Systematic Review and Meta-Analysis of the Financial Impact of 30-Day Readmissions for Selected Medical Conditions: A Focus on Hospital Quality Performance

BACKGROUND

The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA).

METHODS

Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance.

INFORMATION SOURCES

A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers.

SYNTHESIS OF RESULTS

The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01-16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44-7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82-10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14-21,871.85) for THA/TKA.

DISCUSSION

Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions.

CONCLUSIONS

This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance.

Non-operating revenue is an important source of funding for rural hospitals, especially those that are government-owned

PURPOSE

Non-operating revenue (NOR), derived from investments, contributions, government appropriations, and medical space rentals, can contribute to financial stability of hospitals by offsetting operating losses and improving profitability. NOR might benefit rural hospitals that often face intense financial pressures. However, little is known about how much rural hospitals rely on NOR and if certain organizational characteristics are associated with differences in NOR.

METHODS

Healthcare Cost Report Information System data from 2011 to 2019 were used to analyze sources of revenue among Critical Access Hospitals (CAHs) and Rural Prospective Payment System (R-PPS) hospitals through descriptive statistics and regression models. Reliance on NOR was measured by the percentage of total revenue from non-operating sources.

FINDINGS

Results indicate that both CAHs and R-PPS hospitals rely on NOR; however, CAHs have a higher percentage of total revenue derived from non-operating sources (3.2%) as compared to R-PPS hospitals (1.9%) (p < 0.001). Government-owned hospitals have significantly higher reliance on NOR than other ownership types. System affiliation also influences reliance on NOR. Lastly, results suggest that NOR may play a role in improving overall profit margins.

CONCLUSIONS

As rural hospitals disproportionately face challenges related to declining profitability and the risk for closure, they may rely on NOR to continue to strengthen financial performance and provide health care to their communities. However, NOR is not guaranteed, and reliance on NOR further reiterates the value of stable, adequate reimbursement to guard against fluctuations in NOR.

Hospital Finances During the First Two Years of the COVID-19 Pandemic: Evidence From Washington State Hospitals

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

Beyond the Balance Sheet: Investigating the Association Between NHA Turnover and Nursing Home Financial Performance

Introduction

Nursing homes (NHs) serve as a safety net for vulnerable populations such as older adults and people with disabilities. Nursing Home Administrators (NHAs) play a crucial role in managing the daily operations of NHs, including overseeing direct care staff and establishing the facility's strategic direction. Unfortunately, NHs have consistently faced high NHA turnover rates, which have been linked to poor organizational performance. This study aims to investigate the relationship between NHA turnover and financial performance in NHs.

Methods

Using an integrated perspective based on the upper echelons theory and the resource-based view of the firm, we investigated the association between NHA turnover and financial peformance using multiple secondary data sources, such as the Care Compare: Skilled Nursing Facility Quality Reporting Program and Brown University's Long Term Care Focus. We conducted a cross-sectional study using a multivariate linear regression model, measuring financial performance using operating margin while NHA turnover represents the number of administrators that left the organization.

Results

Our findings indicate that NHs with higher NHA turnover rates have lower operating margins. Specifically, compared to facilities with no turnover, one NHA turnover is associated with a 1.14% decrease in operating margin, and two or more turnovers are associated with a 2.25% decrease.

Discussion

This study contributes to the existing literature by demonstrating the financial impact of NHA turnover and provides further evidence of the need for targeted organizational and policy interventions to improve NHA retention.

COVID-19 Pandemic Impact on Nursing Homes Financial Performance

Nursing homes expressed concern about potential severe adverse financial outcomes of COVID-19, with worries extending to the possibility of some facilities facing closure. Maintaining a strong financial well-being is crucial, and there were concerns that the pandemic might have significantly impacted both expenses and income. This longitudinal study aimed to analyze the financial performance of nursing homes during COVID-19 pandemic. Specifically, we examined the impact of the pandemic on nursing home operating margins, operating revenue per resident day, and operating cost per resident day. The study utilized secondary data from various sources, including CMS Medicare cost reports, Brown University's Long Term Care Focus (LTCFocus), CMS Payroll-Based Journal, CMS Care Compare, Area Health Resource File, Provider Relief Fund distribution data, and CDC's NH COVID-19 public file. The sample consisted of 45 833 nursing home-year observations from 2018 to 2021. Fixed-effects regression analysis was employed to assess the impact of the pandemic on financial performance while controlling for various organizational and market characteristics. The study found that nursing homes' financial performance deteriorated during the COVID-19 pandemic. Operating margins decreased by approximately 4.3%, while operating costs per resident day increased by $26.51, outweighing the increase in operating revenue per resident day by about $17. Occupancy rates, payer mix, and staffing intensity were found to impact financial performance. The study highlights the significant financial impact of the COVID-19 pandemic on nursing homes. While nursing homes faced substantial financial strains, the findings offered lessons for the future, underscoring the need for nursing homes to improve the accuracy of their cost reports and enhance financial transparency and accountability.

An Exploratory Analysis of the Association between Hospital Quality Measures and Financial Performance

Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position.

Evaluating the Financial Performances of the Publicly Held Healthcare Companies in Crisis Periods in Türkiye

The purpose of this study was to evaluate the financial performances of the publicly held healthcare companies in crisis periods in Türkiye. The 2018 economic crisis and the COVID-19 pandemic crisis were included in the study as the crisis periods. We collected the financial data of the publicly held healthcare companies and calculated three liquidity, three turnover, three leverage and three profitability ratios through ratio analysis to use as financial performance indicators. We then conducted Wilcoxon signed-rank tests and we performed separate analyses for the 2018 economic crisis and the COVID-19 pandemic crisis. The results of the analyses showed that there were no statistically significant differences between the publicly held healthcare companies' liquidity, turnover, leverage, profitability ratios and thus their financial performances before the crises and after the crises. While the results are reassuring and give valuable insights to managers and policy makers to determine the areas that needs to be strengthened to be better prepared for possible future crises, our sample was limited. Therefore, this study presents an exploratory foundation for future studies which are needed to make a case for financial stability for the publicly held healthcare companies before and after the crisis periods.

