Patterns in hospitals'' use of a regional poison information center

A statewide poison center undertook a study to identify types of hospitals which used its information services. Initial trends in calls from hospitals to the center over the center's first two years and percentages of hospitals' patient caseloads for which the center consulted were analyzed for 104 acute care hospitals by hospitals' location, size, and emergency room staffing. After the center's establishment as a regional resource, emergency room staff in urban teaching hospitals showed the greatest increase in calls within a year (88 per cent) and the highest consultation rates for poison patients seen (57 per cent). Private physician emergency room staff, and staff in distant and rural hospitals, showed lower or no increases in calls and lower consultation rates. Findings suggest that private physician emergency room staff and staff in distant and rural hospitals be considered for poison center outreach. Marketing of consultation services for non-pediatric overdoses is also indicated.     

Impacts of the medical malpractice slowdown in Los Angeles County: January 1976.

The Los Angeles County (California) physician strike of January 1976 resulted in a partial withdrawal of physician services. Among recorded impacts were a $17.5 million loss in hospital revenues and an $8.5 million pay loss for hospital employees. Several surveys revealed no evidence of a significant impact on the general public in finding medical care. Analysis of emergency room visits and paramedical ambulance calls showed no significant increases during the strike. County mortality statistics for the strike were not affected. Eighty-eight fatalities among 2,171 patients transferred during the strike were analyzed; a Case Attributable Mortality Probability generated on 21 cases selected for final review by a five-physician multispecialist panel indicated that 29 per cent of the Attributable Mortality could be ascribed to the strike itself and 71 per cent to ongoing "patient dumping" from private sector to County hospitals. Even if sample attributable mortality rates were generalized to overall county deaths, the resultant figures are below the estimated range of 55 to 153 deaths that did not occur because of the number of elective operations not performed secondary to the strike.     

What can the Canadians and Americans learn from each other's health care systems?

Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single‐payer system to save 12–20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white‐collar jobs at hospitals, physician offices and insurance companies, a long‐term economic gain. Only a few would agree with the statement that Canada already functions with a multi‐payer reimbursement system as evidenced by (1) a federal‐provincial, tax‐supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer‐paid health insurance benefits, underwritten primarily by investor‐owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper‐income Canadians could opt out of their federal‐provincial plan and purchase private insurance coverage — being eligible for far more comprehensive “private” benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non‐emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to “private” wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two‐tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in considerable political rancor. There is greater likelihood, however, that the Canadians because their need to be more effective and efficient in their delivery of care, and their overall long‐term fiscal outlook will agree to the further privatization of their healthcare system before the Americans will mandate universal access, use the smart card to process insurance eligibility and claims or will impose price controls on high‐tech services and on pharmaceuticals. Copyright © 2016 John Wiley & Sons, Ltd.     

Childhood accidents: a registration in publicand private medical facilities of a French health care area

In 1981–2 details were recorded of children treated for accidental injury in an area near Paris: 8026 cases were collected. This is the first French survey involving the entire health care system (including practitioners and private hospitals). Thirty-two per cent of the hospital cases were recorded in private hospitals. These children were relatively older than children treated at public hospitals, and had more often been involved in sports accidents. It appears that the incidence of accidents cannot be assessed from public hospital data only and that practitioners should also be involved in the registration, though their co-operation is hard to obtain in surveys. The high rate of sport accidents (17% after the age of 6 years), often involving fracture, warrants further study.     

The Impact of Accessibility on the Use of Specialist Health Care in Norway

The aim of this study is to explore to what extent the policy goal of allocating health care according to medical need is fulfilled in Norway. Hence, we are interested in studying the impact of a person's health relative to the impact of access to specialist care. We distinguish between services provided by public hospitals and services provided by private specialists financed by the National Insurance Scheme. While a person's self-assessed health plays a major role in the utilization of hospitals, we find no significant effect of this variable on the utilization of private specialists. The accessibility indices for specialist care have significant effects on the utilization of private specialists, but not on hospital visits and inpatient stays. The challenge to policy makers is to consider measures that bring the utilization of publicly funded private specialists in accordance with national health policy.     

