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At least 1,513 records · Page 84Linked to original sources
PubMed1991

National survey of pharmaceutical services in psychiatric hospitals.

The results of a summer 1989 nationwide mail survey of psychiatric hospital pharmaceutical services are reported and discussed. A simple random sample of 200 hospitals was selected from 600 psychiatric hospitals registered by the American Hospital Association. Questionnaires were mailed to the director of pharmacy at each institution. Usable responses were received from 114 hospitals, for a net response rate of 57%. Responses were categorized by hospital size, ownership status, geographic region, and average length of stay. Substantial differences were noted between government and nongovernment hospitals in the number and types of pharmaceutical services provided, as well as in the manner in which services are provided. Non-government hospitals generally appeared to offer more progressive pharmaceutical services. Psychiatric hospitals in western states appeared to offer more advanced clinical pharmacy services than institutions in other geographic areas. The survey established baseline data on the nature and extent of both clinical and distributive services in psychiatric hospital pharmacy departments.

Clinical Pharmacy Information Systems↗
PubMed1991

The impact of nonclinical factors on repeat cesarean section.

Nonclinical factors, including the setting in which health care takes place, influence clinical decisions. This research measures the independent effects of organizational and socioeconomic factors on repeat cesarean section use in California. Of 45,425 births to women with previous cesarean sections in 1986, vaginal birth after cesarean section occurred in 10.9%. Sizable nonclinical variations were noted. By hospital ownership, rates ranged from 4.9% (for-profit hospitals) to 29.2% (University of California). Variations also existed by hospital teaching level (nonteaching hospitals, 7.0%, vs formalized teaching hospitals, 23.3%); payment source (private insurance, 8.1%, vs indigent services, 25.2%); and obstetric volume (low-volume hospitals, 5.4%, vs high-volume hospitals, 16.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and the effects of patient characteristics. The observed variations demonstrate the prominence of nonclinical factors in decision making and question the clinical appropriateness of current practice patterns.

Adult↗
PubMed1990

Strategic change in hospitals: an examination of the response of the acute care hospital to the turbulent environment of the 1980s.

Changes in strategies of hospitals responding to the turbulent health care environment of the 1980s are examined both in the aggregate and from the perspective of the individual hospital. The Miles and Snow typology is used to determine strategy type. Both investor-owned and not-for-profit hospitals were well represented in the broad mix of hospital types sampled. In addition, freestanding hospitals and members of multihospital systems were present in the sample. Last, hospitals of all sizes were included. Strategic change was evaluated by classifying hospitals by strategy type in each of two consecutive five-year time periods (1976 through 1980 and 1981 through 1985). Changes in reimbursement policies, the emergence of new technologies, changing consumer expectations, and new sources of competition made the environment for hospitals progressively more turbulent in the latter period and provided an opportune setting to evaluate strategic change. Results showed that a significant number of hospitals did change strategy as the environment changed, and in the direction anticipated. Logistic regression was used to determine whether prior strategy, type of ownership, system membership, or size would predict which hospitals would change strategy as the environment changed: only prior strategy was found to be a predictor of strategy change.

Economic Competition↗
PubMed1990

The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict.

Age Factors↗
PubMed1989

Should a patient have access to his medical records.

An investigation is undertaken into the right of a patient to have access to medical records concerning himself, and the ownership of medical records and X-ray photographs is discussed. It is argued that record accessibility by patients is to favoured. The current situation in England and the United States of America is considered and proposals de lege ferenda are made with respect to South Africa. The author is of the opinion that the South African legislature should consider legislation in this regard.

England↗
PubMed1989

Characteristics of medical schools and their affiliated institutions.

Survey data from a sample of 58 U.S. and six Canadian medical schools were used to describe the current network of medical schools and their affiliates. Results showed that each medical school in the study averaged over 11 affiliates. The largest percentages of affiliates reported were in the categories of "community" hospitals (that is, the nongovernmental, not-for-profit hospitals), Veterans Administration hospitals, and city hospitals. Characteristics of the medical schools, such as class size, ownership, year established, and the presence of a university hospital, were not related to either the number or the kind of affiliates. However, the sizes of the affiliated institutions were associated with the year the medical school was established, the presence of a university hospital, and the class size of the medical school.

