Hospital market share: the declining share of small players in the market

Analysis of a set of isolated hospital markets reveals that low-market-share hospitals have experienced a consistent decline in their market share for the last five years. The challenges presented by such a decline in market share are compounded by the overall decline in the total market (in terms of number of hospital discharges) for the markets studied. It is suggested that significant strategy changes may be required if low-market-share hospitals are to survive.     

Hospital performance reports: impact on quality, market share, and reputation

This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. The findings indicate that making performance data public results in improvements in the clinical area reported upon. An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.     

Predicting self-assessed health status: a multivariate approach.

Two-stage multivariate analysis was used to examine factors affecting personal perception of health status. In the first stage, sociodemographic variables were used as independent variables in Automatic Interaction Detector (AID) analysis in order to partition the study sample (11,153 civilian noninstitutionalized adults aged 58-63) into subgroups. In the second stage, binary multiple regression analysis was performed on each AID subgroup and on the total sample. Predictors used were indicators of psychological, socioeconomic, and sociomedical well-being. Finally the applicability of these indicators in classifying persons in one of the two categories of perceived health status was examined by discriminant function analysis. Sociomedical health indicators were better explanatory variables of self-assessed health status than socioeconomic or psychological indicators of well-being.     

Hospital marketing: strategy reassessment in a declining market.

Despite continued significant increases in the nation's spending for health care, use of inpatient hospital services has declined. The authors use the product life cycle to analyze the market for inpatient hospital services and to examine competitive strategies for hospital marketing success. The product life cycle literature suggests at least four strategies for products in decline. The authors analyze the advantages and disadvantages of these strategies as they relate to the hospital market.     

Straight talk new approaches in healthcare. The outpatient market: protect important market share

Hospitals are facing competition from myriad freestanding players in the outpatient market. It's a fight hospitals can't afford to lose because they often use outpatient profits to cover losses in other service lines. Indeed about 60% of the average hospital's operating margin depends on outpatient revenues. In this session of Straight Talk, we examine how hospitals can build and finance outpatient services with physicians, increasing their competitiveness in increasingly competitive markets.     

Straight talk. New approaches in healthcare. Hospital/physician partnerships are key to growth of market share

Do you know who your biggest competitor is? It's probably your most loyal physician group. That's because up to 80% of hospitals are competing with their own medical staffs, according to PricewaterhouseCoopers' research. Physicians are launching revenue enhancement and diversification strategies to combat declining reimbursement and respond to the surge in demand for outpatient services. The solution: Hospital administrators need to aggressively develop economic partnerships with their medical staff. In this installment of Straight Talk, we discuss how two institutions have crafted viable hospital and physician ventures. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on growth strategies was held on May 6, 2003. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.     

Hospital mergers and market overlap.

OBJECTIVE: To address two questions: What are the characteristics of hospitals that affect the likelihood of their being involved in a merger? What characteristics of particular pairs of hospitals affect the likelihood of the pair engaging in a merger? DATA SOURCES/STUDY SETTING: Hospitals in the 12 county region surrounding the San Francisco Bay during the period 1983 to 1992 were the focus of the study. Data were drawn from secondary sources, including the Lexis/Nexis database, the American Hospital Association, and the Office of Statewide Health Planning and Development of the State of California. STUDY DESIGN: Seventeen hospital mergers during the study period were identified. A random sample of pairs of hospitals that did not merge was drawn to establish a statistically efficient control set. Models constructed from hypotheses regarding hospital and market characteristics believed to be related to merger likelihood were tested using logistic regression analysis. DATA COLLECTION: See Data Sources/Study Setting. PRINCIPAL FINDINGS: The analysis shows that the likelihood of a merger between a particular pair of hospitals is positively related to the degree of market overlap that exists between them. Furthermore, market overlap and performance difference interact in their effect on merger likelihood. In an analysis of individual hospitals, conditions of rivalry, hospital market share, and hospital size were not found to influence the likelihood that a hospital will engage in a merger. CONCLUSIONS: Mergers between hospitals are not driven directly by considerations of market power or efficiency as much as by the existence of specific merger opportunities in the hospitals'' local markets. Market overlap is a condition that enables a merger to occur, but other factors, such as the relative performance levels of the hospitals in question and their ownership and teaching status, also play a role in influencing the likelihood that a merger will in fact take place.     

Hospital service quality: a managerial challenge

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally.     

Hospital family planning: a vasectomy service

The vasectomy service at King's College Hospital in London has performed over 1600 operations since 1969 and evaluation of the program is presented. A counselling interview is held with the patient and his wife 2-4 weeks before the operation and is considered an indispensable part of the procedure. The outpatient operation is simple and performed under local anesthesia. The patient is advised to take a day or 2 off work, and seminal samples are collected until 2 consecutive negative samples are obtained and sterilization is achieved. The majority of vasectomy patients seen at this hospital were skilled manual laborers under 40 years old. The reason for vasectomy in 72% of the cases was completion of desired family size. A 5% complications rate was reported with this series of operations, and only 3 cases out of 1120 required hospitalization. In 79% of the cases the first 2 postoperative seminal fluid analyses were negative. Recanalization apparently occurred in 3 cases. Vasectomy was well accepted by the patients in this series and is viewed as a highly advantageous means of family planning for certain couples.     

