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Book part
Publication date: 6 December 2007

Gary D. Ferrier and Vivian G. Valdmanis

Based on the Current Population Survey, 46.6 million Americans did not have health insurance in 2005 (Center on Budget and Policy Priorities, 2006). Lack of insurance is often…

Abstract

Based on the Current Population Survey, 46.6 million Americans did not have health insurance in 2005 (Center on Budget and Policy Priorities, 2006). Lack of insurance is often associated with lower utilization rates, which may in turn adversely affect health status (Ayanian, Weissman, Schneider, Ginsburg, & Zaslavsky, 2000). Since universal health insurance is not provided for in the US, uninsured individuals must either self-pay or rely on charity care provided by hospitals and health clinics. The majority of charity care is produced in the public sector, either at the state, county, or local level (federal hospitals primarily serve a particular segment of the population – e.g., veterans in the case of Veterans Administration hospitals). Public hospital provision of “safety nethospital services is particularly prevalent in large urban areas (Lipson & Naierman, 1996). These safety net hospitals are defined by the Institute of Medicine as having an “open door policy to serve all patients regardless of their ability to pay and provide substantial levels of care to Medicaid, the uninsured, and other vulnerable patients” (IOM, 2000). Private not-for-profit (NFP) hospitals also provide charity care but to a lesser extent than public providers, especially since the imposition of cost cutting measures both by Medicare and Medicaid (federal programs that fund health care for the elderly and indigent, respectively) and by managed care. Given that approximately 15% of US GDP is allocated to health care, cost cutting measures are laudable; however, care still needs to be provided for individuals who cannot afford it, and the burden of providing this care has to be borne somewhere in the health care system.

Details

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

Book part
Publication date: 24 October 2019

Susan P. McGrath, Emily Wells, Krystal M. McGovern, Irina Perreard, Kathleen Stewart, Dennis McGrath and George Blike

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering…

Abstract

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering approaches to systems analysis and redesign in the health care domain. Commonly employed methods, such as statistical analysis of risk factors and outcomes, are simply not adequate to robustly characterize all system requirements and facilitate reliable design of complex care delivery systems. This is especially apparent in institutional-level systems, such as patient safety programs that must mitigate the risk of infections and other complications that can occur in virtually any setting providing direct and indirect patient care. The case example presented here illustrates the application of various system engineering methods to identify requirements and intervention candidates for a critical patient safety problem known as failure to rescue. Detailed descriptions of the analysis methods and their application are presented along with specific analysis artifacts related to the failure to rescue case study. Given the prevalence of complex systems in health care, this practical and effective approach provides an important example of how systems engineering methods can effectively address the shortcomings in current health care analysis and design, where complex systems are increasingly prevalent.

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

Keywords

Book part
Publication date: 1 January 2006

Jay J. Shen, Elmer L. Washington, Ralph Bell, Kyusuk Chung and Donna Gellatly

The number of uninsured has increased during recent years. This study explores underlying factors associated with the insurance-status disparities in hospital care by examining…

Abstract

The number of uninsured has increased during recent years. This study explores underlying factors associated with the insurance-status disparities in hospital care by examining 80,730 acute myocardial infarction discharges in the National Inpatient Sample. Compared to patients having private insurance, Medicaid patients’ higher mortality risk related to severity of illness while the higher mortality of uninsured patients related to interactive effects between insurance status and hospital characteristics. Primary care strategies are likely to improve the hospital care for Medicaid patients while ensuring access to high quality care for patients with limited financial means can improve outcomes for uninsured patients.

Details

Access, Quality and Satisfaction with Care
Type: Book
ISBN: 978-1-84950-420-1

Book part
Publication date: 7 February 2024

Nathan W. Carroll, Shu-Fang Shih, Saleema A. Karim and Shoou-Yih D. Lee

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor…

Abstract

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

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Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Keywords

Book part
Publication date: 13 November 2002

Blair D. Gifford, Larry M. Manheim and Diane Cowper

Medicaid, Medicare, and managed care reimbursement changes since the early 1980s have put added financial pressure on hospitals, increasing fears that private hospitals will…