The Impact of COVID-19 on the Financial Performance of Largest Teaching Hospitals

The COVID-19 pandemic disrupted hospital operations. Anecdotal evidence suggests financial performance likewise suffered, yet little empirical research supports this claim. This study aimed to explore the impact of the pandemic on the financial performance of the most prominent academic hospitals in the United States. Data from the 115 largest major teaching hospitals in the United States were extracted from the American Hospital Directory for three years (2019-2021). We hypothesized that the year and region would moderate the relationship between a hospital's return on assets (financial performance) and specific operational variables. We found evidence through descriptive statistics and multivariate moderated regressions that financial positions rebounded in 2021, mainly through reductions in adjusted full-time employees and liabilities and an increase in non-operating income. Our results also found that the Midwest region significantly outperformed the other three regions, particularly in terms of lower salaries and operational expenses. These findings suggest potential for future initiatives encouraging efficiency and finding alternate sources of income beyond patient income. Hospitals should focus on improving financial reserves, building out non-operational revenue streams, and implementing operational efficiencies to foster better financial resiliency. These suggestions may enable healthcare administrators and facilities to adapt to future pandemics and environmental turbulence.

A Perceptual Approach to the Impact of CSR on Organizational Financial Performance

Corporate social responsibility (CSR) is a progressively significant issue for organizations and governments. To benefit from a good reputation that reflects on organizational performance, organizations must ensure the balance between stakeholders' needs. This paper studies the direct and indirect effects of CSR on organizational financial performance as perceived by employees of organizations. The investigation used structural equation modeling to evaluate and describe the nature of the relationship between these two variables. The empirical study uses a perceptual approach, evaluating the perceptions of the closest stakeholders (employees). Data on the perceptions of 431 employees in Romanian organizations were collected following a questionnaire-based survey. The results indicate a strong effect of social responsibility on both direct and mediated organizational financial performance. The relationships established with the stakeholders ultimately affect organizational financial performance through variables such as the attraction and retention of employees, the attraction and loyalty of customers, more accessible access to capital, and the organization's reputation.

SDGs in corporate responsibility reporting: a longitudinal investigation of institutional determinants and financial performance

Companies play a central role in the achievement of Sustainable Development Goals (SDGs); as such, they face institutional pressures to increase their engagement with SDGs. However, given the complexity of SDGs, it is unclear whether these pressures lead firms to adopt engagement approaches that address a few goals or the whole set of 17, and if that choice has any subsequent effect on financial performance. To shed light on these issues, this research draws on the neo-institutional theory to investigate whether two institutional determinants—industry type and country of origin—affect SDG engagement and whether such engagement improves financial performance. Based on a content analysis and a regression analysis on high-reputation companies (the 100 most sustainable firms in the world) over the period 2017–2020, we find that the institutional pressures associated with industry type and country-of-origin positively impact any engagement approach to SDGs. However, we establish that companies’ financial performance only generally improves when engaging with either the whole set of SDGs or a specific subset of the most frequently cited. This study provides important theoretical and practical contributions that illuminate firms’ institutional and financial rationales for adopting SDGs.

The impact of Medicare shared savings program participation on hospital financial performance: An event-study analysis

OBJECTIVE

To evaluate the impact of hospitals' participation in the Medicare Shared Savings Program (MSSP) on their financial performance.

DATA SOURCES

Centers for Medicare & Medicaid Services Hospital Cost Reports and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2011 to 2018.

STUDY DESIGN

We used an event-study design to estimate the temporal effects of MSSP participation on hospital financial outcomes and compared within-hospital changes over time between MSSP and non-MSSP hospitals while controlling for hospital and year fixed effects and organizational and service-area characteristics. The following financial outcomes were evaluated: outpatient revenue, inpatient revenue, net patient revenue, Medicare revenue, operating margin, inpatient revenue share, Medicare revenue share, and allowance and discount rate.

DATA COLLECTION/EXTRACTION METHODS

Secondary data linked at the hospital level.

PRINCIPAL FINDINGS

Controlling for trends in non-MSSP hospitals, MSSP participation was associated with differential increases in net patient revenue by $3.28 million (p < 0.001), $3.20 million (p < 0.01), and $4.20 million (p < 0.01) in the second, third, and fourth year and beyond after joining MSSP, respectively. Medicare revenue differentially increased by $1.50 million (p < 0.05), $2.24 million (p < 0.05), and $4.47 million (p < 0.05) in the first, second, and fourth year and beyond. Inpatient revenue share differentially increased by 0.29% (p < 0.05) in the second year and 0.44% (p < 0.05) in the fourth year and beyond. Medicare revenue share differentially increased by 0.17% (p < 0.01), 0.25% (p < 0.01), 0.32% (p < 0.01), and 0.41% (p < 0.01) in consecutive years following MSSP participation. MSSP participation was associated with 0.33% (p < 0.05) and 0.39% (p < 0.05) differential reduction in allowance and discount rate in the second and third years.

CONCLUSIONS

MSSP participation was associated with differential increases in net patient revenue, Medicare revenue, inpatient revenue share, and Medicare revenue share, and a differential reduction in allowance and discount rate.

COVID-19 and financial performance: Pre and post effect of COVID-19 on organization performance; A study based on South Asian economy

The COVID-19 epidemic has damaged developing as well as developed economies and reduced the profitability of several companies. Technological advancement plays a vital role in the company's performance in this current situation. All activities carry on virtually. In this study, the financial performance of enterprises in the South Asian banking industry will be compared before and after the COVID-19 epidemic. Furthermore, the full influence of the pandemic will take place in the long run. This study also explains the technological effect on improving performance, especially during the period of the COVID-19 pandemic. It has an impact on people's social lives as well as the economic world. This study examined a sample of 34 banks from the South Asian region from 2016 to 2021. A Wilcox rank test was used to determine whether there was a significant difference before and after the epidemic era. The overall conclusion of this study is that the COVID-19 pandemic had a significant influence on the bank's financial performance, particularly in terms of profitability. But technological advancement has a positive effect on organizational performance, ultimately increasing the financial performance of South Asian banks. And there is a big difference between pre-pandemic and post-pandemic organizational performance. The findings of this study have significant policy implications since it is clear that cooperation among governments, banks, regulatory agencies, and central banks is necessary to address the financial and economic effects of the COVID-19 pandemic.