Canada↗
PubMed1988

Strategic orientations of small multihospital systems.

Strategic behaviors of organizations can be classified along two dimensions--growth orientations, or patterns of evolution over time, and action orientations, or strategic aggressiveness in undertaking a particular growth orientation. We create measures of growth and action orientations for small multihospital systems and test the validity of the growth and action orientation typologies, using data from a sample of small multihospital systems. Growth and action orientations do appear to exist independently of each other, and they are related to the ownership status of the systems. Not-for-profit and church-other systems exhibit similar strategic orientations, unlike those of Catholic and investor-owned systems.

Data Collection↗
PubMed1988

The financial performance of selected investor-owned and not-for-profit system hospitals before and after Medicare prospective payment.

This article analyzes determinants of cost and profitability, including the influence of Medicare prospective payment (PPS), between 1983 and 1985 for nearly 300 hospitals belonging to investor-owned (IO) and not-for-profit (NFP) systems. Using approaches that assure comparability of financial data, and including case mix, quality, competition, and regulation measures, the findings indicate that (1) in both years, competitive environment, case mix, age of facility, and scope of diversified services were important determinants of average cost, while a process measure of quality was insignificant and the independent effect of ownership type was insignificant for cost; (2) effects of HMO competition and hospital strategy were stronger in 1985 than in 1983; (3) operating margins for all types of hospitals showed increases, with a somewhat greater improvement for NFP system members; and (4) significantly greater declines in volume of care occurred for IO system members. Implications for future research are discussed.

California↗
PubMed1987

The privatization of health care and physicians' perceptions of access to hospital services.

Health care in the United States is increasingly delivered by for-profit providers, by multi-facility corporations, and under conditions of price-based competition. The joint influence of these three trends is examined through data drawn from a 1984 survey of physicians conducted by the American Medical Association. For-profit ownership and price competition are reported to restrict admission for the poor and uninsured; the effects of system affiliation are shown to be more complex. Policy responses to future restrictions on access are discussed.

Attitude of Health Personnel↗
PubMed1988

Hospital profitability and capital structure: a comparative analysis.

This article compares the financial performance of hospitals by ownership type and of five publicly traded hospital companies with other industries, using such indicators as profit margins, return on equity (ROE) and total capitalization, and debt-to-equity ratios. We also examine stock returns to investors for the five hospital companies versus other industries, as well as the relative roles of debt and equity in new financing. Investor-owned hospitals had substantially greater margins and ROE than did other hospital types. In 1982, investor-owned chain hospitals had a ROE of 26 percent, 18 points above the average for all hospitals. Stock returns on the five selected hospital companies were more than twice as large as returns on other industries between 1972 and 1983. However, after 1983, returns for these companies fell dramatically in absolute terms and relative to other industries. We also found investor-owned hospitals to be much more highly levered than their government and voluntary counterparts, and more highly levered than other industries as well.

Capital Financing↗
PubMed1986

Asset holdings of the newly disabled: findings from the New Beneficiary Survey.

About 3 out of 4 new disabled-worker beneficiaries or their spouses owned some type of financial asset in 1982, but the median value of these assets was quite small, according to data obtained by the Social Security Administration in its New Beneficiary Survey. A smaller majority reported owning their own homes, and home equity accounted for most of the reported wealth. Barely a tenth reported that they owned farms, businesses, or commercial property. Differences in age and marital status within the newly disabled population were associated with large differences in asset holdings. Married couples and older disabled workers generally were more likely to own each kind of asset, and generally reported higher values for these assets. Older married men--the largest subgroup among the disabled--are also relatively well-off, though their median asset portfolios were worth only +3,600 when home equity was excluded. Younger single men, the third largest subgroup, reported median total assets worth less than +50, however home equity was treated. The asset ownership rates and median values reported by the new disabled-worker beneficiaries are much lower for every type of asset considered than the rates and values reported by a comparable sample of new retired-worker beneficiaries.