Factor analyses of the Hospital Anxiety and Depression Scale: a Bayesian structural equation modeling approach

Purpose

The latent structure of the Hospital Anxiety and Depression Scale (HADS) has caused inconsistent results in the literature. The HADS is frequently analyzed via maximum likelihood confirmatory factor analysis (ML-CFA). However, the overly restrictive assumption of exact zero cross-loadings and residual correlations in ML-CFA can lead to poor model fits and distorted factor structures. This study applied Bayesian structural equation modeling (BSEM) to evaluate the latent structure of the HADS.

Methods

Three a priori models, the two-factor, three-factor, and bifactor models, were investigated in a Chinese community sample (N = 312) and clinical sample (N = 198) using ML-CFA and BSEM. BSEM specified approximate zero cross-loadings and residual correlations through the use of zero-mean, small-variance informative priors. The model comparison was based on the Bayesian information criterion (BIC).

Results

Using ML-CFA, none of the three models provided an adequate fit for either sample. The BSEM two-factor model with approximate zero cross-loadings and residual correlations fitted both samples well with the lowest BIC of the three models and displayed a simple and parsimonious factor-loading pattern.

Conclusions

The study demonstrated that the two-factor structure fitted the HADS well, suggesting its usefulness in assessing the symptoms of anxiety and depression in clinical practice. BSEM is a sophisticated and flexible statistical technique that better reflects substantive theories and locates the source of model misfit. Future use of BSEM is recommended to evaluate the latent structure of other psychological instruments.     

医院管理年与医疗服务质量的持续改进

文章结合新的医疗卫生改革形势,从医院管理年活动开展的背景、成效及存在的问题入手,阐述了医院管理年活动对于加强医院管理,促进医疗质量提升以及开展新的医院评审工作的作用及重要意义。     

Elasticities of market shares and social health insurance choice in Germany: a dynamic panel data approach

In 1996, free choice of health insurers was introduced to the German social health insurance system. One objective was to increase efficiency through competition. A crucial precondition for effective competition among health insurers is that consumers search for lower-priced health insurers. We test this hypothesis by estimating the price elasticities of insurers' market shares. We use unique panel data and specify a dynamic panel model to explain changes in market shares. Estimation results suggest that short-run price elasticities are smaller than previously found by other studies. In the long-run, however, estimation results suggest substantial price effects.     

Hospital quality: a PRIDIT approach

BACKGROUND: Access to high quality medical care is an important determinant of health outcomes, but the quality of care is difficult to determine. OBJECTIVE: To apply the PRIDIT methodology to determine an aggregate relative measure of hospital quality using individual process measures. DESIGN: Retrospective analysis of Medicare hospital data using the PRIDIT methodology. SUBJECTS: Four-thousand-two-hundred-seventeen acute care and critical access hospitals that report data to CMS' Hospital Compare database. MEASURES: Twenty quality measures reported in four categories: heart attack care, heart failure care, pneumonia care, and surgical infection prevention and five structural measures of hospital type. RESULTS: Relative hospital quality is tightly distributed, with outliers of both very high and very low quality. The best indicators of hospital quality are patients given assessment of left ventricular function for heart failure and patients given beta-blocker at arrival and patients given beta-blocker at discharge for heart attack. Additionally, teaching status is an important indicator of higher quality of care. CONCLUSIONS: PRIDIT allows us to rank hospitals with respect to quality of care using process measures and demographic attributes of the hospitals. This method is an alternative to the use of clinical outcome measures in measuring hospital quality. Hospital quality measures should take into account the differential value of different quality indicators, including hospital "demographic" variables.     

Space-time variation of respiratory cancers in South Carolina: a flexible multivariate mixture modeling approach to risk estimation

PurposeMany types of cancer have an underlying spatiotemporal distribution. Spatiotemporal mixture modeling can offer a flexible approach to risk estimation via the inclusion of latent variables.MethodsIn this article, we examine the application and benefits of using four different spatiotemporal mixture modeling methods in the modeling of cancer of the lung and bronchus as well as “other” respiratory cancer incidences in the state of South Carolina.ResultsOf the methods tested, no single method outperforms the other methods; which method is best depends on the cancer under consideration. The lung and bronchus cancer incidence outcome is best described by the univariate modeling formulation, whereas the “other” respiratory cancer incidence outcome is best described by the multivariate modeling formulation.ConclusionsSpatiotemporal multivariate mixture methods can aid in the modeling of cancers with small and sparse incidences when including information from a related, more common type of cancer.