial impact of competitive markets on academic missions. The 1997 GME-related cost estimates provide a starting point as public funding mechanisms for academic missions are debated. The efficiency of residency programs, their consistency with national health workforce needs, financial benefits provided to teaching hospitals, and ability of AMCs to maintain higher payment rates are also important considerations in determining future levels of public financial support.

Academic Medical Centers↗
PubMed1995

The evolving role of pharmacy benefits management firms in a managed care environment.

The next five to seven years will see a major shake-up in the pharmacy benefits management industry. A highly competitive race is underway between independent, retail pharmacy chain-sponsored and pharmaceutical manufacturer-controlled PBMs to see who will develop and monitor prescription drug efficacy protocols that reduce the total costs associated with an episode of illness.

Clinical Protocols↗
PubMed2000

What it takes to implement and maintain successful supplier-managed inventory programs.

Besieged by global competition and rapid technology changes, manufacturers subsequently have increased pressures on their suppliers to deliver product in less than traditional lead-times. In order to accomplish this goal, the proper selection of suppliers and inventory management programs is paramount. This article will focus on the selection of suppliers, what it takes to make the programs successful, and the most popular types of supplier-managed inventory programs in today's high-technology marketplace.

Commerce↗
PubMed1997

Improving ambulatory surgery reimbursement.

As outpatient services become the new focal point for managed care, ambulatory surgery reimbursement structures are coming under increasing scrutiny. Operating room managers play a key role in developing ambulatory surgery payment mechanisms that are competitive, clinically meaningful and profitable. Operating room managers must understand the market forces that are redefining outpatient surgery reimbursement as well as the reimbursement mechanisms involved. Payment methodologies in ambulatory surgery are explored.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Analysing the effect of competition on general practitioners' behaviour using a multilevel modelling framework.

This paper examines the effect of competition on the behaviour of Australian general practitioners. The paper represents a considerable improvement on the methods of previous studies by using a random effects probit model in a multilevel modelling framework to obtain a more robust estimate of the effect of GP density, by including data on GP and practice characteristics and by using data with the actual GP consultation as the unit of observation which are disaggregated by medical condition. This latter characteristic enables us to test the hypothesis that the effect of competition varies across medical conditions. The main hypothesis tested is that GPs in areas of high competition are more likely to recommend a follow-up consultation compared to GPs in areas of low competition. The results suggest that the density of GPs influences the decision to follow up for one out of the four medical conditions analysed. However, there are other issues to be resolved before such results can be confidently interpreted as evidence of the effect of competition and as evidence of supplier-induced demand.

Adolescent↗
PubMed1989

One contract alters small-town market balance.

What happens when the largest employer in a small community of 30,000 contracts with one provider's HMO network? Ask hospital executives in Sherman, TX. The exclusive contract, which marks the debut of managed care in the community, has shifted the balance of the local health care market.

Economic Competition↗
PubMedDate not supplied

From product line to disease management--easing the transition.

Most facilities have captured the essence of product-line management, but what is the next step? The traditional reasons for product-line management are still more than valid, but forward-thinking organizations are moving to a disease-management focus.

Disease Management↗
PubMed2001

[Ventricular arrhythmia in the athlete: practical management].

The aim of athletic competition is to exceed ones present limits, which exposes the athlete to increased risk is helshe has a cardiac disorder. Ventricular excitability is not part of the athletic heart syndrome, and only the presence of resting ventricular extrasystoles that are monomorphic, ungrouped and disappear with exercise can be considered physiological. Significant ventricular arrhythmia can reflect a cardiac disorder that should be routinely sought in order to determine if there is a potential risk of sudden death favoured by physical effort. The confirmation of arrhythmia and seeking a cardiac disorder require a rigorous approach based on history-taking, clinical examination and initial performance of non-invasive, orienting examinations. Invasive examinations, based on the case, are often required if a disorder is suspected or if there is a question concerning the severity of the arrhythmia. Decisions concerning aptitude for competition are decided case by case, according to the disorder, with reference to the 26th Bethesda Conference. If the ventricular arrhythmia is shown to be benign and no underlying cardiac disorder exists, athletic competition may be pursued without restrictions. In case of contrary findings, physical activity will be limited and the authorized level will be precisely determined according to the context and the results of exertion tests made during treatment.

Arrhythmias, Cardiac↗
PubMed1987

Promotion and pricing in competitive markets.