Adult↗
PubMed1985

Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.

Certificate of Need↗
PubMed1985

A nationwide survey of civilian air ambulance services.

To identify and characterize civilian air ambulance services, a questionnaire was mailed nationwide to 583 prospective air ambulance services, with 154 responding. Our survey identified differences between hospital, hospital-affiliated, and private air ambulance services as to aircraft ownership, availability, types of aircraft, types of patients being transported, types of medical personnel and equipment, aircraft retrofit, and their feelings regarding air ambulance regulations. We found that hospital air ambulances are better suited for transporting critically ill patients while many private air ambulances appear better suited to transport nonemergency patients. Hospital-affiliated air ambulance services, although not as consistent in providing the specialized care of hospital air ambulances, appear better able to provide critical care than private air ambulance services. Based upon this data, we recommend that air ambulance regulations be directed at levels of patient care. Such regulations and guidelines will assist patient safety during aeromedical transports without jeopardizing currently operating air ambulance services.

Aircraft↗
PubMed1979

Needed: model law on the charitable corporation.

Nearly a dozen years ago, the McGrath Thesis stimulated controversy about Catholic corporations as property owners. Though no court has ever ruled that a charitable corporation's control is vested in the general public, institutions should understand state and federal laws that affect both property ownership and its dissolution.

Catholicism↗
PubMed1983

Hospital closures and survivals: an analysis of operating characteristics and regulatory mechanisms in three states.

This article examines factors related to hospital closures, using a longitudinal sample of surviving and closed hospitals. The hospitals are drawn from three states with different regulatory programs. Size of hospital and occupancy rate are shown to be related to likelihood of closure, while ownership, length of stay, and expenditures are not. These findings are observed both in the aggregate and within the individual states between 1960 and 1980. The three states--Arizona, Pennsylvania, and Maryland--represent different population trends and regulatory mechanisms and goals. The findings indicate that some programs appear to guarantee survival, whereas others are more neutral.

Arizona↗
PubMed1978

Emergency department key factor in hospital admissions.

A significant proportion of a community hospital's inpatient population is admitted through the emergency department. Administrators who are aware of the frequency of this practice in their institutions can schedule and staff services more efficiently. A 1975 survey conducted by the American Hospital Association shows that the number of emergency department admissions depends on hospital size, location, ownership, and type of physician coverage in the emergency department.

Contract Services↗
PubMed1982

Hospital performance in multihospital systems: a comparative study of system and independent hospitals.

Hospital costs and productivity in multihospital systems versus those of independent hospitals are a major source of debate among health care providers and researchers. Previous studies have shown system hospitals perform better than independent hospitals. The evidence, however, has been limited to only a few nonprofit systems. To help fill this research gap, approximately 100 system hospitals from 14 systems and 4 ownership types are compared with approximately 50 independent hospitals using cost and productivity data from one year. The results show that system hospitals realize both significantly higher cost and higher productivity levels, except for county-owned facilities which have lower costs and insignificantly different productivity levels. Factors that help explain these results are discussed and directions for further research are suggested.

Bed Occupancy↗
PubMed1980

The internal organization of hospitals: a descriptive study.

This study presents descriptive information on several dimensions of the internal organization of hospitals, with particular emphasis on medical staff, using data from two unique national surveys. Three alternative theories of hospital behavior by economists are described and evaluated with these data. The study also shows how standard bed size, teaching, and ownership categories relate to important features of hospital organization. In this way, understanding of these standard "control" variables is enhanced. For example, systematic organizational differences between proprietary and other hospitals are reported, holding bed size and teaching status constant. No single theory of hospital behavior emerges as dominant. The tables demonstrate the diversity of hospitals and the likelihood that no single model can adequately describe the behavior of all hospitals.

Hospital Administration↗