How much profit can a not-for-profit hospital make? A defense of the property tax exemption.

After St. Luke's Regional Medical Center in Boise, Idaho, reported a profit of $18 million, Ada County revoked its property tax exemption as a not-for-profit and billed St. Luke's for $3.4 million in property taxes. This article describes how St. Luke's successfully defended its tax exemption in an appeal to the Idaho Board of Tax Appeals and how proposed legislation would reduce uncertainty about taxation of not-for-profit hospitals in Idaho.     

Funding nutrition research: where's the money?

While a great idea that can be developed into a viable hypothesis is central to the development of a meritorious research proposal, without funding, the evidence base supporting or reputing a hypothesis cannot be advanced. A wide variety of funding sources exist for nutrition research, including governmental, organizational, industrial, and intramural-based funding; however, understanding the "language" of research funding can be challenging. This review provides an overview of funding sources, guidelines for securing funding, and recommendations to support a successful application for clinical nutrition research.     

The optimality of hospital financing system: the role of physician–manager interactions

The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93–112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma’s conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.      

Who picks the hospital: practitioner or patient?

This article presents the findings of a survey on consumer versus physician selection of a hospital. Forty-one percent of respondents reported that they or the affected household member selected the hospital. In addition, the perception of who chose the hospital was related to: 1) demographic (age and marital status); sociocultural (number of times moved in the past five years), and psychological (willingness to change physicians) factors which predispose hospital selection; 2) differences in individual resources (type of insurance coverage) which influence decision making; and 3) medical conditions (inpatient vs. outpatient status and the reason for the hospital utilization) which imply specific needs. Knowledge of these factors permits the correct classification of 70.2% of the cases, as opposed to 59.5% without such knowledge. The implications of these findings for healthcare marketing are discussed.     

Valuing the benefits and costs of health care programmes: where's the 'extra' in extra-welfarism?

The application of Sen's notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism?     

The hospital manager and game theory: chess master, poker player, or cooperative game player?

Hospital management can be seen as a game, and doctors, nurses, and health maintenance organizations are its players. The astute hospital manager realizes the interdependence of individual career strategies and the hospital's success, just as players in a game are interdependent on each other. Managers familiar with game theory may successfully transfer that knowledge to the hospital realm. They may recognize patterns and calculate outcomes like chess players, bluff other hospitals into folding services as poker players do, and cooperate with their own team to maximize productivity. Knowledge of game theory may also make the hospital manager's job.     

NHS reforms and resource management: whither the hospital?

This paper considers whether resource management (RM) as currently constituted in the National Health Service (NHS) is likely to fulfil its aim of efficiency. For the individual hospital RM has two key features: changes in managerial structure and changes in information systems. The paper assesses the extent to which the hospital behavioural model that implicitly underlies RM can be judged to reflect well the actual behaviour of hospitals. It is noteworthy that in the RM literature there is no explicit statement about the assumed underlying behaviour of the NHS hospital. Here the author selects the Harris model of hospital behaviour as providing the best explanation of internal hospital organisation. Harris represents the two lines of authority, physicians and administrators (managers in the present-day NHS), as two firms within the hospital structure, each with its own managers, objectives and constraints, making this model particularly appealing as a basis for analysing RM. Using this model the paper concludes that RM alone and as currently constituted will not be successful in promoting efficiency, because the structural and cultural mechanisms put in place by RM will not sufficiently affect physician behaviour.     

Motivating your employees and yourself: how different is the manager from the staff?

Managers often tend to behave as though they are responsive to different motivating forces than their employees. However, employees at all levels are much alike in terms of what they wish to obtain from their work. There are drives that vary in intensity from person to person, but the basic motivating forces remain the same. Essentially, it is not possible to motivate another person as such; it is possible only to create the conditions under which the individual can become self-motivated. The manager must appreciate the key principles of motivation, including the relationship between repetition and reinforcement and the importance of timely feedback. Also, the manager must learn what his or her legitimate role is concerning the fulfillment of employee needs. Successful managers will be those who are sensitive to their own needs and desires, credit their employees with the same or similar needs and desires, and treat employees in the manner in which they would like to be treated by higher management.     

Rural Health Research: Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?

Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board-certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecologists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician-gynecologists need training outside their traditional specialty areas to optimally care for their patients.     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.