Financial Performance is Associated With PPE Shortages in Chain-Affiliated Nursing Homes During the COVID-19 Pandemic: A Longitudinal Study

Many nursing homes operated at thin profit margins prior to the COVID-19 pandemic. This study examines the role of nursing homes' financial performance and chain affiliation in shortages of personal protection equipment (PPE) during the first year of the COVID-19 pandemic. We constructed a longitudinal file of 79 868 nursing home-week observations from 10 872 unique facilities. We found that a positive profit margin was associated with a 21.0% lower probability of reporting PPE shortages in chain-affiliated nursing homes, but not in non-chain nursing homes. Having adequate financial resources may help nursing homes address future emergencies, especially those affiliated with a multi-facility chain.

Healthcare Associated Infections, Nurse Staffing, and Financial Performance

Healthcare associated infections (HAIs) are a concern to patients, hospital administrators and policymakers. For over than a decade, efforts have been made to hold hospitals accountable for the costs of HAIs. This study uses contingency theory as a framework to examine the association between HAIs and hospital financial performance. We use publicly available data on 2059 hospitals in 2014 to 2016 that include HAIs, staffing financial performance, and hospital and hospital market characteristics. The key independent variables are available infection rates and nurse staffing. The dependent variables are indicators of financial performance: operating margin, total margin, and days cash on hand. We find nearly identical negative direct associations between infections and operating margins and total margins (-0.07%), and positive associations between the interaction of infections and nurse staffing (0.05%). A 10% higher infection rate would be predicted to be associated with only a 0.2% lower profit margin. The associations between HAIs, nurse staffing and days cash on hand were insignificantly different from zero.

Business continuity, disaster readiness and performance in COVID-19 outbreak aftermath: A survey

Anchored in the COVID-19 context, this research seeks to examine the role of business continuity practices in improving both disaster readiness and business performance. A survey of 322 French firms was conducted and data were analyzed using structural equation modelling. The findings corroborate the postulates of resource-based view and organizational information processing theories regarding business continuity practices in COVID-19 context. Firms that improve their disaster readiness (B=.243; p-value=.008**) and their business continuity practices (B=.173; p-value=.038*) are more capable of enhancing their performance. The findings raise some questions regarding the validity of the preexisting knowledge on business continuity and disaster readiness in the context of COVID-19.

Tracking Waste Management Information Disclosure Behavior Connected to Financial Performance through Moderating Variables

The current challenges of a circular economy exert a high pressure on manufacturing companies that generate waste to track and implement policies to reduce them and eliminate the toxicity of residues. Hence, the purpose of this study is to analyze the waste management information disclosure linked to the financial performance of companies and test the moderating effect of internal and external variables. The average waste management information disclosure index shows a poor disclosure score for the analyzed period, however, the waste disclosure index after reaching a minimum threshold in 2019 recorded an encouraging increase at the end of 2021. Applying the fixed effects model, ordinary least squares, and two-stage least squares method, the results revealed a positive and statistically significant relationship between management information disclosure and the return on assets, while for the current ratio the connection has been invalidated. A statistically significant influence of the environmental-sensitive industry status, board size, and productivity on the moderating variables was found for the return on assets, while for current ratio, there was none. As for the alternative metrics of financial performance, the results showed that a higher degree of management information disclosure will increase the return on equity and earnings per share, while in the case of liquidity, the results are not conclusive.

How slack resource affects hospital financial performance: The evidence from public hospitals in Beijing

Background

Beijing is a city with high concentration and congestion of quality medical resources in China. While moderate slack seems to be beneficial to the improvement of medical quality. The actual relationship between hospital slack resources and their performance deserves further exploration. The study aims to analyze the slack resources of public hospitals in Beijing and investigate the relationship between slack and hospital financial performance. Finding a reasonable range of slack to optimize resource allocation.

Methods

The panel data of 22 public hospitals in Beijing from 2005 to 2011 were selected as the sample, and the DEA model was applied to measure the main variable using DEAP 2.1. Descriptive statistical analysis was performed using Excel and STATA 15. Pearson correlation coefficient analysis and variance inflation factor test were performed for each variable to avoid multicollinearity. The HAUSMAN test was used to determine the appropriate panel regression model, and then to analyze the influence relationship between the variables.

Results

From 2005 to 2011, hospital slack resource transitioned from high to low. The slack measured by the DEA model has an inverted U-shaped relationship with financial performance, with ROA increasing from 4.088 to 8.083 when slack increases from 0 to about 0.378, and then showing a decreasing trend; slack measured by financial indicators has a transposed S-shaped relationship with financial performance, with ROA increasing when slack increase from 3.772 to 5.933.

Conclusions

The slack resources of Beijing public hospitals decreased year by year from 2005 to 2011. Moderate slack resources are conducive to the improvement of healthcare quality, but when slack resources increase to a certain level, it will have a negative impact on healthcare quality. Therefore, hospital managers should control the slack within a moderate range according to the hospital operation policy and development plan to obtain the best performance.

The Moderating Effect of the Social Deprivation Index (SDI) on the Relationship Between Hospital Strategy and Financial Performance

Background: One of the major tenets of contingency theory is that the appropriate fit between strategy and environmental contingencies results in better financial performance. The purpose of this study was to investigate whether the Social Deprivation Index (SDI) moderates the association between hospital strategy and financial performance. Methods: We used longitudinal data from 2011 to 2016 from US urban general acute care hospitals. Four secondary datasets were used: the American Hospital Association (AHA) Annual Survey, Medicare cost reports (CMS), Area Health Resource File (AHRF), and the Robert Graham Center's SDI. A generalized estimating equation (GEE) regression model was used to analyze the data. An interaction term was used to test the moderating effect of the SDI on the strategy-financial performance relationship. Results and Discussion: Our results showed that compared to hybrids, the SDI moderates the relationship between strategy and financial performance for cost leaders and hybrids. Increasing market social deprivation increases the hospital operating margin of cost leaders by 0.06%. Similarly, increasing levels of market social deprivation increases the hospital operating margin of hybrids by 0.06% (p < 0.05). As such, our results suggest that social deprivation may affect the viability of hospital strategy.

