Non-profit and for-profit organizations in home care services: a comparative analysis

The paper analyzes differences in the organizational, structural and strategic behavior of Non-Profit Organizations and For-Profit Organizations in Israel which provide home care services for the frail elderly. In contrast to other studies which have analyzed differences between institutions delivering various social services in the profit and non-profit sectors, this paper focuses on those organizations supplying home care services in the community. The findings suggest that NPO's have qualitative and operational advantages over FPO's.     

Home care workers' assessment of differences between nonprofit and for-profit organizations delivering home care services to the Israeli elderly

This paper presents research findings analyzing home care workers' assessment of the differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly. The study focuses in particular on the workers' motives for choosing a particular employer, their empowerment, the training and enrichment programs available to them, and their perceptions of organizational fairness and performance. Nonprofit organizations received higher evaluations from workers than did for-profit organizations and invested more in the management of human resources.     

Strategic management and performance differences: nonprofit versus for-profit health organizations

Despite mixed and contradictory findings, for-profits (FPs) and nonprofits (NPs) are assumed to be similar health services organizations (HSOs). In this study, a fifteen-item scale assessing HSOs' strategic management capacity was developed and tested using fifty-seven FP and twenty NP organizations. Then, using item response theory, the items were hierarchically profiled to produce two strategic profile models, a general and an FP anchored model. We find that deviation from the general profile, but not capability attainment level, is related to two of three financial measures. We conclude that studying FPs and NPs together is appropriate.     

Nontraditional services provided by nonprofit and for-profit hospitals: implications for community health

In part because of reimbursement changes in the 1980s, hospitals became involved in health promotion and disease prevention activities often to attract patients. Today, these services may have an effect on the burden of disease and on illness prevention in some communities. Given the changes anticipated in healthcare delivery, assessing the scope of these services and integrating them with other private-public efforts is of utmost importance. Here we use a 1993 survey of all 4,977 private medical and surgical hospitals in the United States to determine the scope of disease prevention, health enhancement, and palliative services provided by facility type, geographic location, and institutional ownership. We found that church-operated and other nonprofit hospitals appear to provide a spectrum of palliative and preventive health services both for their patients and those in the local community. Given their apparent scope, these services could have an effect on the burden of disease and on illness prevention in many communities. With major changes anticipated in future healthcare delivery and the recent failures reported for many community health intervention programs, healthcare administrators need to focus on ways to integrate their services with other private and public health efforts. If this could be achieved, then private hospitals could be more successful in serving their local communities and in enhancing the public's health in the new century. This article outlines several basic steps to assist administrators in achieving these goals.     

南方某省营利性与非营利性医院的比较分析

目的了解某省营利性医院的现状并与同等规模的非营利性医院进行比较。方法利用2002年常规卫生统计资料，使用71所有编制床位的营利性医院和同等规模的132所非营利性医院资料进行分析。结果营利性医院的人员规模小，基本上没有离退休人员的负担；提供的门急诊服务量小，但住院服务量与非营利性医院相同；收入和支出水平尚不到非营利性医院的一半，但是，能够保持收支平衡;营利性医院和非营利性医院一样存在病人欠费问题。结论在支持发展非公有制经济的政策环境下，营利性医院会有很大发展。因此，政策制定应慎重考虑可能的不利影响，并采取相应对策。     

Use of adult day services and home health care services by older adults: a comparative analysis

This study compares adult day services (ADS) and home health care (HHC) users on the indicators of personal characteristics, physical health, mental health and social network contacts. Analysis includes all 62 reported ADS users and a random sample of 91 HHC users from the Longitudinal Study of Aging. Results indicate that ADS users are younger, have greater cognitive impairment, need more supervisory assistance with activities of daily living (ADLs), and have more social contacts than HHC users. The findings also underscore the importance of emphasizing the functional and cognitive limitations in differentiating home- and community-based services. Instead of exclusively focusing on physical needs, authors suggest strategies that ensure integrated care models to address physical, mental and social needs of elders in both settings.     

Models of case management in long term home health care. The evolution of for-profit geriatric care management

Professional geriatric care management has the potential to provide an emotionally satisfying, lucrative career for the social worker or nurse who is self-educated or who has formal continuing professional education in assessment, care options, and care coordination. Yet GCM as an organized profession, or as a career choice for the individual, requires institutional supports to grow and flourish. The GCM profession requires recognition by the states (including certification and credentialing). A network must be developed so that young persons can receive a first professional degree, or at least a concentration within nursing or social work, in the legal and financial implications of elder care as well as the biology of aging and the techniques of hands-on physical care of the elderly. Structures must be created for continuing professional education of the GCM practitioner. The various Medicaid programs that offer home care to the elderly and disabled rely heavily on assessment and case management; so does the entire Medicare system. However, the federal statutes and regulations do not explicitly authorize GCM participation in care planning. More to the point, they do not clearly authorize reimbursement of GCMs as independent professionals or as Medicare/Medicaid service providers. As private long-term care insurance evolves, GCM services should be recognized as proper components of the planning process (and therefore as services that can be reimbursed by the policy). Once this is done, the challenge for GCM professionals is to retain their focus on the needs of the elder and family, rather than to perceive themselves as gatekeepers who function to cut the cost of services instead of optimizing their variety and quality.(ABSTRACT TRUNCATED AT 250 WORDS)     

The merger of rural primary care and home health services.

The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.     

