Hospital corporate restructuring and financial performance

In the last decade, an important innovation in the organizational structure of acute care hospitals occurred. Many hospitals restructured by creating subsidiaries that segment assets or services into separate corporations. We know relatively little about the effects of such restructuring. This paper examines the association of restructuring with financial performance of not-for-profit hospital firms. The study uses data from all not-for-profit acute care hospital firms in Virginia, the only state for which the unique study data are available. We find that the consolidated financial performance of hospital firms is influenced by factors that affect the hospital's financial performance (i.e., payer-mix, staffing and service mix) but not the number or size of non-hospital subsidiaries. Future research should examine the effect of restructuring on other types of performance.

The financial performance of diversified hospital subsidiaries

Despite its proliferation, we know relatively little about the impact of hospital restructuring to offer new services. This exploratory study examines the relationship between types of services offered and financial performance among separately incorporated subsidiaries of acute care hospitals. We draw data from the subsidiaries of all hospital firms operating in one state (Virginia) that requires reporting by all such firms. Results from multiple regression analyses of 1987 data indicate that units that existed longer, produced health care or related products, or were nonprofit subsidiaries of nonprofit firms tended to be more profitable than the other subsidiaries.

Relative performance of for-profit psychiatric hospitals in investor-owned systems and nonprofit psychiatric hospitals

OBJECTIVE

The authors analyzed the differences in operational and financial performance between 42 matched pairs of for-profit psychiatric hospitals belonging to multifacility organizations and nonprofit psychiatric hospitals for the fiscal years ending in 1986 through 1990.

METHOD

The pairs of short-term hospitals were matched according to location, standard metropolitan statistical area, or wage index. Analyses were based on data on these hospitals from the Health Care Financing Administration. The groups of variables studied included the hospitals' operational performance and productivity, profitability and payer mix, revenue and expenses, and capital structure. Differences in the mean values of the variables for the for-profit hospitals and the nonprofit hospitals were analyzed by pairwise t tests.

RESULTS

The for-profit organization hospitals had significantly higher net revenue, lower salary expenses, and higher profits than the nonprofit hospitals. Patients in the for-profit hospitals had longer stays, and these hospitals had fewer full-time employees per adjusted inpatient day and per adjusted discharge.

CONCLUSIONS

The higher prices and operating margins of the for-profit hospitals belonging to investor-owned systems reflect the profit-maximizing goal of these facilities. The ability of for-profit organization hospitals to achieve economies of scale in expenses, however, was not evident except in the case of salary expenses.

Serum antibodies to structural proteins of hantavirus arise at different times after infection

An enzyme-linked immunosorbent assay (ELISA) was developed for the quantification of serum antibodies against group-specific epitopes of the glycoproteins (G1, G2) and nucleoprotein (NP) of the genus Hantavirus. This assay was used to study the kinetics of the development of serum antibodies after natural infection with Puumala-like virus in humans. To this end a panel of 34 serum samples collected from individuals at different times after natural infection was tested by the ELISA. The samples were also tested for specific IgM and IgG levels against Puumala-like virus, which provided confirmatory data about the presumed timing of infection. It was shown that serum antibodies against the G1 epitope were present in the acute and early convalescent period just before antibodies to the NP epitope could be demonstrated. In contrast, antibodies to two G2 epitopes were present not earlier than in the convalescent and late convalescent period. Since all these categories of antibodies seem to persist for long periods, antibodies against the G1 epitope and the NP epitope may be of specific diagnostic value. Furthermore, levels of G1-specific antibodies and antibodies to either NP or G2 may allow estimation of the time elapsed following initial infection.

Characteristics of the divested HCA and AMI hospitals

The primary aim of this study was to compare and contrast the predivestiture managerial and market characteristics of the following: Divested and nondivested hospitals of Hospital Corporation of America (HCA) and American Medical International (AMI). The findings indicated that HCA hospitals with 1) lower occupancy rates, 2) less growth in revenues, 3) higher debt to total asset position, 4) fewer beds, 5) less growth in their elderly populations, and 6) less growth in their markets' per capita incomes had a higher probability of being divested into HealthTrust. The results for the AMI model were similar to those for the HCA model. AMI hospitals with 1) fewer beds, 2) less growth in their markets' per capita incomes, 3) lower salary expenses per discharge, 4) lower occupancy rates, and 5) increased growth in populations had a higher probability of being divested into EPIC.