Do financial performance and firm's value affect the quality of corporate social responsibility disclosure: Moderating role of chief executive officer's power in China

This paper investigates the correlation between the quality of corporate social responsibility disclosure (CSRD) and financial performance (FP). It also investigates the moderating role of chief executive officer power (CEOP) in the relationship between the quality of CSR disclosure and firm value (FV) in Chinese listed companies. The evidential research used the up-to-date sample (3, 248) of unbalanced findings for the period of 2014-2020, from the registered Chinese firms in the Shenzhen and Shanghai Stock Exchanges as samples for the study. As a starting point technique, the STATA 15 has been used to test pooled ordinary least squares (OLS) regression on a sample of Chinese listed companies. We use 1-year lagged regression and two SLS regressions to monitor the potential endogeneity problem. The imbalanced data set was received from the China Stock Market and Accounting Research (CSMAR) web page, which is the most significant source of information for Chinese publicly listed firms. Data on CSR information items and media reporting are compiled manually. The findings of the study revealed that there are positive FP consequences for the companies engaged in the quality of CSR disclosure. We also report that higher CEO power negatively enhances the quality of CSR disclosure effect on the FP of FV. The research investigates the impact of CSR disclosure and FP by presenting evidence of the moderating role of CEO power. Therefore, it is suggested that a higher law for CSR engagement and disclosure be implemented in China, and robust measures for the implementation of CEO power, although there are financial advantages to be gained. A key relevance to the empirical quality of CSR disclosure research can be recognized as the moderating role of CEO power in the quality of CSR disclosure, FP, and FV in the context of Chinese study. The findings are robust with the use of an instrumental variable method.

How Corporate Social Responsibility Boosts Corporate Financial and Non-financial Performance: The Moderating Role of Ethical Leadership

Corporate social responsibility has always been considered an important topic, and many studies discuss the association between corporate social responsibility (CSR) and corporate performance, but the results are still inconclusive. This study is to examine the impact of CSR on corporate performance (financial and non-financial) with the moderating impact of ethical leadership. Data is gathered from 222 companies in Morocco using a simple random sampling technique. Moreover, for measuring customer satisfaction and corporate image in the kinds of customers targeted by the CSR activities of the firms, we collected data from customers and got 209 responses. For analyzing the results of this study, structural equation modeling has been used, while for moderation, the hierarchical regression technique has been adopted. Findings revealed a significant positive association found between CSR and corporate finance as well as non-financial performance (corporate image and customer satisfaction). Ethical leadership helps in increasing the financial and non-financial performance of an organization. The findings further revealed that ethical leadership moderates the relationship between CSR and firm financial and non-financial (corporate image and customer satisfaction) performance. This study will assist management in realizing the importance and implementation of CSR practices in organizations, especially in the Moroccan context.

Improving pharmacy performance through market orientation and the implementation of expanded pharmacy services

This study seeks to extend the limited knowledge of market orientation's effects in retail pharmacy. Specifically, this study explores market orientation's role in the implementation of expanded pharmacy services and resulting performance implications among Canadian retail pharmacies. The results of the structural equation model showed that market orientation directly influenced the implementation of expanded pharmacy services and professional performance. The implementation of expanded pharmacy services was linked to professional performance and ultimately furthered financial performance. This study highlights the importance of how a market-oriented strategy and a pharmacy's decision to implement expanded pharmacy services can increase the dual objectives of the retail pharmacy.

An integrated approach to improve clinical trial efficiency: Linking a clinical trial management system into the Research Integrated Network of Systems

Low-accruing clinical trials delay translation of research breakthroughs into the clinic, expose participants to risk without providing meaningful clinical insight, increase the cost of therapies, and waste limited resources. By tracking patient accrual, Clinical and Translational Science Awards hubs can identify at-risk studies and provide them the support needed to reach recruitment goals and maintain financial solvency. However, tracking accrual has proved challenging because relevant patient- and protocol-level data often reside in siloed systems. To address this fragmentation, in September 2020 the South Carolina Clinical and Translational Research Institute, with an academic home at the Medical University of South Carolina, implemented a clinical trial management system (CTMS), with its access to patient-level data, and incorporated it into its Research Integrated Network of Systems (RINS), which links study-level data across disparate systems relevant to clinical research. Within the first year of CTMS implementation, 324 protocols were funneled through CTMS/RINS, with more than 2600 participants enrolled. Integrated data from CTMS/RINS have enabled near-real-time assessment of patient accrual and accelerated reimbursement from industry sponsors. For institutions with bioinformatics or programming capacity, the CTMS/RINS integration provides a powerful model for tracking and improving clinical trial efficiency, compliance, and cost-effectiveness.

The consequence of the credit risk on the financial performance in light of COVID-19: Evidence from Islamic versus conventional banks across MEA region

Purpose

The increased number of nonperforming loans (NPLs) during COVID-19 pandemic has interrogated the robustness of banks and stability of the whole banking segment. We examine the impact of credit risk (CR) on financial performance (FP) by comparing Islamic banks (IBs) to conventional banks (CBs). We also investigate the influence of COVID-19 on this association.

Design/methodology/approach

Our sample includes the largest 200 banks across 15 countries from the Middle East and the Africa (MEA) region over a four-year period (2018–2021). Panel ordinary least squares (OLS) with fixed and random effects were used.

Findings

We find a negative association between NPLs and FP for IBs and CBs. We reveal that COVID-19 is partially mediated the association between NPLs and FP in case of the whole sample and separated sample of CBs while not in case of IBs.

Originality

The evidence of CR and FP on samples of financial sector across MEA region has not been studied in the era of COVID-19 as far as we know.

Research limitations/implications

This study contributes to the knowledge of the risk and financial performance during the crisis nexus and provides information that is valued to bankers, academics, managers and regulators for policy formulation.

NCHL's "Best Organizations for Leadership Development" Program: A Case Study in Improving Evidence-based Practice through Benchmarking and Recognition

Increasingly, addressing healthcare's grand challenges requires complex system-level adaptations involving continuously evolving teams and leaders. Although leadership development strategies have been shown to improve individual leader effectiveness, much less is known about how organization-level leadership development affects organization-level outcomes. To begin building an evidence base as well as encouraging evidence-based practices, the US-based National Center for Healthcare Leadership developed a program capitalizing on leaders' demonstrated interest in organizational competitiveness: the biennial Best Organizations for Leadership Development (BOLD) program. In this chapter, we describe the philosophy behind this unique survey program and summarize research to date on relationships between survey dimensions and organizational outcomes such as patient experience and financial performance. We conclude with a description of promising areas for future study.

