Who is willing to pay for long-term care insurance in Catalonia?

Both public and private insurance for long-term care (LTC) in European countries employed is underdeveloped. However, limited evidence is gathered on the behavioural demand responses to the introduction of insurance schemes expanding insurance coverage. This paper aims at empirically examining the determinants of the ex ante demand for LTC coverage drawing upon an insurance-based WTP referendum approach format. Data is collected from a representative population sample of Catalonia (Spain), before a countrywide funding system was developed. Our findings suggest that (based on our questionnaire format) only one-fifth of the population is willing to pay for LTC coverage though it is a highly elastic product. Ex ante demand for LTC coverage is driven by individual's perceptions of old age disability risk (private information asymmetry) and housing tenure (giving rise to self-insurance), the latter reduces the probability of insurance coverage demand.     

Do patient perceptions of quality relate to hospital financial performance?

Analysis confirms that patient perceptions of quality are associated with hospital financial performance. Multivariate analysis involving more than 15,000 patients discharged from 51 medical/surgical hospitals shows that discrete dimensions of hospital quality (i.e., medical and billing systems and discharge processes) explain approximately 17%-27% of the variation in financial measures such as hospital earnings, net revenue, and return on assets. The findings suggest that measurable improvements in patients' judgments of hospital quality might translate into better financial performance. The implications of these results and the limitations of the study are discussed.     

How far to the hospital? The effect of hospital closures on access to care

Do urban hospital closures affect health care access or health outcomes? We study closures in Los Angeles County between 1997 and 2003, through their effect on distance to the nearest hospital. We find that increased distance to the closest hospital increases deaths from heart attacks and unintentional injuries. This finding is robust to several sensitivity checks. We also find that, for residents with health insurance, increased distance shifts regular care towards doctor's offices. While most residents are otherwise unaffected, we find some evidence that seniors perceive more difficulty accessing care.     

Compensation in the year 2000: pay for performance?

Notes the attempts by many companies today to identify innovative compensation strategies that are directly linked to improving organizational performance. Observes that there are many approaches to incentive compensation such as cash bonuses, stock purchase and profit sharing. Examines the individual and group incentive concepts that reward performance based on predetermined organizational goals and metrics, several behavioural theories that can be associated with reward and compensation, and convergent and divergent views and conclusions from the business community.     

Minding our Ps and Qs? Financial incentives for efficient hospital behaviour

In this paper, the empirical evidence addressing the particular issue of how hospitals may be reimbursed is reviewed. Most forthcoming is the indeterminate effect of prospective payment systems using diagnosis-related groups as a means of controlling costs. Such systems, by controlling only the price of hospital care, remain vulnerable to compensatory increase in patient throughput, cost-shifting and patient-shifting despite hospital cost per case being reduced. Health maintenance organisations have been shown to reduce hospital costs, but their effects on patients selection and patient outcome are unclear. Selective contracting in California (similar to the U.K. Government's proposed internal market) has also been shown to reduce costs by affecting both the price and quantity of hospital care. But these effects have occurred only in areas with high concentrations of hospitals. Global and clinical budgeting (which control price times quantity) seem to offer the most potential for cost reduction whilst maintaining patient outcome. By monitoring both cost and outcome within clinical budgets it should be possible to reduce wasteful variations in health care and so establish more efficient hospital practice.     

Why doesn't performance pay work?

The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff.     

Who bears the burden of uncompensated hospital care?

This paper considers the question of who bears the burden of uncompensated hospital care. The thesis is that the hospital that provides the services received by indigent patients may not be the one that eventually bears the financial burden. The various sources of funds available for the payment of indigent care are identified and the incidence of financial burden discussed. The paper ends by addressing several considerations that should be taken into account in evaluating how fairly the indigent care burden is distributed.     

Who walks through the door? The effect of the uninsured on hospital use

Hospitals are concerned about the implications of an increase in the number of uninsured people. Using data from the 1999 Medical Expenditure Panel Survey (MEPS), we calculate what percentage of hospital inpatient, emergency department, and outpatient visits are accounted for by uninsured people and predict how those shares would change under three different scenarios. We find that although the burden of the uninsured would remain a severe problem for some hospitals, it would not likely increase much for most of them. This finding reflects the relatively low utilization rates among those most likely to lose coverage: nonelderly, nonpregnant, and nondisabled workers and their families.     

Does hospital competition improve efficiency? The effect of the patient choice reform in England

We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences‐in‐differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/2003 to 2010/2011. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%.