Hospital financial performance: does IT governance make a difference?

This study examined whether information technology (IT) governance, a term describing the decision authority and reporting structures of the chief information officer (CIO), is related to the financial performance of hospitals. The study was conducted using a combination of primary survey data regarding health care IT adoption and reporting structures of Florida acute care hospitals, with secondary data on hospital financial performance. Multiple regression models were used to evaluate the relationship of the 3 most commonly identified reporting structures. Outcome variables included measures of operating revenue and operating expense. All models controlled for overall IT adoption, ownership, membership in a hospital system, case mix, and hospital bed size. The results suggest that IT governance matters when it comes to hospital financial performance. Reporting to the chief financial officer brings positive outcomes; reporting to the chief executive officer has a mixed financial result; and reporting to the chief operating officer was not associated with discernible financial impact.     

East–west: does it make a difference to hospital efficiencies in Ukraine?

Ukraine's history has given it a split personality (e.g. divergent cultural influences on economic and managerial behavior), as was observed in the recent political developments both prior to and following the December 2004 elections. Eastern regions were heavily influenced by Russo-Soviet rule, while western regions have more of a European outlook. This study, which is largely exploratory, compares recent trends in hospital efficiency in Ukraine to see if this split personality manifests itself in differential rates of improvement. Given the inflexibility of Soviet-style planned economies, it is hypothesized that western regions will show greater improvement in economic efficiency that can be attributed to higher levels of managerial and medical entrepreneurship. Data for this study comes from three oblasts (i.e. geopolitical regions), one in the west and two in the east, spanning from 1997 to 2001. Data envelopment analysis (DEA) was used to estimate technical efficiency for the hospitals. After correcting for bias, a second-stage Tobit regression was estimated. Results indicate that hospitals in the west improved efficiencies, while those in the east stayed constant. These western areas of the nation, being more amenable to western management and medical 'business' practice, may be quicker to pick up on new techniques to increase healthcare delivery efficiencies. This may stem from the more limited effects of a shorter history of incorporation into a Soviet-style planned and controlled economy in which individual decision-making and entrepreneurship was suppressed in favor of central decision-making by the state.     

Physicians' working conditions and job satisfaction: does hospital ownership in Germany make a difference?

Background  

A growing number of German hospitals have been privatized with the intention of increasing cost effectiveness and improving the quality of health care. Numerous studies investigated what possible qualitative and economic consequences these changes issues might have on patient care.     

Smoking in Ontario schools: does policy make a difference?

OBJECTIVE: Studies in other countries have shown that school tobacco control policy has potential to prevent smoking uptake in adolescents. Since no Canadian research has studied this association, we assessed the statistical link between school tobacco policy and smoking status in Ontario elementary and secondary schools. METHODS: We conducted secondary analysis of data collected using the School Smoking Profile, a cross-sectional, self-report questionnaire. School policy variables were formed from five survey items concerning students' perceptions of school tobacco control policy. Smoking status was determined through self-report measures which had been validated by carbon monoxide testing. Logistic regression models used school policy variables to explain smoking status in elementary and secondary schools, controlling for school location, school size, and student's grade level. RESULTS: The smoking policy variables, rules and enforcement, explained smoking status after controlling for other variables. In elementary schools, perceptions of stronger enforcement reduced the odds of being a smoker (OR = 0.39, CI99 = 0.34-0.44). In secondary schools, enforcement lost its protective effect (OR = 1.05, CI99 = 1.00-1.10). In addition, student perceptions that rules were strong were indicative of increased smoking in secondary schools (OR = 1.32, CI99 = 1.27-1.37). DISCUSSION: Strong enforcement of school tobacco control policy appears to be effective in elementary schools but is not as helpful in secondary schools. Secondary school policymakers should consider modifying their sanctions to avoid alienating smokers.     

Maternal health: does prenatal care make a difference?

This research attempts to close an important gap in health economics regarding the efficacy of prenatal care and policies designed to improve access to that care, such as Medicaid. We argue that a key beneficiary-- the mother-- has been left completely out of the analysis. If prenatal care significantly improves the health of the mother, then concluding that prenatal care is 'ineffective' or that the Medicaid expansions are a 'failure' is premature. This paper seeks to rectify the oversight by estimating the impact of prenatal care on maternal health and the associated cost savings. We first set up a joint maternal-infant health production framework that informs our empirical analysis. Using data from the National Maternal and Infant Health Survey, we estimate the effects of prenatal care on several different measures of maternal health such as body weight status and excessive hospitalizations. Our results suggest that receiving timely and adequate prenatal care may increase the probability of maintaining a healthy weight after the birth and, perhaps for blacks, of avoiding a lengthy hospitalization after the delivery. Given the costs to society of obesity and hospitalization, these are benefits worth exploring before making conclusions about the effectiveness of prenatal care-- and Medicaid.     

Modern contraception use in Ethiopia: does involving husbands make a difference?

OBJECTIVES. This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. METHODS. A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. RESULTS. A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. CONCLUSIONS. The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important "sleeper" effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples.     

The corporate social responsiveness orientation of hospital directors: does occupational background make a difference?

