Mission statements in Canadian not-for-profit hospitals: does process matter?

Mission statements abound in health care organizations. And much is written on what they should contain. But, the process of creating and implementing mission statements in health care organizations has received virtually no attention in the literature. This article presents findings from a research study that sought to determine whether or not a relationship existed between selected mission process characteristics and various measures of a hospital's performance.     

Cost and technical efficiency of German hospitals: does ownership matter?

This paper is the first to investigate both the technical and cost efficiency of more than 1500 German general hospitals. More specifically, it deals with the question how hospital efficiency varies with ownership, patient structure, and other exogenous factors, which are neither inputs to nor outputs of the production process. The empirical results for the years from 2001 to 2003 indicate that private and non-profit hospitals are on average less cost efficient and less technically efficient than publicly owned hospitals. The hospital rankings based on estimated efficiency scores turn out to be negatively correlated with average length of stay, which is highest in private hospitals. The results are derived by conducting a Stochastic Frontier Analysis assuming both Cobb-Douglas and translog production technologies and using a newly available and multifaceted administrative German data set.     

What is quality and how much does it really matter?

Perhaps no single word has appeared more often in health care literature during the last 12 months than "quality." Designing and marketing high quality health care services is likely to be a strategic issue through the 1990s. The purpose of this commentary is to describe why the adoption of a three-component definition of quality may be useful for designing strategies for continual quality improvements, as well as to suggest the principal ways quality should be assessed. Answers to the question, "How much does quality really matter?" are examined. The commentary is based on the keynote address presented at the 1991 Health Care Consumer Buying Guides Conference in Cleveland, Ohio, sponsored by the Academy for Health Services Marketing.     

Community attitudes and mammography use: does it really matter what other people think?

This study examined whether community characteristics, particularly community attitudes regarding mammography use, are associated with women's use of mammography in rural communities. Forty communities in predominantly rural areas of Washington State were selected for inclusion in this study based on their size and distance from an urban center. Characteristics of the communities were assessed as were characteristics of women living in the communities. From each community, random samples of 352 women between 50 and 80 years old participated by completing a telephone survey that included questions on a variety of topics, including their use of mammography. Logistic regression analyses revealed community of residence to be a significant predictor of individual women's mammography use after adjusting for individual level predictors of mammography use including age, education, employment, marital status, financial situation, and ease of access to medical services. An examination of the influence of community characteristics revealed women living in communities with supportive community attitudes towards mammography use report higher levels of mammography use than do women living in communities with less supportive attitudes. The presence or absence of male or female physicians or of mammography facilities in a local community was not associated with statistically significant effects on women's mammography use. Community attitudes are associated with mammography use in rural communities. Public health interventions that change community attitudes may have effects that extend beyond the people directly contacted by these interventions.     

Hepatitis A surveillance in England--how many cases are not reported and does it really matter?

Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture-recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81.7% (95% CI 55.3-95) in the first outbreak in North East England and reporting through Lab Base was 65.7% (95% CI 42.8-76.4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27.8% (95% CI 19-38.7) and through Lab Base 16.6% (95% CI 11.4-23.1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.     

Control and end-of-life care: does ethnicity matter?

Patient control and autonomy are core values in Western bioethics and important components of end-of-life (EOL) care. However, the centrality of the patient as decision maker may not be relevant to culturally diverse groups of people. The purpose of this article is to present results of a literature review of patient control and ethnicity within the context of EOL care. The review revealed that the interplay between control and ethnicity in EOL care is complex and unpredictable. Implications for clinical care and future research are presented.     

Ethnic differences in self-rated and functional health: does immigrant status matter?

The current study examines self-rated health status and functional health differences between first-generation immigrant and Canadian-born (CB) persons who share the same ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Multivariate analyses of data from the 2000/2001 Canadian Community Health Survey indicate that first-generation immigrants of Black and French ethnicity tend to have better health than their CB counterparts, while the opposite is true for those of South Asian and Chinese origins, providing evidence that for these groups, immigrant status matters. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign-born and CB persons generally converge after controlling for sociodemographic, socioeconomic status (SES), and lifestyle factors. Analysis of the data does however reveal extensive ethnocultural disparities in self-rated and functional health within both the immigrant and CB populations. Implications for health care policy and programme development are discussed.     

