For-Profit Status and Geographic Distribution of Trauma Centers in the US

This cohort study assesses geographic distribution of for-profit and not-for-profit trauma centers in the US designated by their states between 2014 and 2018.

Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey

OBJECTIVE

To assess Brazilian pediatric intensivists' general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications.

METHODS

This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence.

RESULTS

The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%).

CONCLUSION

Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.

The strange case of less C-sections: Hospital ownership, market concentration, and DRG-tariff regulation

We evaluate the relationship between hospital ownership and responses to a policy providing large financial incentives for vaginal deliveries and financial disincentives for C-sections. We compare for-profit, nonprofit, and public hospitals operating in a public health care system organized according to the quasi-market model. We first theoretically show that hospital ownership matters insofar different hospitals are characterized by different ethical preferences. We also show that competition makes ownership less important. We then consider the case study of Lombardy in Italy. We exploit spatial variation in hospital ownership and in market concentration at the local level to evaluate the relationship between ownership and the probability of C-section. According to theory, empirical results strongly suggest that competitive pressures from alternative providers tend to homogenize behaviors. However, in local monopolies, in presence of a strong monetary incentive toward vaginal deliveries, we do observe less C-section from private for-profit hospitals than from public and private nonprofit hospitals, especially when C-sections are medically appropriate.

Competition and screening with motivated health professionals

Two hospitals compete for the exclusive services of health professionals, who are privately informed about their ability and motivation. Hospitals differ in their ownership structure and in the mission they pursue. The non-profit hospital sacrifices some profits to follow its mission but becomes attractive for motivated workers. In equilibrium, when both hospitals are active, the sorting of workers to hospitals is efficient and ability-neutral. Allocative distortions are decreasing in the degree of competition and disappear when hospitals are similar. The non-profit hospital tends to provide a higher amount of care and offer lower salaries than the for-profit one.

The Capital Budgeting Process of Healthcare Organizations: A Review of Surveys

Several surveys have been administered over the last 40 plus years to learn about capital budgeting practices of healthcare organizations. In this report, we analyze and synthesize these surveys in a four-stage framework of the capital budgeting process: identification, development, selections, and post-audit. We examine three issues in particular: (1) efficiency of for-profit hospitals relative to not-for-profit hospitals, (2) capital budgeting practices of the healthcare industry vis-à-vis other industries, and (3) effects of healthcare mergers and acquisitions on capital budgeting decisions. We found indirect evidence that for-profit hospitals exhibited greater efficiency than not-for-profit hospitals in recent years. The acquisition of not-for-profits by for-profits is credited as the primary reason for growth of multihospital systems; these acquisitions may have contributed to the more efficient capital budgeting practices. One unique attribute of healthcare is the dominant role of physicians in almost all aspects of the capital budgeting process. In agreement with some researchers, we conclude that the disproportionate influence of physicians is likely to impede efficient decision making in capital budgeting, especially for nonprofit organizations.

Barriers to use of oral rehydration salts for child diarrhea in the private sector: evidence from India

Diarrhea is the second leading cause of child mortality in India. Most deaths are cheaply preventable with the use of oral rehydration salts (ORS), yet many health providers still fail to provide ORS to children seeking diarrheal care. In this study, we use survey data to assess whether children visiting private providers for diarrheal care were less likely to use ORS than those visiting public providers. Results suggest that children who visited private providers were 9.5 percentage points less likely to have used ORS than those who visited public providers (95% CI 5-14). We complimented these results with in-depth interviews of 21 public and 17 private doctors in Gujarat, India, assessing potential drivers of public-private disparities in ORS use. Interview results suggested that lack of direct medication dispensing in the private sector might be a key barrier to ORS use in the private sector.

Independent partners. Unlike mergers or sales, noncontrol deals preserve local governance

Noncontrol deals protect local governance, yet yield mergerlike benefits.

Strategic IT alliances. Independent hospitals tap into the benefits of scale by forming regional coalitions

By forming regional coalitions, independent hospitals are able to access big system-size technology.