This paper provides a conceptual framework for health care managers to evaluate the relative desirability of competitive pricing or promotional policies. Competitive pricing or promotional decisions are defined as a function of two factors: the relative financial strength of the competitor and the potential marginal profit of the competitive action. Methods for measuring and assessing financial strength and marginal profit are described. As competition in the health care industry increases, the concepts and measures described should become very useful.

Economic Competition↗
PubMed1995

Hospital managed care diversification and reinsurance strategies.

As increasing numbers of patients enroll in managed care plans, health care providers are faced with new operational and financial challenges. This article, the fourth in a series on the financial perils of managed care contracting, addresses issues related to diversification of risk and reinsurance.

Capitation Fee↗
PubMedDate not supplied

Is Germany a model for managers?

Most American managers have a hard time making sense of Germany. The country has a fraction of the resources and less than one-third the population of the United States. Labor costs are substantially higher, paid vacations are at least three times as long, and strong unions are deeply involved at all levels of business, from the local plant to the corporate boardroom. Yet German companies manage to produce internationally competitive products in key manufacturing sectors, making Germany the greatest competitive threat to the United States after Japan. The seemingly paradoxical nature of the German economy typically evokes one of two diametrically opposed responses. The first is to celebrate the German economy as a "model" worth emulating--indeed, as the answer to declining U.S. competitiveness. The alternative, more skeptical response is to question Germany's staying power in a new, more competitive global economy. According to Kirsten Wever and Christopher Allen, the problem with both points of view is that they miss the forest for the trees. Observers are so preoccupied with praising--or blaming--individual components of the German economy that they fail to see the dynamic logic that ties these components together into a coherent system. In their review of recent research on the German business system, Wever and Allen argue that managers can learn an important lesson from Germany. In the global economy, competition isn't just between companies but between entire socioeconomic systems. Germany's ability to design a cohesive economic and social system that adapts continuously to changing requirements goes a long way toward explaining that country's competitive success.

Administrative Personnel↗
PubMedDate not supplied

Is American business working for the poor?

At first glance, poverty seems to have little to do with business. When most people--managers included--think about poverty, they assume that people are poor because they are isolated from the mainstream economy, not productive participants in it. But according to Harvard University professors Mary Jo Bane and David Ellwood, this is a misleading image of the true face of poverty in the United States today. Most poor adults--and a full 90% of poor children--live in families where work is the norm, not the exception. Poor people often work or want to work. But at the low-wage end of the American economy, having a job is no guarantee of avoiding poverty. Poverty is a business issue, then, because the American poor are part of the American work force. And this poses a problem for managers. In a more competitive and fast-changing economic environment, the performance of companies increasingly depends on the capabilities of their employees. In response to this human-resource challenge, more and more managers are embracing the language of "empowerment". And yet how can low-wage employees believe empowerment when their experience of work is, quite literally, impoverishment? It is unlikely that American companies can create the work force of the future with the poverty policies of the past. Fortunately, there are some simple policy mechanisms that can assist the working poor without putting an undue burden on business. Enacting them, however, requires managers to see poverty policy as one part of a national human-resource strategy that links the strategic concerns of companies to a broad social agenda.

Child↗
PubMedDate not supplied

A time for growth: an interview with Amgen CEO Kevin Sharer. Interview by Paul Hemp.

Fast growth is a nice problem to have--but a hard one to manage well. In this interview, Kevin Sharer, the CEO of biotech giant Amgen, talks about the special challenges leaders face when their companies are on a roll. Sharer, who was also head of marketing at pre-WorldCom MCI and a division head and a staff assistant to Jack Welch at GE, offers insights drawn from his own experience--and from his own self-proclaimed blunders: "I learned the hard way that you need to become credible and enlist support inside the company before you start trying to be a change agent. If you think you're going to make change happen simply by force of personality or position or intellect, you'd better think again." And change there was: Under Sharer's leadership, Amgen overhauled its management team, altered its culture, and launched a couple of blockbuster products. How do chief executives survive in that kind of dizzying environment? "A CEO must always be switching between different altitudes--tasks of different levels of abstraction and specificity," Sharer says. "You might need to spend time working on a redesign of your organizational structure and then quickly switch to drafting a memo to all employees aimed at reinforcing one of the company's values." Having a supportive and capable top team is also key: "A top management team is the most revealing window into a CEO's style, values, and aspirations.... If you don't have the right top team, you won't have the right tiers below them. [The] A players won't work for B players. Maybe with a company like GE, the reputation of the company is so strong that it can attract top people to work for weaker managers. In a new company like Amgen, that won't happen."

Administrative Personnel↗