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PubMedDate not supplied

Hospital-physician vertical integration.

Vertical integration of healthcare services has been viewed by hospitals as an effective strategy for maintaining institutional viability in the face of increased competitive pressures. This paper examines the effects of vertical integration on hospital utilization and market share, based on the experience of a selected set of hospitals that developed primary care group practices as part of a national demonstration program conducted over the period 1976 to 1982. Inpatient days and admissions for the average hospital increased 9.0 percent and 8.2 percent, respectively, over the initial four-year period of group operation, while average market share of inpatient days and admissions rose by 4.9 percent and 3.6 percent, respectively. The establishment of the group practices also helped most hospitals achieve a more favorable outpatient payor mix.

Financial Management↗
PubMed2001

Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals.

Although, empirically, for-profit hospitals serve few poor and indigent patients, they may be able to shift capital more quickly than hospitals of other ownership types, thereby spatially avoiding poor patients. However, in a market with a relatively high proportion of for-profit hospitals, spatial avoidance of poor patients is not possible because spatial competition will exist in non-poor areas. The study examines hospital choice for maternity care in a market with many for-profits using a gravity model or conditional logit. The analysis shows that poor and Medicaid populations choose for-profit hospitals overall. Income, along with distance, is an important factor in hospital choice.

Catchment Area, Health↗
PubMed2001

Casemix reimbursement: a Singapore Children's Hospital perspective.

INTRODUCTION: Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. MATERIALS AND METHODS: Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. RESULTS: The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. CONCLUSION: While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

Adolescent↗
PubMed1988

Patient dumping in the hospital emergency department: renewed interest in an old problem.

Alarm about the adverse effects of transferring emergency patients for economic reasons has resulted in federal legislation aimed at curbing the practice. We review the history of common law hospital liability for denial of emergency care and analyze the federal legislation designed to restrict the transfer of medically indigent patients with emergency problems. We conclude that the currently proposed solutions to patient dumping will have limited effectiveness without more specific incentives for the provision of health care to the medically indigent.

Emergency Service, Hospital↗