What do we want and what do we get from not-for-profit hospitals?

The tax exemption for not-for-profit hospitals has been subject to many recent challenges, in part related to concerns over whether these hospitals provide sufficient levels of community benefits to merit tax exemption. Computing the value of community benefits for California hospitals as the sum of uncompensated care, education and research, net income, money-losing services, and price discounts from for-profit hospitals reveals that 20 to 80 percent of hospitals would have met various recommended community benefits standards. There is a clear need for hospitals and their communities to establish dialogues on what levels of community benefits are appropriate.     

Maternal employment and overweight children: does timing matter?

Recent literature has shown consistent evidence of a positive relationship between maternal employment and children's overweight status. These studies largely use average weekly work hours over the child's life to measure employment. This paper specifically aims at exploring the importance of the timing of employment. Using various econometric techniques to control for observable and unobservable child and family characteristics, the results show that full-time maternal employment during mid-childhood positively affects the probability of being overweight at age 16. There is no evidence that part-time or full-time employment at earlier/later ages affects this probability.     

Contrast sensitivity in occupational and environmental neurotoxicology: what does it really mean?

Contrast sensitivity (CS) emerged more than 30 years ago as an alternative to traditional acuity testing, and recently it has become the focus of attention in the field of neurotoxicology. CS testing may be useful for detecting defects in oculoneural processing and therefore possible chemical-induced neurotoxicity, such as solvent-induced encephalopathy. The authors' objective in this article is to introduce the concept of CS and CS testing, summarize recent reports describing its use in occupational and environmental toxicology, and challenge the validity of CS testing in its present state as a toxicological assessment. Although CS testing appears to be an attractive and cost-effective screening tool for identifying possible neurotoxicity, additional work will be required before it can become a meaningful and widely accepted diagnostic tool.     

Meningococcal disease and the law: does non-notification really happen?

In Victoria, legislation clearly makes the notification of clinical or confirmed cases of meningococcal disease mandatory. Statistical modelling suggests that meningococcal disease is significantly under-notified, and that incorrect codes might be being ascribed to some in-patient episodes. The aims of this study were (i) to test the assumption that cases identified as non-notified cases were true cases, and (ii) to identify the reasons for non-detection on the hospital separation database and non-notification to the infectious diseases unit. Of 26 cases not identified on the in-patient dataset, the main causes were either being given completely incorrect ICD-9-CM codes (11 cases) or being given codes for a different type of meningitis (8 cases). Of 29 non-notified admissions, most were clinically (17) or microbiologically (6) confirmed cases, although 5 were coded in error and were not cases of meningococcal disease. Therefore, although the allocation of incorrect ICD-9-CM codes at separation was a major reason for discrepancy, non-notification was a real and recent problem. It is also possible that some clinical staff did not understand the relationship between Neisseria meningitidis and meningococcal disease, the public health implications of this infection, or the law relating to it.     

Preventable hospitalization and medicaid managed care: does race matter?

This study examines the preventable hospitalization patterns of Medicaid patients by race/ethnicity to determine whether Medicaid managed care (MMC) has been more effective in some subgroups than others. It uses logistic models for three states, comparing preventable hospitalizations with marker admissions (urgent admissions, insensitive to primary care). Hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient database of the Agency for Health Care Research and Quality for New York, Pennsylvania, and Wisconsin residents aged 20-64 years is used. In a more urban state, New York, MMC was effective for Whites but not for minorities. In a more rural state, Wisconsin, MMC was effective for minorities. Overall, the evidence is not strong that any particular racial group consistently benefited from MMC, or that any state consistently showed a favorable impact of MMC across racial groups. However, racial/ethnic disparity associated with the risk of preventable hospitalization is significantly lower among Medicaid patients than among private fee-for-service patients.