Hospital capital structure decisions: theory and practice.

The paper explores capitalisation decisions within the hospital sector. This is done theoretically by examining the appropriateness of capital structure theory of hospitals and also in a real world context of soliciting the views of hospital chief financial officers. The ways in which capital decisions are made is described and the relationship of practice to theoretical models discussed.     

Severity of illness and profitability: a patient level analysis.

Crafting a payment mechanism for hospitals that provides for the legitimate operating needs of efficient institutions is an enduring health policy dilemma. The Prospective Payment System used by Medicare and some other payers in the US has been criticized for not adjusting for differences in severity of illness within diagnosis-related groups (DRGs). Previous studies have examined the relationship between profitability and severity of illness at the hospital level. This study examines the relationships between severity of illness and cost, revenue, and profit at the patient level. Two measures of severity (disease stage and number of unrelated diseases) were significant predictors of cost per case, and often had better predictive power than DRGs. In most instances, payers did not compensate adequately for severity so that higher values for the severity variables resulted in financial losses for the hospital.     

Hospital audit committees: a comparative analysis of structural and functional characteristics

In an effort to counteract rising costs and financial problems, many hospitals have adopted certain management practices that are followed by commercial corporations. In particular, the boards of directors for many hospitals have created audit committees to enhance organizational governance in the areas of internal control, accounting, auditing, and financial reporting. The formative stages in which most hospital audit committees currently exist creates a need for shared information. Such information can serve as a potential source of guidance for the further development of existing hospital audit committees, as well as for boards that are near the point of establishing an audit committee for the first time. The purpose of this study is to present an analysis of the structure, responsibilities, and activities of hospital audit committees. Data for the analysis was obtained through a questionnaire survey of 400 hospitals. The analysis of structural and functional differences affords a basis for suggesting several specific ways in which hospitals can improve their organizational governance through a more effective audit committee.     

Social capital and mental health: a comparative analysis of four low income countries

Women and the poor are disproportionately affected by common mental disorders (CMD), and women in low income countries are particularly at risk. Social capital may explain some of the geographical variation in CMD, but the association between social capital and CMD in low income countries has rarely been studied. This paper aims to explore the relationship between individual and ecological measures of social capital and maternal CMD in four low income countries. Cross-sectional data from the Young Lives (YL) study with information across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh (India) were used. The mental health of mothers of one-year-old children (n=6909), and the individual cognitive and structural social capital of all respondents was assessed. Ecological social capital was calculated by aggregating individual responses to the community level. Multi-level modelling was used to explore the association between individual and ecological (community level) social capital and maternal CMD in each of the four countries, adjusting for a wide range of individual and community level confounders. The analysis shows that individual cognitive social capital is associated with reduced odds of CMD across all four countries. The results for structural social capital are more mixed and culturally specific, with some aspects associated with increased odds of CMD. This suggests that structural social capital has context-specific effects and cognitive social capital more universal effects on maternal CMD.     

Community social structure, social capital and adolescent smoking: a multi-level analysis

Using a sample of 6818 individuals in 83 public school districts in Iceland, this study explored the influence of three community characteristics: Residential mobility, proportion of single-parent families, and poverty on adolescent daily smoking. Building on Coleman's social capital theory, we also examined the mediating and moderating role of several measures of social capital. Both self-reported and official data were used to measure key variables. The main findings are consistent with theoretical predictions showing that social capital partly mediates the association between community characteristics and adolescent daily smoking both on the community and individual levels. Likewise, the findings show that the association between individual level poverty and adolescent daily smoking varies across levels of neighborhood social capital.     

Social capital and self-rated health: a contextual analysis.

OBJECTIVES: Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. METHODS: Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. RESULTS: Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. CONCLUSIONS: These results extend previous findings on the health advantages stemming from social capital.     

Hospital food service: a comparative analysis of systems and introducing the ''Steamplicity'' concept

BACKGROUND: Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; 'stakeholders' (i.e. patients, staff, etc.) satisfaction with both systems; and patients' acceptability of the food provided. METHOD: The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors. RESULTS: Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g. CONCLUSIONS: The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.     

医院知识资本与资金资本的运营

从探索医院知识资本与资金资本互动的全新视角,提出了医院知识资本与资金资本互动的理论依据和现实意义,并且通过建立医院资本运营假设模型,采用数学分析与推导的方法对知识资本与资金资本互动增值关系进行理论分析,进一步论证医院知识资本与资金资本结合互动是确保医院能够在更高水平层面上高速运转、使医院综合竞争能力始终处于强势地位的重要条件。     

Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and (3) identify common trends, success factors and challenges for reforms. Methods applied involved five stages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative data characterizing hospital sectors were compared; (3) a scoping review was performed to identify an initial list of reforms per country; (4) the list was sent to national researchers who described the top three reforms based on a standardized questionnaire; (5) received questionnaires were analysed and validated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet, reforms related to hospital sector governance and changes in purchasing and payment systems are much more frequent than reforms concerning relations with other providers. Most governance reforms aimed at transforming hospital infrastructure, improving financial management and/or improving quality of care, while purchasing and payment reforms focused on limiting hospital activities and/or on incentivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensive approach; unclear outcomes; and political influence. Given similar reform areas across countries, there is considerable potential for shared learning.     

Hospital performance in multihospital systems: a comparative study of system and independent hospitals.

Hospital costs and productivity in multihospital systems versus those of independent hospitals are a major source of debate among health care providers and researchers. Previous studies have shown system hospitals perform better than independent hospitals. The evidence, however, has been limited to only a few nonprofit systems. To help fill this research gap, approximately 100 system hospitals from 14 systems and 4 ownership types are compared with approximately 50 independent hospitals using cost and productivity data from one year. The results show that system hospitals realize both significantly higher cost and higher productivity levels, except for county-owned facilities which have lower costs and insignificantly different productivity levels. Factors that help explain these results are discussed and directions for further research are suggested.     

社会资本与孕产妇抑郁研究的Meta分析

目的对国内外现有社会资本与孕产妇抑郁关系的定量文献研究进行Meta分析,为相关研究提供参考。方法系统检索现有社会资本与抑郁定量研究的文献,按照纳入标准筛选,对入选的文献提取数据,对文献纳入发表情况、研究目的及方法进行系统评价。结果共纳入文献14篇,对社会资本定义目前较为公认的是基于Putnam和Bourdieu的观点,测量量表种类较多,研究对象多为产妇,研究类型多为现况研究,研究方法多为回归与相关分析,社会资本对孕产妇抑郁的关系以保护因素为主流,亦有危险因素。结论社会资本对孕产妇的部分直接影响已被欧洲、非洲、亚洲、北美洲部分国家证实,但因果作用及强度不确定,测绘量表不统一且研究方法有局限。中国应开发本土化社会资本量表,开展较大规模的前瞻性队列研究,为孕产妇抑郁预防干预途径提供理论参考。     

Hospital structure and consumer satisfaction.

This study examines the relationship between hospital structural characteristics and patient satisfaction with hospital care. Teaching hospitals and private hospitals were expected to receive higher ratings of patient satisfaction than were nonteaching and government-controlled hospitals, because they generally are reputed to be technologically superior. Results show that, in general, most patients are satisfied with their hospital stays, but they are clearly more dissatisfied with their stays in teaching hospitals. Although a number of other correlates of patient satisfaction with the hospital stay are identified, no measure succeeds in reducing to insignificance the strong relationship between teaching status and dissatisfaction. Some suggestions are made as to why teaching hospital receive relatively poor evaluations from their patients.