Hospital-sponsored primary care: I. Organizational and financial effects

Findings are presented from a seven-year (1976-83) evaluation of the Community Hospital Program (CHP), a national demonstration program sponsored by the Robert Wood Johnson Foundation to assist 54 community hospitals in improving the organization of access to primary care. Upon grant expiration, 66 per cent of hospital-sponsored group practices continued under some form of hospital sponsorship; over 90 per cent developed or were planning to develop spin-off programs; and new physicians were recruited and retained in the community. About 9 per cent of hospital admissions were accounted for by group physicians and grantee hospitals experienced a greater annual increase in their market share of admissions than competing hospitals in the area. While only three of the groups generated sufficient revenue to cover expenses during the grant period, 21 additional groups broke even during the first post-grant year. Productivity and cost per visit compared favorably with most other forms of care. Hospitalization rates from the hospital-sponsored practices were somewhat lower than those for other forms of care. Medical director leadership and involvement and the organization design of the practice were among several key factors associated with higher performing practices. The ability of such joint hospital-physician ventures to meet the needs of the poor and elderly in a time of Medicare and Medicaid cutbacks is discussed along with suggestions for targeting future initiatives in primary care.     

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.     

城乡医院医生工作效率的分析

分析不同地区、类别医院工作效率变动效率，为医院改革提供依据。该采用医生日均门诊数和医生床日数在1986－1997年间的变动趋势，进行投入-产出分析。结果显示12年间门诊和住院工作效率指标都有下降，平均下降1／3左右。城市医院效率优于农村、经济发达地区医院效率优于不发达地区。建议进一步分析引起医院效率下降的原因，并提出综合卫生改革的建议。     

Health care reform: how hospitals, physicians should prepare

As the momentum behind health care reform continues to build, hospitals should take specific steps to prepare for each likely scenario. The authors speculate about what form health care reform will take, discuss the strategic implications of each scenario and suggest steps hospitals should take, including an analysis of hospital/physician integration, marketing, services and efficiency.     

Variations in physicians' hospitalization practices: a population-based study in Manitoba, Canada.

This paper uses claims data from a universal health care system to describe physicians' hospitalization styles after adjusting for case-mix characteristics of their primary patients. Patients were uniquely assigned to that physician (general or family practitioners, internist, general surgeon, or obstetrician/gynecologist) seen most frequently over each two two-year periods (1972-74 and 1974-76). Four indices were developed including: 1) percentage of primary patients hospitalized; 2) mean number of readmissions for such patients; 3) mean length of stay; and 4) total days of hospitalization per primary care patient (a summary measure combining the first three). Rates of admission, not length of stay, were shown to be strongly related to this summary measure. Marked variations in the hospitalization indices were observed across physicians; these variations cannot be explained by the health or sociodemographic characteristics of a physician's patients. Rural physicians practicing in areas with high bed-to-population ratios and low occupancy rates were particularly high users of hospitals. The economic implications of different practice styles are shown to be large; physicians who were high users of hospitals serve 27 per cent of the patients but their patients consume 42 per cent of the hospital days.     

Public money, private control: a case study of hospital financing in Oakland and Berkeley, California

Government support of public and private hospitals in Oakland and Berkeley, California was investigated. The private hospitals received government subsidies amounting to at least 60 per cent of their total revenues. The dollar amount of the subsidies to private hospitals was four and one-half times greater than government expenditures on the public hospital. In Oakland and Berkeley, as in many cities, public medical services have been reduced while both government health expenditures and private hospital revenues have increased sharply. The private hospitals, although all nominally non-profit, exhibit revenue maximizing behavior which results in socially unjust and medically irrational resource allocation. Funds might be found for public hospitals and clinics, and resources allocated more justly and rationally, if government expenditures in the private sector were brought under greater public scrutiny and control.     