Mediating Role of Change Capability in the Relationship Between Transformational Leadership and Organizational Performance: An Empirical Research

Background

Improving organizational performance for firms in developing countries like Vietnam by huge investments in technological innovation is not feasible, because the majority of firms in these nations are small and medium size, with a lack of capital, resources, and R&D capabilities. Given the important role of change capability for organizational performance, the purpose of this paper is to investigate the impacts of transformational leadership (TL) on organizational performance via the mediating role of organizational change capability in cases of Vietnamese enterprise.

Methods

Based on the cross-sectional design method and empirical data, this study applied analysis of moment structures (AMOS) and structural equation modeling (SEM) to inspect the link between the latent variables in the proposal research model through the empirical data gathered from 302 participators in 125 Vietnamese firms.

Results

The findings of this study show the significant and positive influences of TL on organizational change capability and organizational performance. Importantly, organizational change capability significantly mediates the influence of TL on operational and financial performance.

Conclusion

This study contributes to filling the gaps in the literature and advancing the insights of how TL fosters specific aspects of change capability for improving two crucial components of organizational performance, namely operational and financial performance.

The Effect of CEO on Bank Efficiency: Evidence From Private Commercial Banks

The main purpose of this study was to analyze the effects of Chief Executive Officer (CEO) Key attributes on the financial performance of banks. Current literature gives little attention to the important characteristics of CEOs, therefore, this paper investigates the effects of characteristics of CEOs, such as education, experience, nationality, military background (MTB), and political connectedness (PC), on the financial (return on assets) performance of listed private commercial banks in Pakistan. This research sample included 20 private commercial banks of Pakistan and used Secondary data that was derived from 2011 to 2020, which contained 200 sample observations. This paper used the Fixed effect model, Normality test, Breush–Pagan, white test, multi-collinearity, and Augmented Dickey–Fuller test to investigate the study hypotheses. The main results revealed that CEO MTB and PC significantly and positively affected the financial performance of the bank. It is also found that the CEO's education and Experience have a significant and positive relationships with bank profitability. In contrast, the nationality of the CEO has no significant relationship with the financial performance of the bank.

COVID-19 Outbreak and Financial Performance of Chinese Listed Firms: Evidence From Corporate Culture and Corporate Social Responsibility

This research described Chinese listed firms' COVID-19 Outbreak and financial performance using corporate culture (CC) and corporate social responsibility (CSR) evidence. The epidemic's impact on Chinese companies' profits was much less than the impact on their sales growth rates. Although the COVID-19 has had a more significant negative impact on the financial performance of Chinese listed companies in sectors that are more severely impacted, such as travel and entertainment, we believe that the financial performance of the medical industry has improved as a result of the outbreak. Meanwhile, Chinese listed companies in high-risk areas experience more significant financial losses during the epidemic, and the Hubei impact is hefty weight. Corporate social responsibility moderated the inverse relationship between this epidemic and Chinese firms' economic success. This research enhances the current literature on the effects of the COVID-19 on financial success and practical, realistic, and theoretical consequences in companies worldwide.

Entrepreneurship, Corporate Social Responsibilities, and Innovation Impact on Banks' Financial Performance

The basic aim of this research was to check the impact of innovation, corporate social responsibilities (CSR), and entrepreneurship on the monetary performance of banks in five different countries: Qatar, Pakistan, China, the United States (US), and France. This research was conducted to measure the relationship of these factors and innovative workforce activities. The secondary data were collected from websites of twenty five banks in different countries, including Islamic and conventional banks. Different econometric analyses, such as descriptive statistical analysis, correlation coefficient test for measuring the interaction, and ordinary least square regression analysis for determining the impact of dependent and independent variables, were carried out. In the present study, entrepreneurship, CSR, and innovation were taken as independent variables. Board size, frequency of assemblies, and self-employed with large shareholders were included as sub-parts of entrepreneurship. On the other hand, the financial performance of banks was taken as the dependent variable. Return on assets (ROA) and return on equity (ROE) were considered parts of economic performance. The overall conclusions drawn in this study showed that there was a significant relationship between all the studied variables. The research provided useful insights into the long-debated question regarding the relevance of entrepreneurship and CSR.

Effects of affiliation network membership on hospital quality and financial performance

OBJECTIVE

To examine the effects of hospital membership in affiliation networks-franchise-like networks sponsored by high-quality health systems in which affiliate hospitals pay an annual fee for access to sponsor's operational and clinical resources-on clinical quality, patient experience ratings, and financial performance of affiliates and their competitors.

DATA SOURCES

Network membership data from press releases and websites of four sponsors (Mayo Clinic, Cleveland Clinic, MD Anderson, Memorial Sloan Kettering), American Hospital Association's Annual Survey, Centers for Medicare & Medicaid Services' Hospital Compare, and Healthcare Cost Report Information System, all for 2005-2016.

STUDY DESIGN

We used a quasi-experimental design and estimated hospital-level regressions with hospital-fixed effects. Dependent variables were measures of clinical quality, patient experience, and financial performance. Independent variables included an indicator for affiliate versus nonaffiliate and fixed effects for hospital characteristics and year. To analyze effects on competitors, we repeated analyses by comparing hospitals in the same county as an affiliate to nonaffiliated, noncompetitor hospitals.

DATA COLLECTION

Membership was obtained through press releases and network websites then linked across datasets by name and Medicare's identification number.

PRINCIPAL FINDINGS

Across networks, affiliates (N = 199) experienced insignificant clinical quality changes but increased net income by $38,500 and operating margin by 6.6% (p values = 0.01-0.08) compared to nonaffiliates. Multispecialty affiliates improved on no measures. Cancer-specific affiliates improved their net income ($96,900) and operating margin (3.6%; p-values < 0.05). Affiliates' competitors experienced mixed changes in clinical measures relative to hospitals without affiliates in market (p-value < 0.05) but no financial effects. Affiliation was not associated with patient experience ratings for affiliates nor competitors.

CONCLUSIONS

Despite quality-focused missions, affiliation networks are not guaranteed to improve public measures of quality in affiliated hospitals, although hospitals in these communities improve financially. Future research should assess the conditions and mechanisms by which affiliation improves quality consistently and which forms of quality.

