Search results

1 – 10 of over 12000
Article
Publication date: 23 March 2022

Xiaosong (David) Peng, Yuan Ye, Raymond Lei Fan, Xin (David) Ding and Aravind Chandrasekaran

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs…

Abstract

Purpose

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

Design/methodology/approach

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

Findings

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

Practical implications

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Originality/value

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

Details

International Journal of Operations & Production Management, vol. 42 no. 5
Type: Research Article
ISSN: 0144-3577

Keywords

Book part
Publication date: 30 May 2018

Luigi Siciliani

Hospitals are complex organisations accounting for most of total health expenditure. They play a critical role in providing care to patients with high levels of need. A…

Abstract

Hospitals are complex organisations accounting for most of total health expenditure. They play a critical role in providing care to patients with high levels of need. A key policy concern is that patients receive high quality care. Policymakers have attempted to influence hospital quality in different ways. This chapter focuses on three key policy levers: the extent to which hospital competition and higher hospital tariffs (of the DRG type) can stimulate quality, and whether non-profit hospitals provide higher or lower quality than for-profit ones. The chapter outlines key methodological challenges and selectively reviews the main findings from the literature. While several studies suggest that hospital competition reduces mortality rates for heart attack cases when hospital tariffs are fixed (under a DRG system), at this stage is unclear whether the effect holds across a range of quality indicators. Moreover, the limited literature on hospital mergers tends to suggest that hospital quality does not change following a merger. Finally, whether non-profit hospitals provide higher or lower quality varies across regions and institutional arrangements. The economic theory suggests several mechanisms with opposite effects on quality. To guide policy, future work needs to further unpack the various mechanisms through which these three key policy issues affect hospitals incentives.

Details

Health Econometrics
Type: Book
ISBN: 978-1-78714-541-2

Keywords

Book part
Publication date: 6 December 2007

Nazmi Sari

The health care industry has been influenced by changes in the market structure and new technological developments during the recent decades. With the new technological…

Abstract

The health care industry has been influenced by changes in the market structure and new technological developments during the recent decades. With the new technological developments in medicine, some less complex care moved out of the hospitals that led to decrease in demand for inpatient services. This recent change in hospital care created excess capacity in hospital markets, and therefore hospitals started to explore potential financial gains through horizontal consolidations. This has resulted in a wave of mergers in 1990s, which transformed the US, Canadian and European hospital markets. This, in turn, created concerns among policy makers and researchers in terms of its welfare implications.

Details

Evaluating Hospital Policy and Performance: Contributions from Hospital Policy and Productivity Research
Type: Book
ISBN: 978-0-7623-1453-9

Article
Publication date: 5 November 2020

Lior Naamati Schneider

This study aims to map perceptions and changes in public hospitals in response to competition with the private health system, describes solutions adopted by the public…

Abstract

Purpose

This study aims to map perceptions and changes in public hospitals in response to competition with the private health system, describes solutions adopted by the public hospitals and considers their implications for the business and strategic management of those hospitals.

Design/methodology/approach

This paper opted for a qualitative study using the open-ended approach of grounded theory, including 40 in-depth interviews with key figures in the health system and administrators at various levels of management.

Findings

Public hospitals are constantly adopting changes because of state-mandated reforms and growing competition with private hospitals. Notable measures include making hospitals customer-oriented and adopting business-oriented behaviors and competitive and marketing strategies. However, because public hospitals are unable to institute radical changes, they typically introduce hybrid services (private services within public services) and other creative solutions such as business-funded research foundations operating alongside them.

Research limitations/implications

The main methodological limitation of this study was the difficulty in obtaining data because of the limited cooperation and lack of transparency of Israel’s health-care system. The interviewees expressed concerns that their department or hospital would appear in a negative light, especially as motivated solely by financial considerations. In anticipation of this difficulty, requests for participation were addressed individually and contained extensive detail regarding the study, the ethics committee’s approval, the data gathering and the strict maintenance of anonymity and confidentiality.

