Do hospital mergers reduce costs?

Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals.     

Do health maintenance organizations work for Medicare?

Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.     

Do they work? Regulating for-profit providers in Zimbabwe

The experience of low- and middle-income countries (LMC) with respect to regulation and legislation in the health sector is in marked contrast to that of Canada and Europe. It is suggested that the degree to which regulatory mechanisms can influence private sector activity in LMC is quite low. However, there has been little work done on exploring just how, and to what extent, these regulations fail. Through the use of stakeholder interviews, this study explored the effectiveness of regulations directed at the private-for-profit sector (general practitioners, private clinics and hospitals) in Zimbabwe. The study found that there was limited and asymmetric knowledge of basic regulations among government bodies and private providers. However, there was a clear feeling that regulations are not being implemented and enforced effectively. A variety of opportunistic practices have been observed among private providers, including: practices of self-referral, where patients are sent to other services the provider has a financial interest in; over-servicing; doctor-patient collusion to collect health insurance payments; and the use of unlicensed staff in private facilities. Key factors limiting effectiveness of regulation in the health sector include the over-centralization and lack of independence of the regulatory body, the absence of legal mechanisms to control the price of care, and the lack of knowledge by patients of their rights. The study also identified a number of potential strategies for improving the current regulatory environment. For example, in order to improve monitoring, 'informal' arrangements between the centralized regulatory body and local authorities developed. There is a need to develop ways to formalize the role of these authorities. In addition, professional associations of private providers are also identified as key players through which to improve the impact of regulation among private providers. Increasing consumer access to information and knowledge is another potential way to improve information within the regulatory process as well as implementation.     

Do French low-income GPs choose to work less?

In France, a significant number of General Practitioners (GPs) earn less than 1.5 times the French minimum salary. Using a representative panel of self-employed GPs over the years 1993-2004, this paper tests whether these low-income GPs choose to work less than all other GPs or whether they are constrained to do so. The test is based on measuring reactions to positive and negative demand shocks. As low-income GPs do not increase activity in response to a positive demand shock but decrease activity in response to a negative demand shock, it appears that their low-income status is attributable to a strong preference for leisure.     

Do hospital mergers increase hospital efficiency? Evidence from a National Health Service country

OBJECTIVES: To analyse the effects on technical and cost efficiency of seven hospital mergers over the period 1992-2000 in Norway. The mergers involved 17 hospitals. METHODS: First, efficiency scores were generated using Data Envelopment Analysis for 53 merged and non-merged hospitals over the nine years. Second, the effect of mergers was estimated through panel data analysis. RESULTS: In general, the mergers showed no significant effect on technical efficiency and a significant negative effect of 2-2.8% on cost efficiency. However, positive effects on both cost and technical efficiency were found in one merger where more hospitals were involved, and where administration and acute services were centralized. CONCLUSION: The findings indicate that large mergers involving radical restructuring of the treatment process may improve efficiency as intended, but most mergers do not.     

Do economic stresses influence child work hours on family farms?

BACKGROUND: Economic stresses are a frequently cited reason for children doing farm work. OBJECTIVE: To explore the relationship between economic indicators and child agricultural work hours between January 2001 and October 2003. METHODS: This ecologic study design compares trends in aggregate child work hours with national and regional economic indicators. Child work hours were obtained from quarterly surveillance data from a randomized field trial of agricultural task guidelines for children. 2,360 children living or working on 845 farms in central New York participated in the original study. The relationship between child work hours and three economic indicators: national all farm index (AFI) ratio, national fuel index, and regional milk prices was analyzed using times series plots, correlation, and multiple linear regression. RESULTS: The AFI ratio was positively correlated with child work hours (r = 0.49, p = 0.008) but there was no significant correlation between child work hours and fuel or milk prices. Multiple linear regression demonstrated that the relationship between AFI and child work hours is independent of a seasonal effect. CONCLUSIONS: Increased child work hours may be associated with periods of higher farm sector productivity, rather than economic stress per se. Findings are limited by the ecologic study design, use of national economic indicators, and the limited number of cycles of child work hours available for time series analysis. Economic conditions may influence decisions about children's farm work.     

Do the long-term unemployed regard themselves as able to work?

Aims

Although work ability has been extensively explored in the occupational setting, this issue is only marginally studied among the unemployed. In the presented study, we examine whether long-term unemployed persons regard themselves as able to work, and we analyse their employability in specific sub-groups as well as compare it with the work ability of the general population.

Subjects and method

The data were collected in three European cities, Frankfurt/Main, Warsaw and Graz. The participants were recruited in social institutions that help people find employment. The evaluation instrument of employability was the first dimension of Work Ability Index developed by the Finnish Institute of Occupational Health in Helsinki. Additionally, socio-demographic features were enquired.

Results

Compared to the representative Finnish adult population, the study sample has significantly lower work ability scores. The Kruskal-Wallis test shows no significant differences among study samples of the long-term unemployed regarding their experience and evaluation of work ability in relation to their country of origin. Noteworthy, we found significant differences among the analysed groups of the long-term unemployed, e.g. persons with health impairments regarded their work ability significantly lower than other groups. According to the Pearson’s correlations, work ability is significantly and negatively associated with length of unemployment and age.

Conclusions

There is no single level of work ability among the long-term unemployed. Furthermore, the work ability decreases with the length of unemployment as well as with age. In the context of high rates of unemployment, it is important for health promotion and labour market integrating programmes to maintain and stabilise work ability in due consideration of a need to conceptualise problem-orientated measures for these vulnerable groups.     

Do parents' perceptions of risks protect children engaged in farm work?

BACKGROUND: The purpose was to describe farm parents' perceptions of risks on their farms and determine if these perceptions were associated with (1) using of the North American Guidelines for Children's Agricultural Tasks (NAGCAT) and (2) making NAGCAT-recommended changes to enhance the safety of farm work for their children. METHODS: This is a secondary analysis of data collected by telephone interview during a randomized trial that involved 450 farms in the United States and Canada. RESULTS: While 81% of farm parents perceived farming to be more dangerous than other occupations, only 66% of those parents felt that it was more dangerous for children to work on a farm than at other work. Furthermore, risk perception scores were only weakly associated with parents' use of NAGCAT and making NAGCAT-recommended safety changes. CONCLUSION: Even with voluntary safety guidelines in hand and the general perception of farming as a dangerous occupation, many farm parents were not actively using NAGCAT to reduce the exposure of their children to hazardous farm work. Together with the continuing morbidity and mortality among farm children, this suggests that voluntary guidelines alone may not be sufficient to protect children working on farms.