Impact of External Environmental Dimensions on Financial Performance of Major Teaching Hospitals in the U.S

Teaching hospitals have a unique mission to not only deliver graduate medical education but to also provide both inpatient and ambulatory care and to conduct clinical medical research; therefore, they are under constant financial pressure, and it is important to explore what types of external environmental components affect their financial performance. This study examined if there is an association between the short-term and long-term financial performance of major teaching hospitals in the United States and the external environmental dimensions, as measured by the Resource Dependence Theory. Data for 226 major teaching hospitals spanning 46 states were analyzed. The dependent variable for short-term financial performance was days cash on hand, and dependent variable for long-term financial performance was return on assets, both an average of most recently available 4-year data (2014-2017). Utilizing linear regression model, results showed significance between outpatient revenue and days cash on hand as well as significant relationship between population of the metropolitan statistical area, unemployment rate of the metropolitan statistical area, and teaching hospital's return on assets. Additionally, system membership, type of ownership/control, and teaching intensity also showed significant association with return on assets. By comprehensively examining all major teaching hospitals in the U.S. and analyzing the association between their short-term and long-term financial performance and external environmental dimensions, based upon Resource Dependence Theory, we found that by offering diverse outpatient services and novel delivery options, administrators of teaching hospitals may be able to increase organizational liquidity.

Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?

The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.

Hospital Board of Directors' Composition and Financial Performance: Empirical Evidence from Taiwan

The board of directors of a nonprofit proprietary hospital is responsible for supervising and managing major operational matters and reviewing operational results. This study investigates how hospital financial performance is influenced by director and supervisor characteristics among the board members of nonprofit proprietary hospitals in Taiwan. Data were obtained from the Division of Medical Services of the Ministry of Health and Welfare. A generalized linear model was used to evaluate 32 non-profit proprietary hospitals for the years 2006 to 2017, totaling 363 observations. The empirical results revealed a significant positive correlation between the proportion of directors with management qualifications and hospital financial performance. Moreover, the results represented that a higher proportion of board members with a medical background did not correspond to higher hospital financial performance. Although doctors accounted for the highest proportion of board members, indicating their key role in hospital management, the need for board members with management expertise cannot be ignored. Therefore, a balance between directors with management experience and medical knowledge on the board of directors is beneficial for hospital financial performance.

Does Eco-Certification Correlate with Improved Financial Performance? Evidence From a Longitudinal Study in the US Hospital Industry

Health care-based negative production externalities, such as greenhouse gas emissions, underscore the need for hospitals to implement sustainable practices. Eco-certification has been adopted by a number of providers in an attempt, for instance, to curb energy consumption. While these strategies have been evaluated with respect to cost savings, their implications pertaining to hospitals' financial viability remain unknown. We specify a fixed-effects model to estimate the correlation between Energy Star certification and 3 different hospitals' financial performance measures (net patient revenue, operating expenses, and operating margin) in the United States between 2000 and 2016. The Energy Star participation indicators' parameters imply that this type of eco-certification is associated with lower net patient revenue and lower operating expenses. However, the estimated negative relationship between eco-certification and operating margin suggests that the savings in operating expenses are not enough for a hospital to achieve higher margins. These findings may indicate that undertaking sustainable practices is partially related to intangible benefits such as community reputation and highlight the importance of government policies to financially support hospitals' investments in green practices.

Global banking stability in the shadow of Covid-19 outbreak

The ongoing Covid-19 pandemic has been exerting negative effects on several economies in 2020. Therefore, it is of paramount importance to examine the impact of this pandemic on the global banking stability and to assess any potential recovery signals. This study is timely, in that we consider 1090 banks from 116 countries for quarterly periods across 2019–20. The results provide strong empirical evidence that, in the global banking sector, the Covid-19 outbreak has had detrimental impacts on financial performance across various indicators of financial performance (i.e., accounting-based and market-based performance measures) and financial stability (i.e., high-risk indicators including default risk, liquidity risk and asset risk). These results are consistently observed for various regions, countries (US, China and others), and different bank-level characterises, and across income-generation levels among countries. We also find differential effects of the pandemic on alternative banking systems (i.e., conventional and Islamic). Moreover, our trend analysis, based on bank average performance and financial stability over quarterly periods, identifies a signal of recovery for bank stability during the second quarter of 2020. The findings presented in this study offer important financial observations and policy implications to many stakeholders engaging with global banking.

Debt, Ownership, and Size: The Case of Hospitals in Poland

The goal of this study is to compare the financial performance of public hospitals according to ownership and size. The study covered public hospitals in Poland and covered two hospitals types depending on their founding authority, i.e., hospitals established and financed by the Marshal’s Office (Marshal hospitals) or the City Hall (poviat-commune hospitals). The study was based on an analysis of the hospitals’ financial situation (using debt and solvency ratios) and its relationship to the founding body and size. The verification of hypotheses was carried out using the Mann–Whitney U test. The results led to the conclusion that the vast majority of public hospitals are indebted, and their ownership structure does not affect their financial condition. The study did not confirm a significant relationship between size or ownership and the financial status of the hospital. The article aims to fill the research gap regarding the debt analysis between different types of public hospitals. It also presents a new research direction aimed at finding the factors that determine the difficult financial situation of public hospitals in Poland.

Influence of ESGC Indicators on Financial Performance of Listed Pharmaceutical Companies

The pharmaceutical industry, concerned about the impact of its activity, has integrated responsible principles and practices with a view to improving its sustainable and financial performance. This study analyzes the relationship between environmental, social, governance, and controversy indicators and financial performance, measured through return on equity (ROA), return on assets (ROE), and Tobin’s Q, which are applied to the listed companies in the Nasdaq US Smart Pharmaceuticals Index. This index is composed of 30 international companies with a presence at the global level. All the data have been extracted from the Thomson Reuters database. The analysis was performed using structural equation modeling implemented with partial least squares. The results confirm the positive relationship between the construct composed of environmental, social, and governance (ESG) indicators and the aforementioned financial ratios. Additionally, a positive relationship of the controversy indicator with Tobin’s Q is supported. This suggests that the pharmaceutical multinationals focus their investments in sustainability on ESG and pay attention to controversies to boost the visibility of the company and thus increase its value. These conclusions confirm that investing in ESG is a profitable strategy. It is also relevant for managers as it increases the profits and the market value of multinational pharmaceutical companies.