The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals

Administrative costs account for 25 percent of health care spending, but little is known about the portion attributable to billing and insurance-related (BIR) functions. We estimated BIR for hospital and physician care in California. Data for physician practices came from a mail survey and interviews; for hospitals, from regulatory reporting; and for private insurers, from a consulting company. Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7-11 percent, respectively. Overall, BIR represents 20-22 percent of privately insured spending in California acute care settings.     

Small Town Health Care Safety Nets: Report on a Pilot Study

CONTEXT: Very little is known about the health care safety net in small towns, especially in towns where there is no publicly subsidized safety-net health care. PURPOSE: This pilot study of the primary care safety net in 7 such communities was conducted to start building knowledge about the rural safety net. METHODS: Interviews were conducted and secondary data collected to assess the community need for safety-net care, the health care safety-net role of public officials, and the availability of safety-net care at private primary care practices and its financial impact on these practices. FINDINGS: An estimated 20% to 40% of the people in these communities were inadequately insured and needed access to affordable health care, and private primary care practices in most towns played an important role in making primary care available to them. Most of the physician practices were owned or subsidized by a hospital or regional network, though not explicitly to provide charity care. It is likely this ownership or support enabled the practices to sustain a higher level of charity care than would have been possible otherwise. In the majority of communities studied, the leading public officials played no role in ensuring access to safety-net care. CONCLUSIONS: State and national government policy makers should consider subsidy programs for private primary care practices that attempt to meet the needs of the inadequately insured in the many rural communities where no publicly subsidized primary safety-net care is available. Subsidies should be directed to physicians in primary care shortage areas who provide safety-net care; this will improve safety-net access and, at the same time, improve physician retention by bolstering physician incomes. Options include enhanced Medicare physician bonuses and grants or tax credits to support income-related sliding fee scales.     

Hospital utilization and reimbursement method in Brazil

Urban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case-based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit-making hospitals is very high. The case-based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit-making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from ‘patient day’ to case or procedure.     

Evaluation of Viewpoints of Health Care Professionals on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas Based on Practice Environment

We sought to evaluate whether health care professionals’ viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals (one tertiary care academic medical center, three large community hospitals and two small community hospitals). The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and case specific queries. Respondents used a 5-point Likert scale to express their degree of agreement with the premises posed. We used the ANOVA test to evaluate whether respondent views significantly varied based on practice location. 240 health care professionals (108—tertiary care center, 92—large community hospitals, 40—small community hospitals) completed the survey (response rate: 63.6 %). Only three individual queries of 32 showed any significant response variations across practice locations. Overall, viewpoints did not vary across practice locations within question categories on whether the ethics committee or hospital had a role in case resolution, what that role might be and case specific queries. In this multicenter survey study, the viewpoints of health care professionals on the role of ethics committees or hospitals in the resolution of clinical ethics cases varied little based on practice location.     

Privatization of hospitals: meeting divergent interests

The United States, Germany, and the United Kingdom are experiencing a trend toward the privatization of hospitals--most frequently involving poorly positioned facilities that need: additional capital for replacement of plant and equipment; improved management systems to reduce the number of their nondirect patient care employees; and an aggressive physician recruitment effort. A number of these institutions might have been otherwise shut down, resulting in the loss of good paying jobs; however, these closures would have reduced the nation's total health care expenditures. The acquisition in the United States and Germany by investor-owned hospital corporations of major teaching institutions suggests that the for-profits have become an integral part of their country's health care delivery system. Privatization now even occurs within the egalitarian British National Health Service with the availability of private medical insurance, private hospitals, and private beds in public hospitals being managed by investor-owned groups. Being acquired by a for-profit is often a means to secure needed capital and is politically less fractious than closing down a marginally needed government-sponsored or a not-for-profit facility.     