The results of a survey of 184 directors from 15 hospitals are analyzed to determine their corporate social responsiveness orientation. They indicate that board members whose occupational background is not in health care exhibit greater concern for economic performance and the legal component of corporate responsibility than their counterparts whose occupational background is in health care. No significant differences between the two groups were observed with respect to the ethical and discretionary dimensions of corporate social responsibility. Some explanations as well as limited generalizations and implications are developed.     

Profitability of HMOs: does non-profit status make a difference?

This study, based on 163 HMOs, tests the hypothesis that the rates of return on assets (ROA) are not significantly different between for-profit and non-profit HMOs. It finds no statistical support for rejecting the hypothesis. The marked similarity in profitability is fully explained by analyzing methods of cost control and accounting, operational incentives and constraints, and price determination. The paper concludes that profitability is not a defining distinction in the operation of managed care.     

For profit versus non-profit: does economic sector make a difference in child-care?

The child-care industry in a large, southeastern community serves as this study's vehicle for comparing non-profit with for profit dependent care in areas not easily observable to clients. The cross-sectional analysis compares child-care centers on marketed and actual staff-to-child ratio; staff salary; consistency in the child's group environment; staff stability; and extent of parental involvement. Findings are based on self-reports of directors and support hypotheses derived from the theory that for profit day care centers will use their discretionary authority to vary the care environment to achieve profit goals despite the potential effect on the quality of the child's environment. Further, despite potential cost economies and enhanced quality of care achievable as a non-profit entity, few for profit center directors consider becoming non-profit centers.     

Federal investment in health information technology: how to motivate it?

Health care market failures include inefficient standard making, problems with coordination among local providers to optimize care, and inability to measure quality accurately, inexpensively, or reliably. Study of other industries suggests policy directions for health information technology and the magnitude of gains from improving market functioning, which are very large. A perspective drawn from U.S. industrial history--in particular railroads and the interstate highway system--suggests an investment level roughly consistent with recent estimates drawn from the medical literature. The benefits of quick action probably outweigh the benefits of delaying and choosing the perfect funding mechanism.     

Two models of raters in a structured oral examination: does it make a difference?

Oral examinations have become more standardized over recent years. Traditionally a small number of raters were used for this type of examination. Past studies suggested that more raters should improve reliability. We compared the results of a multi-station structured oral examination using two different rater models, those based in a station, (station-specific raters), and those who follow a candidate throughout the entire examination, (candidate-specific raters).Two station-specific and two candidate-specific raters simultaneously evaluated internal medicine residents’ performance at each station. No significant differences were found in examination scores. Reliability was higher for the candidate-specific raters. Inter-rater reliability, internal consistency and a study of station inter-correlations suggested that a halo effect may be present for candidates examined by candidate-specific raters. This study suggests that although the model of candidate-specific raters was more reliable than the model of station-specific raters for the overall examination, the presence of a halo effect may influence individual examination outcomes.     

Covering the uninsured through TennCare: does it make a difference?

Tennessee created TennCare in 1994 to address the needs of "poor and uninsured citizens ... excluded from the health care system." Under TennCare, Tennessee implemented managed care in its Medicaid program and used savings anticipated from the switch to expand insurance coverage to uninsured and uninsurable adults and children. Our analysis of the expansion suggests that it improved access to care, reduced unmet need, and encouraged use of preventive services, particularly for children. These changes coincided with higher levels of satisfaction with care among TennCare beneficiaries.     

Carbohydrates and increases in obesity: does the type of carbohydrate make a difference?

With the prevalence of obesity increasing in the U.S. and elsewhere, the place of carbohydrates in the diet has recently been under closer examination. This has led to the development of methods for analyzing the effects of dietary carbohydrate. Primary among these methods is the glycemic index, a measure of a food's effect on blood glucose levels, which was initially designed as a method for determining suitable carbohydrates for people with diabetes. However, the glycemic index does not address other metabolic issues related to excess sugar consumption. Prominent among these issues is the use of low glycemic index sweeteners, particularly fructose, which is increasingly present in processed food. Fructose is associated with increased adiposity, which may result from its effects on hormones associated with satiety. Other methods of determining "good" carbohydrates have also been developed. The common theme among them is increased nonstarchy vegetables and higher-fiber legumes.     

Behavior change at the worksite: does social support make a difference?

PURPOSE: This study examines whether social support for behavior change at work is associated with changes in employee heart disease risk factors. DESIGN: A prospective correlational design was used with data sets collected 12 months apart. SETTING: Twenty-five small to medium worksites in Oregon. SUBJECTS. Participants were 689 men and 421 women volunteers who participated in two health assessments at the worksite on company time. MEASURES: Demographic characteristics, gender, social support, smoking behavior, dietary fat intake, and total blood cholesterol. RESULTS: Employees reporting strong social support at work for not smoking and for limiting dietary fat were less likely to smoke (r = -.11, odds ratio [OR] = .86) and to consume fat in their diets (r = -.10) at baseline. Employees who reported the most change in social support over a 12-month period were most likely to have stopped smoking (r = .15, OR = 1.31). Social support at baseline, however, was unrelated to change in smoking, dietary fat, or total blood cholesterol in a prospective design. Although women reported more social support at work than did men, no differential gender effects of social support were reported on heart disease risk status or change in risk status. CONCLUSION: Baseline social support at work did not predict future behavior change. The observed association between social support and lifestyle may be better explained as cognitive rationalization than by the impact of social support on behavior.