[Current status of late onset delusion in the elderly]

In the field of chronic delusions, authors make synthesis of the delusion with late emergence in the elderly. This delusion is at once replaced in the history of its nosographic position, then defined in its presentation. The question of its refer with depression and its place in the limits of dementia are approached. Authors outline the importance of biological, psychological and sociological factors in induction of this particular delusion to clarify the means for its management.

Identification of Hantavirus serotypes by testing of post-infection sera in immunofluorescence and enzyme-linked immunosorbent assays

Serum samples were collected from 27 individuals who had been infected with a member of the genus Hantavirus in the Netherlands or Belgium during the last 15 years. These samples were tested in an immunofluorescence assay (IFA) and two enzyme-linked immunosorbent assay (ELISA) systems, using different virus strains that represented each of the four recently proposed serotypes of this genus. The serum samples from 11 individuals who had been infected through contacts with laboratory rats showed the highest reactivities with Hantaan virus (serotype I) and SR-11 (serotype II) in the IFA and ELISA systems. The samples of 16 individuals who had probably been infected through contacts with wild rodents showed the highest reactivities with Hällnäs virus (serotype III) in the IFA. All except two of these also showed the highest reactivity with Hällnäs virus in the two different ELISA systems.

Value of serum aluminium monitoring in dialysis patients: a multicentre study

The clinical relevance of regular serum aluminium monitoring in dialysis patients was investigated in a multicentre study by 6-monthly determination of the serum aluminium during 4 consecutive years. In a group totalling 1193 patients, a striking decrease of mean serum aluminium was observed the last 2 years of the study. This phenomenon was accompanied by a substantial reduction of the prescribed dose of aluminium hydroxide (Al(OH)3) and its partial replacement by calcium carbonate (CaCO3) and/or magnesium hydroxide (Mg(OH)2). Under this policy serum phosphate control remained satisfactory. In all the centres, water treatment was found to be adequate, yielding dialysate aluminium around 2 micrograms/l. Dialysis patients with clinically overt liver disease showed a significantly greater median serum aluminium concentration than that observed in a control dialysis population. Compared to the latter group, the median serum aluminium concentration of dialysis patients with diabetes mellitus did not differ significantly. Results further indicated that patients with biopsy-proven osteomalacia presented a significantly greater median serum aluminium compared to that of patients without osteomalacia. We demonstrated that a serum aluminium of 60 micrograms/l provides a relatively sensitive (82%) and specific (86%) index for the detection of aluminium-related bone disease (ARBD). Provided the aluminium determinations are performed by a qualified laboratory, serum monitoring in dialysis patients (a) allows the safer use of aluminium-containing phosphate binders, and (b) is of value in the diagnosis of overload/toxicity.

Mucinous pancreatic duct ectasia in the body of the pancreas

The authors describe one case of mucinous pancreatic duct cancer (ductectatic cystadenocarcinoma). This disease is characterized by dilatation, with mucoid secretion, in side branches of the main pancreatic duct. Unlike in other reported cases in which mean age of the patients is over 57 years, this case involved a young woman (aged 30 years), and the lesion was located in the body of the pancreas rather than in the uncinate process. Malignant transformation was noted.

Vertical integration and diversification of acute care hospitals: conceptual definitions

The terms vertical integration and diversification, although used quite frequently, are ill-defined for use in the health care field. In this article, the concepts are defined--specifically for nonuniversity acute care hospitals. The resulting definitions are more useful than previous ones for predicting the effects of vertical integration and diversification.

Idiopathic muscular hypertrophy of the esophagus: CT features

Idiopathic muscular hypertrophy of the esophagus is a rare, benign esophageal disease, characterized by hyperplasia of all layers of the wall and, in particular, muscle layers. The authors describe the CT findings and review the relevant literature.

Does hospital diversification improve financial outcomes?

Service or product diversification is a popular recommendation made to hospitals to increase profitability and reduce financial risk as they face a more hostile environment. This paper presents results from an empirical study of these claims. Using data from all California nonprofit hospitals, the study finds that diversification, regardless of whether it is related or unrelated to preexisting services, is not associated with either increased profitability or reduced financial risk. However, other variables that do have these effects are identified in the research. Future research should evaluate the effect of both the size of and the length of time since the initial diversifying investment on financial variables.