Public health in hospitals: the missing link in health improvement

Traditionally, public health professionals have scorned hospitals as the antithesis of community health. Secondary care remains notably distant from public health practice and policy. Yet hospitals consume over 50 per cent of the health budget and over a quarter of the population have contact with hospital services every year. There is an important public health agenda in hospitals for promoting health and an environment that encourages community partnership and a healthy place to work and be. Public health skills have a key role in ensuring high-quality, safe and evidence-based health care. Epidemiological support for hospitals can promote a much-needed culture of monitoring and evaluation of health services. A public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. We argue that public health hospitals should not be an oxymoron, but an essential component of public health strategy. Different approaches to putting public health into hospitals are discussed.     

Charges and charge coverage in the treatment of HIV/AIDS patients in a rural southern state

In Mississippi it was not known where Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Disease Syndrome (AIDS) persons receive care, what type of care is available to them, and how care is financed. To ascertain inpatient treatment charges of HIV/AIDS patients, a medical record review was conducted at 10 priority hospitals distributed across Mississippi. One-hundred fifty-six (156) patient records were randomly selected from a population of persons with HIV/AIDS. A total of 3,865 patient days was recorded for all hospitals. Available overall hospital charges per paid day ranged from +401.63 to +1,261.34, with an average charge of +741.65 per day. Average length of stay was 25 days. Average charge per hospitalization per patient totaled +18,541. Concerning source of payment, 44.8% of the patients had private insurance, 29.9% listed Medicaid as their payment source, 7.8% were on Medicare, 1.3% had supplemental insurance, and 16.2% of patients reviewed had no payment source. Based on this review, it is evident that the number of AIDS patients covered by private health insurance will continue to decline and the payment responsibilities will continue to shift to public supported programs. Acquired immunodeficiency syndrome brings attention to the weakness of Mississippi's health care financing system and will continue to force consideration of alternative financing mechanisms.     

Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles

The internal validity of the recording of information about ischaemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in the administrative health care datafiles of the Canadian province of Saskatchewan is investigated. Comparisons between hospital data and medical charts for acute myocardial infarction and chronic airways obstruction patients showed excellent diagnostic agreement: 97 per cent and 94 per cent, respectively. Appropriate physician service claims were identified for 89 per cent of hospitalizations for IHD and COPD and exact concordance between diagnoses in the two datafiles varied between 15 per cent for acute/sub-acute IHD and 80 per cent for asthma; including any physician diagnosis within the same broad category (IHD or COPD) increased concordance to 79–94 per cent for IHD and 64–88 per cent for COPD. Contextual information related to the hospitalizations was clinically and epidemiologically realistic.     

Coverage of cancer patients by hospice services, South Australia, 1990 to 1993

Abstract: A population-based observational study of South Australian cancer patients was used to identify: the level of coverage of cancer patients by hospice services; the types of patients who miss out on hospice care; and the place of death of hospice and other cancer patients. We reviewed patients who died in 1990 and 1993 using the Central Cancer Registry database together with an identifier of hospice involvement. In 1990, 56 per cent of cancer patients who died had care from a hospice service, and this proportion increased to 63 per cent in 1993. Elderly patients, rural residents and those with a haematological malignancy were less likely than other patients to receive care from a hospice service, while patients aged between 40 and 60 years, longer survivors and those born in the United Kingdom and Europe were more likely to receive hospice care. Hospice involvement increased significantly between 1990 and 1993 for patients who died at home (59 to 73 per cent), in nursing homes (20 to 45 per cent), private hospitals (33 to 52 per cent) and public hospitals (48 to 55 per cent), but the proportion of patients with hospice involvement who died in country hospitals remained at 45 per cent. The increase in hospice coverage of terminal cancer patients reflects the continued integration of hospice care into the mainstream of health care delivery. The types of patients who miss out on hospice services should be given special consideration in the future planning of terminal care services. ( Aust N Z J Public Health 1998; 22: 45-8)