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PubMed2002

Conflicting interests in private hospital care.

This article looks at key changes impacting on private hospital care: the increasing corporate ownership of private hospitals; the Commonwealth Government's support for private health; the significant increase in health fund membership; and the contracting arrangements between health funds and private hospitals. The changes highlight the often conflicting interests of hospitals, doctors, Government, health funds and patients in the provision of private hospital care. These conflicts surfaced in the debate around allegations of 'cherry picking' by private hospitals of more profitable patients. This is also a good illustration of the increasing entanglement of the Government in the fortunes of the private health industry.

Australia↗
PubMed1997

To market, to market: corporatisation, privatisation and hospital costs.

The Australian political arena echoes with calls for the privatisation of health care institutions, the contracting-out of health care services and the introduction of various marketing strategies into hospital management. These calls are justified by asserting that the market, rather than the public sector, can provide better services, greater productivity and increased efficiency. The National Health Strategy (1991, p 17) provides a good example. Noting that Australia is copying American investment trends for hospital 'chains' rather than for independent small establishments, the strategy dismisses any concern over changes in ownership, pointing instead to a 'process of rationalisation' that is to be 'welcomed'. Using evidence from the United States, United Kingdom and Australian hospital sectors, this paper examines claims for the greater efficiency of market processes.

Australia↗
PubMed2002

The impact of the Balanced Budget Act on the utilization and financial condition of children's services in California hospitals.

The objective of this study was to evaluate the utilization and financial performance of children's services after the Balanced Budget Act of 1997. The author analyzed these performance factors by hospital ownership, HMO penetration, and disproportionate share hospitals. Using data from California hospitals and conducting an analysis from 1997 to 1999, the author found that public hospitals were able to increase their profits from pediatric and neonatal intensive care services. The study also revealed that DSH hospitals located in high HMO penetration markets reduced their operating losses in nursery and pediatric services.

Budgets↗
PubMed2001

Interprofessional collaboration: a stakeholder approach to evaluation of voluntary participation in community partnerships.

A major goal of community coalitions is to engage the community in large-scale systems change. This paper examines how five interprofessional partnerships in South Africa involved their local communities as well as a variety of voluntary agencies in the long-term planning and delivery of health care. The obstacles and difficulties encountered by the volunteers who participate in the partnerships are highlighted. The paper compares the views of 427 participants from four stakeholders: the community health workers; the projects' core staff; 'solo' community members; and representatives of voluntary agencies, community-based agencies and non-governmental organisations. This article considers the benefits and costs of participation as well as satisfaction, ownership, representation, contributions, and commitment. The findings suggest that while the stakeholders value their partnerships, some of the costs associated with their participation may affect their satisfaction and commitment. The challenges of working in partnerships with volunteers in a community setting are discussed and strategies for addressing them are considered. The implications for coalition functioning and the lessons for future community involvement in the planning of local health services by way of interprofessional partnerships are also addressed.

Adult↗
PubMed1993

Outpatient parenteral antibiotic therapy. Management of serious infections. Part I: Medical, socioeconomic, and legal issues. Legal issues.

The tremendous growth of outpatient services has spurred closer legal scrutiny of patient referrals to physician-owned companies (self-referral). Federal "safe harbor" regulations protect certain arrangements, but much of the law remains vague. Future legislation is likely to be more specific, however. Physicians should obtain legal counsel before entering into any ownership or investment opportunities in home infusion therapy.

Ambulatory Care↗
PubMed1992

Methicillin-resistant Staphylococcus aureus: a questionnaire survey of 75 long-term care facilities in western New York.

OBJECTIVES: To determine the frequency of recognition of methicillin-resistant Staphylococcus aureus (MRSA) as an infection control problem and its prevalence among long-term care facilities, and to evaluate whether certain long-term care facility characteristics such as bed size, ownership, level of infection control activity, and frequency of resident transfers to acute care hospitals are related to the recognition or prevalence of MRSA in this setting. DESIGN: Questionnaire survey. SETTING: Seventy-five long-term care facilities in the 8 counties of western New York. RESULTS: Seventy-five of 81 (92.6%) long-term care facilities returned a completed questionnaire. Seventy-nine percent were considered to have a "limited" level of infection control activity (part-time infection control practitioner who spent less than 10 hours a week on infection control activities). The larger the long-term care facility, the more time was spent on infection control activities (p = .01). Seventy-two percent of the long-term care facilities screened new admissions for MRSA by reviewing culture reports; 69% of the long-term care facilities had a specific infection control policy for MRSA. Sixteen of the 75 (21%) facilities felt they had an infection control problem with MRSA. By univariate analysis, the only characteristic significantly associated with this recognition was use of nurse practitioners or physician assistants by a facility (p < .05). Eighty-one percent of the 75 long-term care facilities had identified one or more patients with MRSA in the year prior to the survey. By univariate analysis, the only characteristics that were significantly associated with the number of residents with MRSA were the monthly average number of residents transferred to acute care facilities (p = .034) and facility bed size (p = .022); there was also a trend toward increasing intensity of infection control activities (p = .085). However, facility bed size and the average number of resident transfers per month to acute care facilities were strongly associated (p = .0002). By stepwise logistic regression analysis, only bed size was an independent predictor of the number of residents with MRSA. Many long-term care facilities had tried to eradicate MRSA; ciprofloxacin was most commonly used to eradicate MRSA. CONCLUSIONS: The vast majority of the 75 long-term care facilities in the 8 counties of western New York have identified patients with MRSA, although only a minority (21%) of them actually believed that an infection control problem existed. Facility size (a surrogate for the monthly average number of resident transfers to acute care facilities) seems to be an important factor in determining the number of residents with MRSA in long-term care facilities in our geographic region. The major longitudinal studies of MRSA in such facilities have so far been done only in Veterans Affairs facilities. Further studies are needed in freestanding long-term care facilities, the largest group of long-term care facilities in the United States, to determine the epidemiology of MRSA in this setting and to develop practical and valid infection control methods for residents with MRSA.