Intellectual Capital and Financial Performance: Comparison With Financial and Pharmaceutical Industries in Vietnam

This study investigates the impacts of intellectual capital through Value-Added Intellectual Capital (VAIC) and its components: human capital efficiency (HCE) and structural capital efficiency (SCE) on financial performance in terms of return on assets (ROA) and return on equity (ROE). In addition, this study compares the effects between firms from financial and pharmaceutical industries. A total of 149 Vietnamese firms comprising of 108 financial firms and 41 pharmaceutical firms were examined. Based on the findings, VAIC and HCE show beneficial impacts on both financial performance measures, ROA, and ROE. However, SCE shows adverse and beneficial implications on ROA and ROE, respectively. In terms of industry comparison, VAIC has positive effects on ROA and ROE among the firms from financial industry, whereas it has no effect in the firms from pharmaceutical industry. The effect of HCE on ROA is stronger in the firms from financial industry than firms from pharmaceutical industry while the effect of HCE on ROE is stronger in the firms from pharmaceutical industry than firms from financial industry. The effect of SCE on ROA is stronger in the pharmaceutical firms than financial firms while the effect of SCE on ROE is stronger in the financial firms than pharmaceutical firms. Lastly, the implications of the importance of knowledge-based resources on value creation were elaborated.

Female Micro-Entrepreneurs and Social Networks: Diagnostic Analysis of the Influence of Social-Media Marketing Strategies on Brand Financial Performance

The business world is facing a very complicated situation due to the COVID-19 pandemic. Small- and medium-sized companies (SMEs)—both in Spain and at the global level—are seeing their survival jeopardized by a fall in revenues. This scenario is aggravated in the case of micro-SMEs headed by female entrepreneurs. Accordingly, micro-SMEs, particularly those led by female entrepreneurs, need to reinvent themselves to overcome the current adversities that could lead to the destruction of their businesses and hence their jobs. One of the ways to do this is to take advantage of digital transformation. Therefore, the aim of this paper is to analyze which variables influence the financial results of female-led Spanish micro-SMEs when they carry out social marketing actions. For that purpose, an online survey was designed and analyzed using the “PROCESS” macro. Results show that social media marketing actions have significant effects on financial performance.

Labour accidents and financial performance: empirical analysis of the type of relationship in the Spanish context

This article performs empirical research and finds a negative relationship between accidents in the workplace and financial performance. The relationship is stronger and more persistent for performance 1 year ahead than for the current year. We find no significant evidence of curvilinear U-shaped or inverted U-shaped relationships. Results are strong across different industries and samples, variable definitions and model specifications. The study contributes to the scarce extant research with reliable data and samples of a wide span of industries. The study also contributes methodologically with refined analyses of the curvilinear relationship and providing robust widespread inference for a large number of industries.

Environmental Sustainability Commitment and Financial Performance of Firms Listed on the Johannesburg Stock Exchange (JSE)

The importance of heeding the environmental sustainability commitment call cannot be underestimated. Laggards in terms of environmental sustainability commitment are likely to face fines and penalties as talks to tighten environmental legislation are now at an advanced stage globally. The current work assessed the link between environmental sustainability commitment and financial performance of firms listed on the Johannesburg Stock Exchange (JSE). The study was quantitative in nature with a case study research design. The longitudinal design was adopted where the researcher collected panel data from 2011–2018. The population of the study included all firms listed on the JSE Responsible Investment Index in South Africa. The sample constituted of 32 firms listed on the Financial Times Stock Exchange FTSE/JSE Responsible Investment Index in South Africa. The researchers employed the panel regression analysis model to analyze the data. Specifically, the Feasible Generalized Least Squares regression model was used in this study. Financial performance was treated as the dependent variable as measured by earnings per share and share price. The independent variables of the study included components of environmental sustainability such as carbon emission reduction and environmental compliance. Control variables such as firm size and liquidity were used in the study. The findings indicated that carbon emission reduction was positively and significantly related to earnings per share and share price. The findings further exhibited that environmental compliance was positively related to earnings per share and share price. It was concluded that firms can enhance their financial performance from environmental investment as all the hypotheses were supported. This study contributes practically towards shaping environmental policies and it also serves as motivation to listed companies that they can enhance both their profitability and market value from environmental investments.

Financial Performance Analysis in European Football Clubs

The financial performance of football clubs has become an essential element to ensure the solvency and viability of the club over time. For this, both the theory and the practical and regulatory evidence show the need to study financial factors, as well as sports and corporate factors to analyze the possible flow of income and for good management of the club's accounts, respectively. Through these factors, the present study analyzes the financial performance of European football clubs using neural networks as a methodology, where the popular multilayer perceptron and the novel quantum neural network are applied. The results show the financial performance of the club is determined by liquidity, leverage, and sporting performance. Additionally, the quantum network as the most accurate variant. These conclusions can be useful for football clubs and interest groups, as well as for regulatory bodies that try to make the best recommendations and conditions for the football industry.

Adopting Occupational Health and Safety Management Standards: The Impact on Financial Performance in Pharmaceutical Firms in China

BACKGROUND AND PURPOSE

In recent years, the frequent occurrence of occupational accidents, illness, and injuries has become a major issue in China. This study aims to investigate the relationship between the adoption of Occupational Health and Safety Management System (OHSMS) standards and financial performance, with a particular focus on the pharmaceutical firms in China.

METHODS

The study is based on a sample consisting of 125 pharmaceutical firms listed on the Shanghai and the Shenzhen stock exchanges in China for the period 2010-2018. Each sample firm was evaluated by whether and when it is certified by an OHSMS standard depending on secondary data collected from an independent certification database. Panel-based regression models were employed to explore whether adoption of an OHSMS standard has had an impact on financial performance.

RESULTS

The regression results reveal that the adoption of an OHSMS standard positively affects contemporaneous financial performance measured by return on assets (ROA), return on equity (ROE), and earnings per share (EPS). Mixed results were found when financial performance indicators were extended by two years, suggesting that ROE will increase in the second year after a firm is certified with the standard, but EPS will decline in the third year.

CONCLUSION

The study findings empirically show that adoption of an OHSMS standard contributes to better financial performance for pharmaceutical firms of China in the short term. However, executives of pharmaceutical firms need to be aware of the increased costs related to certification renewal and audit in the following periods and exercise their management discretion to achieve a win-win situation between OHSMS implementation and financial benefit.