The big squeeze. CHS-HMA merger tightens the vise on independent hospitals

News of the Community-HMA merger shows the increasing momentum for such deals. The merger will allow Community to diversify and find synergies where it can cut expenses. "The volumes are a little more critical in nonurban hospitals than urban hospitals. As 2014 gets here and we start enrolling people (in health insurance exchanges), then the revenue will start to grow," says Wayne Smith, left, Community's chairman, president and CEO.

No ROI in ACO. Risk, expense of Medicare program has most for-profit groups shying away

For-profit healthcare companies aren't beating down the door to get in on Medicare ACOs. Several of the big chains say there is too much uncertainty about the experiment, and they're waiting to see how the program evolves. One company on the sideline is Capella Healthcare. Chairman and CEO Daniel Slipkovich, left, says there is a potential for high patient dropout rates and risks in population management.

Change of status: the conversion from nonprofit to for-profit status requires extensive due diligence from the board

Trustees must demonstrate due diligence in a for-profit conversion.

Global implications from the US hospitals privatization experience

This Article summarizes the US market and regulatory forces which have contributed to--and are expected to accelerate the pace of--"public" or "governmental" hospital privatizations. It also sets forth the rationale for why we can expect to see an increasing number of governmental hospitals worldwide likewise choosing to restructure their governance platforms.

Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

BACKGROUND

The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served.

METHODS

We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR) (N = 10,478) and total knee replacement (TKR) (N = 15,312) in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999-2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR), hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data.

RESULTS

Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P < .001), were less likely to be affiliated with a medical school (6% vs. 43%, P = .05), and were more likely to be for profit (94% vs. 28%, P = .001). Patients who underwent major joint replacement in physician owned specialty hospitals were less likely to be black than patients in non physician owned specialty hospitals (2.5% vs. 3.1% for THR, P = .15; 1.8% vs. 6.3% for TKR, P < .001), yet physician owned specialty hospitals were located in neighborhoods with a higher proportion of black residents (8.2% vs. 6.7%, P = .76). Patients in physician owned hospitals had lower rates of most common comorbid conditions including heart failure and obesity (P < .05 for both).

CONCLUSION

Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.

Variation in the rates of operative delivery in the United States

OBJECTIVES

This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making.

STUDY DESIGN

We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004.

RESULTS

In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% +/- 5% (range 9-37) and 7% +/- 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery.

CONCLUSION

Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.

Chains weigh on on access. The FAH joins the throng offering proposals to solve the uninsured crisis, but some say their plan lacks a key element

Yet another proposal for covering the uninsured landed in the news last week, as the Federation of American Hospitals offered its plan, estimated to cost 115 dollar billion annually. While the plan drew some praise, others questioned its validity. "It's hard to take seriously a proposal that doesn't even attempt to address the fundamental issue of how all is this going to get paid for," says Susan Sherry, left.

Comparing public and private hospital care service quality in Turkey

PURPOSE

The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey.

DESIGN/METHODOLOGY/APPROACH

This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality.

FINDINGS

The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals.

ORIGINALITY/VALUE

Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.

Is there a future for the not-for-profit hospital?

The issue of the future of the not-for-profit hospital is not one of not for profit versus investor owned, but of economic viability. A shift toward business practices in the not-for-profit hospital is occurring and may help explain why few studies have been able to show distinctive differences between not-for-profit and investor-owned hospitals. Although the system is set up to give not for profits special privileges for promoting a societal common good, a gradual erosion of those privileges has blurred the distinction between the two types of entities. With a process I call "competitive advantage incrementalism," investor-owned hospitals chip away at the privileges afforded their tax-exempt competitors. At the same time, the not-for-profit hospitals increasingly adopt the successful practices of the business world, and are guided by board members and executives who hold to a big-business view of healthcare. What is the future for the not-for-profit hospital? They must continue to exist, although they can expect increasing operating burdens to continue as not for profits. They and investor-owned facilities become progressively more similar in operations and structure. The not-for-profit institutions must prove that they produce a community benefit to justify not-for-profit status. That is a heavier burden than merely producing a high rate of return for investors.