To outsource or not to outsource

Outsourcing work can be a positive intervention if the environment and strategies are properly coordinated, but there is no guarantee of success. Today, more than ever before, hospitals are suffering from two pressures: economic constraints and the migration of managerial talent out of the field to other sectors of the economy. With these two pressures, hospitals are searching for ways to reduce costs and find skilled personnel. A common strategy is to seek support from the open market and outsource. This article looks at tools for making the outsourcing decision, such as risk and force field analysis.     

Improving financial performance: a study of 50 hospitals

This article provides an analysis of key differences between a small sample of high-performing and low-performing hospitals where performance was defined as return on equity. Some of the more significant findings were: (1) high-performing hospitals achieve their superior performance through cost control rather than higher prices; (2) high-performing hospitals minimize their investment in plant assets and accounts receivable. They are also likely to have a newer plant than low-performing hospitals; (3) high-performing hospitals are not afraid to use debt in their capital structure, but they use significantly less debt than low-performing hospitals; (4) high-performing hospitals have set aside greater reserves for future plant replacement, which helps them to keep their level of debt reasonable and generates significant amounts of investment income; and (5) high-performing hospitals have greater market share than low-performing hospitals.     

To house or not to house: the effects of providing housing to homeless substance abusers in treatment

OBJECTIVES: Housing typically is not provided to homeless persons during drug abuse treatment. We examined how treatment outcomes were affected under 3 different housing provision conditions. METHODS: We studied 196 cocaine-dependent participants who received day treatment and no housing (NH), housing contingent on drug abstinence (ACH), or housing not contingent on abstinence (NACH). Drug use was monitored with urine testing. RESULTS: The ACH group had a higher prevalence of drug abstinence than the NACH group (after control for treatment attendance), which in turn had a higher prevalence than the NH group. All 3 groups showed significant improvement in maintaining employment and housing. CONCLUSIONS: The results of this and previous trials indicate that providing abstinence-contingent housing to homeless substance abusers in treatment is an efficacious, effective, and practical intervention. Programs to provide such housing should be considered in policy initiatives.     

To work or not to work: that is the question

Medical publications contain numerous references to obstacles or disincentives confronting patients who wish to return to work after illness or injury. Current developments of importance to this aspect of medical practice and four recent studies, conducted in Edinburgh, that may contribute to the continuing debate about how best to deal with such problems are reviewed. The studies concern measurement of rehabilitation status, identification of potential to benefit from rehabilitation, medical contributions to occupational assessment of accident victims, and patients' patterns of involvement with medical and vocational rehabilitation services. It is concluded that coordination between services is still a major problem and is likely to remain so if more effective bridging between medical and vocational aspects of rehabilitation is not achieved.     

公立医院财务治理绩效评价的理论探讨

主要从公立医院财务治理绩效评价的视角选择、公立医院财务治理绩效评价涉及的范围、公立医院财务治理的主体及其权责和目标、公立医院财务治理绩效评价基本维度的构建4个方面,对我国公立医院财务治理绩效评价所涉及的基本理论问题进行探讨,以提高绩效评价工作的效率和质量.     

Editorial choices: To expand or not to expand ...

Editorial

Editorial choices: To expand or not to expand ...     

To round or not to round: that is the question!

Bedside rounding and clinical examination has been an integral part of medical education and patient care for centuries. With the advent of computers and regulatory requirements for documentation by insurance carriers and third party providers, bedside rounding time has consistently decreased over the past several decades. Several studies have attempted to address the most effective way of bedside rounding, but no definite conclusion has been reached. We suggest multi-center broad base studies of key stakeholders to address this challenging issue.     

To work or not to work: that is the question.

Medical publications contain numerous references to obstacles or disincentives confronting patients who wish to return to work after illness or injury. Current developments of importance to this aspect of medical practice and four recent studies, conducted in Edinburgh, that may contribute to the continuing debate about how best to deal with such problems are reviewed. The studies concern measurement of rehabilitation status, identification of potential to benefit from rehabilitation, medical contributions to occupational assessment of accident victims, and patients' patterns of involvement with medical and vocational rehabilitation services. It is concluded that coordination between services is still a major problem and is likely to remain so if more effective bridging between medical and vocational aspects of rehabilitation is not achieved.     

The role of non-financial performance measures in predicting hospital financial performance: the case of for-profit system hospitals

Non-financial measures have found increasing acceptance in the business world--however, their application in the health care industry remains limited. The purpose of this article is to understand the influence of non-financial measures (efficiency, productivity, and quality) on the financial performance of for-profit system hospitals. The sample consists of 499 for-profit system hospitals in the United States from 1999 to 2002. Data analyzed include the American Hospital Association's Annual Survey, Medicare Cost Reports, Joint Commission's quality scores, and the Centers for Medicare & Medicaid Services' Hospital Case Mix Index. Dependent variables consist of financial measures (operating and total margins), while independent variables include measures of efficiency, productivity, and quality. Our results suggest the influence of non-financial performance measures on financial performance; occupancy rate positively influences financial performance while greater labor intensity may have negative implications for financial performance. In addition, we show that quality positively influences financial performance thereby offering a potential business case for quality. This result has important managerial and policy implications as it may incentivize capital and human resource investments required to improve hospital quality of care.