Financial performance of hospitals: A critical obligation of corporate governance dimensions

BACKGROUND

This paper aims to investigate the effects of corporate governance mechanisms on the financial performance of hospitals. The statement, "good corporate governance" has been incorporated in the health care sector over the last decade, as an element to improve financial performance.

METHODS

The researchers relied on both primary and secondary data in the study. For the primary data, the authors used structured and nonstructured questionnaires to obtain data from 125 hospitals. The secondary data used emanated from board meetings, financial statements and relevant reports of the selected hospitals from 2010 to 2017. However, the data was then sorted out to get the required information on Chief Executive Officer (CEO) presence, board relationship, governance dynamics, gender diversity and financial performance.

RESULTS

On the basis of empirical evidence provided in this study, the results show that the Independent Directors (INDPDR) variable has a positive effect on Return on Assets and Net Profit Margin and also a high statistically significant value of 0.000 for both performance measures. This is an indication that the variable, INDPDR, is highly capable of improving hospital financial performance. From our studies, Board Size and CEO Duality exhibited a negative relationship with the financial performance measures.

CONCLUSIONS

Every hospital needs money to maintain a standard health facility and to sustain in operation. However, the inclusion of board of directors improves hospital financial management and enhances performance. Corporate governance mechanisms influence the behavior of health systems in ways that are associated with financial performance.

Internal Control Quality, Enterprise Environmental Protection Investment and Finance Performance: An Empirical Study of China's A-Share Heavy Pollution Industry

As an important measure of enterprise governance, internal control can enhance the organizational rationality of the enterprise, ensure that the enterprise consciously assumes social responsibility for the protection of the natural environment and resources, and promote the sustainable development of the national economy. Using data from China’s A-share heavy pollution industry listed companies from 2009 to 2018, this study explored the relationships among internal control quality, enterprise environmental protection investment, and financial performance. The results show that the quality of internal control has a significant positive impact on enterprise environmental protection investment and financial performance. Enterprise environmental protection investment has a significant positive impact on financial performance and plays a partial intermediary role in the positive impact of internal control quality on financial performance. While expanding the theory of resource-based concepts, this study clarified the positive impact of corporate environmental management and practical behavior on corporate value and provides a theoretical basis for companies to actively implement environmental protection responsibilities, strengthen internal environmental management capabilities, and enhance corporate value. At the same time, it also provides a basis for the government to issue relevant environmental protection policies, strengthen enterprise internal control construction guidelines, and encourage third-party organizations to evaluate the effectiveness of enterprise internal control.

Economics of Disagreement-Financial Intuition for the Rényi Divergence

Disagreement is an essential element of science and life in general. The language of probabilities and statistics is often used to describe disagreements quantitatively. In practice, however, we want much more than that. We want disagreements to be resolved. This leaves us with a substantial knowledge gap, which is often perceived as a lack of practical intuition regarding probabilistic and statistical concepts. Here, we propose to address disagreements using the methods of financial economics. In particular, we show how a large class of disagreements can be transformed into investment opportunities. The expected financial performance of such investments quantifies the amount of disagreement in a tangible way. This provides intuition for statistical concepts such as the Rényi divergence, which becomes connected to the financial performance of optimized investments. Investment optimization takes into account individual opinions as well as attitudes towards risk. The result is a market-like social mechanism by which funds flow naturally to support a more accurate view. Such social mechanisms can help us with difficult disagreements (e.g., financial arguments concerning the future climate). In terms of scientific validation, we used the findings of independent neurophysiological experiments as well as our own research on the equity premium.

Financial Performance of Hospitals in the Appalachian Region Under the Hospital Readmissions Reduction Program and Hospital Value-Based Purchasing Program

PURPOSE

The Hospital Readmission and Reduction Program (HRRP) and Hospital Value-Based Purchasing Program (HVBP) propose to improve quality of patient care by either rewarding or penalizing hospitals through inpatient reimbursement. This study analyzes the effect of both programs on profitability of hospitals located in the Appalachian Region (AR) compared to hospitals in Appalachian states and the rest of the United States.

METHODS

This study used a retrospective research design with a longitudinal unbalanced panel dataset from 2008 to 2015. Hospitals participating in both HRRP and HVBP during this time frame were included in the study. A difference-in-difference model with hospital-level fixed effects, controlling for hospital and market characteristics, was used to determine effects of both programs on profitability of hospitals serving the AR, Appalachian states, and the rest of the United States.

FINDINGS

After implementation of HRRP and HVBP, only hospitals located in Appalachian states experienced a significant decrease in operating margin (-1.14 percentage points). Unexpectedly, during the same time period, total margin increased significantly for hospitals located in the AR (1.05 percentage points), Appalachian states (1.71 percentage points), and the rest of the United States (2.38 percentage points).

CONCLUSIONS

HRRP and HVBP financially incentivize hospitals to focus efforts on improving patient care. The programs may not have the anticipated results. Increases in total margin for all hospitals during the study period indicate access to nonpatient revenues, offsetting the financial penalties from both programs. This revenue source may undermine the program's objectives of delivering value and achieving quality outcomes.

Financial Performance of Public Hospitals: A Cross-Sectional Study among Polish Providers

There is growing evidence of a positive association between health care providers’ financial standing and the quality of care. In Poland, the instable financial situation and growing debt of public hospitals has been a source of concern for more than two decades now. The objectives of this paper were to compare the financial performance of public hospitals in Poland, depending on the ownership and organizational form; and analyze whether there is an association between financial performance and the chosen variables. We conducted a cross sectional study covering the whole population of public hospitals operating in 2018. The total number of included units was 805. The hospitals’ financial outcomes were measured by several variables; Spearman’s rank correlation was calculated, and a multivariable logistic regression model was performed. In 2018, the majority of public hospitals in Poland (52%) generated a gross loss, while 40% hospitals had overdue liabilities. There were statistically significant differences between hospital groups, with university hospitals and those owned by counties (local hospitals) being in the most disadvantageous situation. Additionally, corporatized public hospitals performed worse than those functioning in the classic legal form of independent health care units. Urgent actions are needed to measure and monitor the potential impact of financial performance on the quality of care.