The convergence between for-profit and nonprofit hospitals in the United States

This paper proposes a novel model of the hospital industry in the United States in which firms in effect choose their ownership type and the regulatory and tax regimes under which they must function. Accordingly, I develop a model in which firms have identical objectives but differ in their ability to benefit from a given ownership form. Changes in the economic environment alter firms’ incentives to maintain a given ownership type. This in turn induces firms to modify their capacity and encourages some firms to switch ownership type. One implication of this model is that changes in the economic environment that have occurred since 1960 imply that the optimal size of those firms which choose to be for profit should more closely approximate the optimal size of firms which choose to be nonprofit. Hospital level data indicate that this size convergence has indeed occurred. In 1960, U.S. nonprofit hospitals maintained on average more than three times as many beds per hospital as their for-profit counterparts; following a monotonic decline in relative size, by 2000, the average nonprofit hospital was only 32% larger than the typical for-profit hospital. Declining roles of government hospitals, population growth, suburbanization, and increasing government intervention in the healthcare market help explain the convergence in size. Analysis of data at the state and Metropolitan Statistical Area (MSA) levels is consistent with the principal theoretical predictions.     

Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals.

Although, empirically, for-profit hospitals serve few poor and indigent patients, they may be able to shift capital more quickly than hospitals of other ownership types, thereby spatially avoiding poor patients. However, in a market with a relatively high proportion of for-profit hospitals, spatial avoidance of poor patients is not possible because spatial competition will exist in non-poor areas. The study examines hospital choice for maternity care in a market with many for-profits using a gravity model or conditional logit. The analysis shows that poor and Medicaid populations choose for-profit hospitals overall. Income, along with distance, is an important factor in hospital choice.     

Use of covered services in Medicare home health care

Using data on 295 patients entering Medicare home health care at discharge from Medicare hospital stays, we explain receipt of Medicare home health nursing, PT and OT visits, and length of stay. Care reflected need, but other factors also affected service allocation. Medicare program requirements, as well as variation in provider structure and case load, appear to introduce inequities. Critical in light of recurrent proposals to change Medicare coverage and benefits, findings underline the need to reconsider Medicare home health policies that lead to denial of needed services, inequitable allocation of benefits, and premature termination of care.     

The home health care routing and scheduling problem with interdependent services

This paper presents a model for the daily planning of health care services carried out at patients’ homes by staff members of a home care company. The planning takes into account individual service requirements of the patients, individual qualifications of the staff and possible interdependencies between different service operations. Interdependencies of services can include, for example, a temporal separation of two services as is required if drugs have to be administered a certain time before providing a meal. Other services like handling a disabled patient may require two staff members working together at a patient’s home. The time preferences of patients are included in terms of given time windows. In this paper, we propose a planning approach for the described problem, which can be used for optimizing economical and service oriented measures of performance. A mathematical model formulation is proposed together with a powerful heuristic based on a sophisticated solution representation.     

Growth of for-profit health care institutions

In a policy statement adopted by its Governing Council on 16 November 1983, the American Public Health Association (APHA) expresses its opposition to the growth of for-profit health care institutions. APHA reiterates its support for a comprehensive national health service and for interim measures leading in that direction. The statement calls upon Congress and the Department of Health and Human Services to investigate the social impact and monitor the growth of for-profit health care institutions.     

Physicians' attitudes and behaviors toward home health care services

The authors investigate physicians' attitudes, information-seeking behaviors, and behavioral intentions toward home health care programs. Survey results show that physicians favor the concept, but knowledge and awareness levels about available programs vary with the physicians' specialties. Evidence also is reported on specific problems encountered, sources of information used to make home care referrals, and physicians' perceptions of the impact of home care programs on their practice. Finally, policy implications are drawn for marketers of home health care programs.     

Measuring primary care services performance: issues and opportunities from a home care pilot experience in the Tuscan health system

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from 'hospital-centred' health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.     

A comparative analysis of agencies providing home health services.

This study analyzed hospital-based and community-based home health care agencies by means of a small purposive comparative case analysis. The results revealed that hospital-based agencies were different from community-based agencies in terms of agency organization, management, personnel, revenues and expenditures. The voluntary community-based agencies examined were free-standing, single purpose agencies providing the lion's share of direct services to the home health care population. The hospital-based agencies (and public community-based agencies) examined were components of larger organizational structures. Hospital-based agencies concentrate their activities on case finding, case management, and the coordination of patient services, as well as the direct provision of medical therapy and social services. The type of home health agency, community-based or hospital-based, or those examined has been found to define this agency's primary function. This also determined its personnel/staffing pattern and consequently, to a large extent, its expenditure pattern. Additionally, most revenues for certified home health agencies are derived from cost-based reimbursement methodologies of public funding sources. Therefore, agency surpluses or shortages are primarily associated with personnel expenditures and therefore with agency mission and agency type. This study concludes with a discussion of some trends and events that are likely to affect the home health care agencies of the future.     

Marketing home health care medical services: the physician's view

The authors surveyed physicians serving the Jackson, Mississippi home health care market. They identified problems and studied physician perceptions regarding services provided by home health care agencies, private duty nursing agencies, and durable medical equipment suppliers. Respondents perceived home health care as providing: (1) increased patient satisfaction, (2) greater patient convenience, (3) earlier discharge, and (4) lowered patient costs. They least liked: (1) lack of control and involvement in the patient caring process, (2) paperwork, (3) quality control potential, and the possibility that patient costs could increase. Two sets of implications for health care marketers are presented that involve both national and regional levels. Overall results indicate that a growing and profitable market segment exists and is being served in an effective and socially responsible manner.