Originality/value

Adopting business-oriented behaviors in public hospitals is somewhat contrary to the principles of public medicine. Their adaptation to the market is partial, and their creative hybrid solutions require state regulation. The absence of controls leads to duplication and waste, causing various problems, including increased social inequality, costs and deficits.

Details

International Journal of Organizational Analysis, vol. 29 no. 6
Type: Research Article
ISSN: 1934-8835

Keywords

Book part
Publication date: 20 August 2012

Victoria Serra-Sastre and Alistair McGuire

Purpose – The aim of this paper is to examine the diffusion of a new surgical procedure with lower per-case cost and how its diffusion path is affected by the simultaneous…

Abstract

Purpose – The aim of this paper is to examine the diffusion of a new surgical procedure with lower per-case cost and how its diffusion path is affected by the simultaneous introduction of a new drug class that may be an effective treatment to prevent surgery. In particular, we examine whether a process of technology substitution exists that influences the diffusion process of the surgical technology. Given their different cost implications, the interaction of these two different technologies, surgery and drug intervention, is relevant from the perspective of health expenditure. This is of particular interest in health care as technology adoption and diffusion has been cited as a major driver of expenditure growth. Such expenditure growth has been increasingly targeted through the use of market-orientated policy tools aimed at increasing efficiency. Our research is thus addressing the question of how economic incentives influence the diffusion process and we discuss the impact of a set of incentives on hospital behavior.

Design/methodology – Hospital admission data for the financial years 1998/1999 to 2007/2008 in England are used to empirically test the contribution of prescription uptake and market-oriented reforms. Dynamic panel data models are used to capture any changes in technology preference during the period of study.

Findings – Our results suggest that the hospital sector exhibits a strong new technology preference, tempered by the interaction of competition for patients and the ability of the primary care sector to substitute treatments.

Value/originality – Given the current fast technological change, we examine the technological race occurring in the health care sector. We account simultaneously for the diffusion of different technologies not only within the same typology but also with technologies of a different class.

Details

The Economics of Medical Technology
Type: Book
ISBN: 978-1-78190-129-8

Keywords

Book part
Publication date: 6 September 2000

Sheri L Eisert

This paper empirically tests whether the nonprofit hospital is influenced by the community benefit standard by analyzing differences in nonprofit and for-profit hospital

Abstract

This paper empirically tests whether the nonprofit hospital is influenced by the community benefit standard by analyzing differences in nonprofit and for-profit hospital inpatient Medicaid share, while controlling for the effects of hospital market competition. Hospital specific data for this study are from the 1991 American Hospital Association Annual Survey of Hospitals and the 1991 Medicare Minimum Cost Report by the Health Care Financing Administration. The sample includes 192 for-profit, 899 nonprofit and 221 government-owned general acute care hospitals. Key variables in the multivariate analysis include hospital inpatient Medicaid share as the dependent variable and Medicaid demand, market competition and input quality as independent variables. The principal findings are that nonprofit hospitals serve a larger share of Medicaid inpatients than for-profit hospitals although the greater the presence of for-profit hospitals in the market (one measure of market competition) the smaller the nonprofit hospital Medicaid share. It is concluded that nonprofit hospitals reduce their level of community benefit, where community benefit is measured as a hospital's percent Medicaid share, in markets with a greater presence of for-profit hospitals.

Details

Research in Law and Economics
Type: Book
ISBN: 978-1-84950-022-7

Book part
Publication date: 29 August 2018

Paul A. Pautler

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the…

Abstract

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

Details

Healthcare Antitrust, Settlements, and the Federal Trade Commission
Type: Book
ISBN: 978-1-78756-599-9

Keywords

Article
Publication date: 23 August 2021

Barbara Tip, Frederik Guido Sebastiaan Vos, Esmee Peters and Vincent Delke

Procurement professionals widely use purchasing portfolio models to tailor purchasing strategies to different product groups’ needs. However, the application of these…

Abstract

Purpose

Procurement professionals widely use purchasing portfolio models to tailor purchasing strategies to different product groups’ needs. However, the application of these approaches in hospitals and the impact of a pandemic shock remain largely unknown. This paper aims to assess hospital purchasers’ procurement strategies during the COVID-19 pandemic, the effects of factor-market rivalry (FMR) on strategies and the effectiveness of purchasing portfolio categorizations in this situation.