Health Facility Size↗
PubMed2003

Designing a report card for nursing facilities: what information is needed and why.

PURPOSE: This article presents a rationale and conceptual framework for making comprehensive consumer information about nursing facilities available. Such information can meet the needs of various stakeholder groups, including consumers, family/friends, health professionals, providers, advocates, ombudsman, payers, and policy makers. DESIGN AND METHODS: The rationale and framework are based on a research literature review of key quality indicators for nursing facilities. RESULTS: The findings show six key areas for information: (a) facility characteristics and ownership; (b) resident characteristics; (c) staffing indicators; (d) clinical quality indicators; (e) deficiencies, complaints, and enforcement actions; and (f) financial indicators. This information can assist in selecting, monitoring, and contracting with nursing facilities. IMPLICATIONS: Model information systems can be designed using existing public information, but the information needs to be enhanced with improved data.

Information Dissemination↗
PubMed1995

Decision-making influence: an empirical study of social workers in nursing homes.

Health care research on social workers' organizational influence has focused almost exclusively on the hospital setting. Little is known about social workers' influence in nursing homes, in particular organizational factors that support or constrain their impact on resident care. This article presents findings from a survey of 90 social workers employed in 53 nursing homes who identified their level of influence in five spheres of organizational decision making. With the exception of personnel decisions, there were few differences between the influence levels of the directors of social services and social workers without administrative responsibilities. Number of full-time-equivalent social workers, type of ownership, and length of employment of the director of social services were significantly related to the level of perceived influence held by the director of social services. The implications of these findings for social work practice in nursing homes are discussed.

Administrative Personnel↗
PubMed1988

The peaceable pluralistic society and the question of persons.

In his recent book The Foundation of Bioethics, H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises.

Beginning of Human Life↗
PubMed2005

The supply and demand for guns to juveniles: Oakland's gun tracing project.

In response to Oakland, California's high level of gun violence affecting young people, the East Oakland Partnership to Reduce Juvenile Gun Violence, a citywide collaboration, was formed in 1997. In 1999, the Partnership established the Oakland Gun Tracing Project to develop evidence-based policy recommendations aimed at reducing the supply of and demand for gun acquisition among urban youth. The advocacy project involved gathering, analyzing, and using police record and gun sale/registration data to inform policy and practice. Such data were collected for all gun crimes committed in Oakland, California between 1998 and 1999 in which a juvenile was either the suspect or the victim. The 213 cases involved 263 juveniles of which 170 were suspects/perpetrators and 93 were victims. Suspects as well as victims were predominantly male and African American. The 213 cases involved 132 recovered guns. Only 55% of the cases were traced to a federally licensed dealer. Three-quarters of the guns were purchased near Oakland, California. Successful traces, defined as the ability to identify federally licensed dealers and initial purchasers, were completed on only 52 of the 132 guns, demonstrating systemic tracing difficulties. Data gathered for the project was used to advocate for numerous policy changes. Recommended policy strategies include initiating a comprehensive gun tracing program so police can track all secondary sales, new laws requiring federal handgun registration which would track ownership changes, required reporting of stolen firearms, and providing effective intervention services to all juveniles the first time they enter the criminal justice system.

Adolescent↗
PubMed2000

The genome sequence DataBase.

The Genome Sequence DataBase (GSDB) is a database of publicly available nucleotide sequences and their associated biological and bibliographic information. Several notable changes have occurred in the past year: GSDB stopped accepting data submissions from researchers; ownership of data submitted to GSDB was transferred to GenBank; sequence analysis capabilities were expanded to include Smith-Waterman and Frame Search; and Sequence Viewer became available to Mac users. The content of GSDB remains up-to-date because publicly available data is acquired from the International Nucleotide Sequence Database Collaboration databases (IC) on a nightly basis. This allows GSDB to continue providing researchers with the ability to analyze, query and retrieve nucleotide sequences in the database. GSDB and its related tools are freely accessible from the URL: http://www.ncgr.org

Databases, Factual↗
PubMed1999

How does the prevalence of specific morbidities compare with measures of socio-economic status at small area level?