Design/methodology/approach

This qualitative study of hospital purchasing in the Netherlands is supported by secondary data from official government publications. Semi-structured interviews were conducted with 13 hospital purchasers at large hospitals. An interpretative approach is used to analyze the interviews and present the results.

Findings

The findings reveal that product scarcity forces purchasers to treat them as (temporary) bottleneck items at the hospital level. The strategies adopted largely aligned with expected behavior based on Kraljic’s commodity management model. Adding the FMR perspective to the model helped to further cluster crisis strategies into meaningful categories. Besides inventory management, increasing supply, reducing demand and increasing resource coordination were the other common strategies. An important finding is that purchasers and governments serve as gatekeepers in channeling FMR, thereby reducing potential harmful competition between and within hospitals.

Social implications

The devastating experience of the COVID-19 pandemic is unveiling critical weaknesses of public health-care provision in times of crisis. This study assesses the strategies hospital purchasers apply to counteract shortages in the supply chain. The findings of this study emphasize the importance of gatekeepers in times of crisis and present strategies purchasers can take to assure the supply of resources.

Originality/value

No research has been conducted on purchasing portfolio models and FMR implications for hospitals during pandemics. Therefore, the authors offer several insights: increasing the supply risk creates temporary bottleneck strategies, letting purchasers adopt a short-term perspective and emphasizing the high mobility of commodities in the Kraljic commodity matrix. Additionally, despite more collaboration uncovered in other studies regarding COVID-19, strong rivalry arose at the beginning of the pandemic, leading to increased competition and less collaboration. Given such increased FMR, procurement managers and governments become important gatekeepers to balance resource allocation during pandemics both within and between hospitals.

Details

Journal of Public Procurement, vol. 22 no. 1
Type: Research Article
ISSN: 1535-0118

Keywords

Article
Publication date: 31 October 2008

Patrick A. Rivers and Saundra H. Glover

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision…

3992

Abstract

Purpose

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry.

Design/methodology/approach

A literature review was conducted. A total of 50 items of literature related to the subject were reviewed.. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined

Findings

A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Practical implications

Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment.

Originality/value

The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

Details

Journal of Health Organization and Management, vol. 22 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 8 June 2012

Diego Fornaciari and Stefaan Callens

Competition rules maximise consumer welfare by promoting efficient use of scarce resource and thus high output, low prices, high quality, varied services, innovation…

973

Abstract

Purpose

Competition rules maximise consumer welfare by promoting efficient use of scarce resource and thus high output, low prices, high quality, varied services, innovation, production and distribution. European courts consider doctors and hospital staff as undertakings (any entity that performs economic activities), so that if they enter into agreements then they have to comply with competition rules. This paper's objective is to determine whether competition law, which applies to undertakings, can in fact be applied to different healthcare‐sector players and whether specific rules are needed regarding competition between healthcare undertakings.

Design/methodology/approach

Data were selected from relevant European and national case law, European institution legal documents (such as regulations, guidelines and communications) and healthcare competition law literature, and then examined.

Findings

The paper finds that competition rules are applicable to healthcare players considering the consequences if competition rules are applied to the healthcare market. For market processes to result in the appropriate cost, quality and output, competition law must be proactive. In other words, quality must be fully factored into the competitive mix, allowing consumers to weigh healthcare price and non‐price characteristics.

Research limitations/implications

Countries have different healthcare system and competition rules (although similar), competition rule impact is different for each country. Some healthcare systems are more regulated and there will be less opportunity for healthcare players to compete.

Practical implications

Efficiently applying competition law to healthcare players means that several challenges need facing, such as healthcare quality complexity and court scepticism.

Originality/value

This article points out the challenges when competition law is applied to the healthcare sector and how these challenges are faced in certain countries such as The Netherlands.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 5
Type: Research Article
ISSN: 0952-6862

Keywords

1 – 10 of over 12000