BACKGROUND: Evidence from other studies has show large, systematic differences between the health of social groups. It is not clear whether this relationship applies equally to all areas of health need. We assess whether a variety of areas of ill health show positive correlations with increasing socioeconomic disadvantage, and whether there are indicators of socio-economic disadvantage that are better than others at predicting the prevalence of specific morbidities at a population level. METHODS: The prevalence of a range of common morbidities was determined by a postal questionnaire sent to 16,750 subjects (response rate 79 per cent), and compared with socio-economic information obtained from the 1991 Census. RESULTS: There was substantial variation in the degree to which the various morbidities were related to the socioeconomic variables. When compared with socio-economic variables, long-term limiting illness, respiratory conditions and depression had high correlations of +0.8 or more. Cardiovascular conditions were less related (r = +0.60 to +0.79). None of the disorders of the gastrointestinal system showed a high correlation with socio-economic variables. There was also substantial variation in the degree of correlation of the socio-economic measures with each area of morbidity. The measures that showed the highest correlations were in respect of household characteristics such as car ownership and single parent households. Variables describing household amenities such as lacking a bath or central heating were least related to the morbidity measures. CONCLUSIONS: Some areas of morbidity show strong associations with socio-economic disadvantage, but others show only modest or no relationship. The optimum choice of socio-economic variable as a proxy for health need depends on the area of illness being considered.

Adolescent↗
PubMed2001

Building effective community-academic partnerships to improve health: a qualitative study of perspectives from communities.

PURPOSE: To identify, through a qualitative study, community perspectives on the critical factors that facilitate the development, effectiveness, and sustainability of community-academic partnerships. METHOD: Between June 1998 and April 1999, 25 semistructured interviews were conducted with community members who represented eight partnerships at five academic health centers. Content analysis and open coding were performed on the data, and patterns of ideas and concepts were categorized. RESULTS: After review of the data, responses from three partnerships were excluded. Nine major themes that community respondents thought strongly influenced the effectiveness of community-academic partnerships emerged from respondents from the remaining five partnerships: (1) creation and nurturing of trust; (2) respect for a community's knowledge; (3) community-defined and prioritized needs and goals; (4) mutual division of roles and responsibilities; (5) continuous flexibility, compromise, and feedback; (6) strengthening of community capacity; (7) joint and equitable allocation of resources; (8) sustainability and community ownership; and (9) insufficient funding periods. CONCLUSION: The themes that emerged from this study of the perceptions and experiences of the community partners in community-academic partnerships can be critical to further developing and evolving these partnerships.

Academic Medical Centers↗
PubMed1993

The determinants of hospital CEO compensation.

This study finds a significant difference in the compensation levels of public and private hospital CEOs. The difference, however, is not found to be associated with ownership structure. Rather, it is attributable to hospital characteristics such as size, location, and affiliation with a multihospital chain, and human characteristics such as gender, education, and experience.

Chief Executive Officers, Hospital↗
PubMed1993

Organizational characteristics and administrative strategies associated with staff turnover.

In a study at 55 hemodialysis facilities, turnover was not associated with organizational size, location, or ownership but varied according to administrative strategies. Technician turnover (32 percent) was lower in facilities with shorter hours and choice of work schedule even though workload was higher. Clerical turnover (36 percent) was reduced with lower workloads. Nursing turnover (31 percent) was reduced in facilities in operation longer with shorter hours but equivalent workloads. Administrative turnover was negligible.

Cross-Sectional Studies↗
PubMed2000

The strategic behavior of U.S. rural hospitals: a longitudinal and path model examination.

This article explores the relationships among rural hospital strategic behavior (market power and cost control strategies), environmental and organizational characteristics, and the influence these have on the financial performance of rural hospitals in the United States. The study finds that only market power strategies and organizational characteristics (ownership and size) exhibit significant impacts on rural hospital financial performance.

Causality↗
PubMedDate not supplied

Effect of hospital conversion on organizational decision making and service coordination.

This study looks into the "black box" of hospital ownership conversion in a "natural experiment." We posed two competing theories about how conversion might influence management practices. Results support complexity theory and not threat-rigidity theory. As predicted from complexity theory, MDs and RNs had greater levels of participation and influence over final decision choices in converted hospitals than in nonconverted hospitals.

Decision Making, Organizational↗
PubMed1981

Why do nursing home costs vary? The determinants of nursing home costs.

Since the costs of nursing home care are a major component of the rapidly rising costs of health care, it is appropriate to base public policy discussions about cost containment on the determinants of nursing home costs. This article investigates the determinants of nursing home operating costs and reviews the results of 11 related econometric cost analyses conducted by the authors. Single-equation cost analyses are developed for nursing homes in three states and in the nation. The cost results of a multi-equation model of nursing home behavior are also reviewed. The analyses indicate that facility size and occupancy rate are minimally important in determining cost variation. Facility characteristics, particularly type of facility and ownership, are important variables. Nonprofit facilities consistently had higher costs than for-profit facilities, after controlling for patient mix and service differences, and, in one analysis, for a measure of quality.

Costs and Cost Analysis↗