Abstract

Medicaid, Medicare, and managed care reimbursement changes since the early 1980s have put added financial pressure on hospitals, increasing fears that private hospitals will decrease support for indigent care and that those hospitals that serve a disproportionately large indigent population may be forced to close. Wilson and Kizer (1997) use the term “safety net” to convey the notion that public health facilities, such as Veterans Affairs Medical Centers (VA), municipal hospitals, community health centers, and local public health departments, are providing uncompensated care for an increasing number of uninsured due to increasing cost pressures on private health facilities. Other research efforts also give evidence of increasing patient demand pressures on public health facilities in recent years (Lipson & Naierman, 1996). However, these efforts are often cross-sectional in design or limited to information from only one or a few health facilities in a metropolitan area (Baxter & Mechanic, 1997). As such, it is very difficult to measure fully the extent to which new legislation and private market changes have an effect on the public health “safety net” over time.This research considers the longitudinal relationship between the effect of Illinois implementation of the ICARE Medicaid reimbursement program, private hospital closings and the demand for VA inpatient services in a large metropolitan market in Chicago in the 1980s. Analysis is conducted with a combination of VA hospital discharge data, zip code level sociodemographic data from the U.S. Census, and data on hospital closures in the Chicago area between 1980 and 1990. The combined data allow for a longitudinal analysis of the tradeoffs between new state policy and hospitals over the provision of care for the indigent, including the effects of changes in reimbursement for Medicaid patients.

Details

Social Inequalities, Health and Health Care Delivery
Type: Book
ISBN: 978-1-84950-172-9

Case study
Publication date: 2 October 2020

Miriam Weismann, Sue Ganske and Osmel Delgado

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing…

Abstract

Theoretical basis

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process.

Research methodology

This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources.

Case overview/synopsis

Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it?

Complexity academic level

This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

Book part
Publication date: 25 July 2012

Peter Lazes, Liana Katz, Maria Figueroa and Arun Karpur

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and…

Abstract

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

Keywords

Book part
Publication date: 1 January 2006

Vicky M. MacLean, Patricia Parker and Melissa Sandefur

The study assesses public health programs to shed light on the experiences of low-income and minority women with children seeking health services. Thirteen focus groups were…

Abstract

The study assesses public health programs to shed light on the experiences of low-income and minority women with children seeking health services. Thirteen focus groups were conducted with 111 pregnant women or women with children. Women consumers of public health services experience difficulties accessing health services due to a lack of insurance, information and language barriers about programs and eligibility, a shortage of Medicaid providers and specialist services, long waits, bureaucratic barriers, and dismissive treatment. Accessibility and information barriers were more prominent in rural regions whereas bureaucratic barriers were more pronounced in urban areas. Lower satisfaction with services was reported among ethnic minority women compared to whites.

Details

Access, Quality and Satisfaction with Care
Type: Book
ISBN: 978-1-84950-420-1

Book part
Publication date: 6 December 2007

Jos L.T. Blank and Vivian G. Valdmanis

It is well recognized that hospitals do not operate in a competitive market typically observed in the economics literature, but rather alternative measures of performance must be…

Abstract

It is well recognized that hospitals do not operate in a competitive market typically observed in the economics literature, but rather alternative measures of performance must be developed. In other words, health policy analysts, managers, and decision-makers cannot rely on determining efficiency via the typical profit maximizing/cost minimizing firm but develop techniques that address the issues germane to hospital productivity. What has been presented in this book demonstrates the research in both productivity and policy that must attend to this anomaly. In this introductory section, we briefly summarize the theoretical underpinnings of this book.

Details

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

Content available
Book part
Publication date: 6 December 2007

Chapter 1 discusses the objective of the book and presents an outline. It explains the relevance of the subject not only from a social point of view, but also for the economy as a…

Abstract

Chapter 1 discusses the objective of the book and presents an outline. It explains the relevance of the subject not only from a social point of view, but also for the economy as a whole. Hospitals worldwide command the majority of any countries’ health care budget. Reasons for these higher costs include the aging of the population requiring more intensive health care treatments, the relatively high costs of labor in this labor-intensive industry and payment systems that may encourage inefficient behavior on the part of hospital managers and physicians. There is also a special role of technology in the hospital. It has been argued that advances in technology are one of the major reasons for hospital cost increases. Further Chapter 1 indicates that from international comparison we may conclude that large differences in hospital productivity exists. Chapter 1 presents an outline of the other chapters in the book, varying from issues dealing with privatizing, liberalizing, ownership, networks, budgeting, management skills, innovations and government facilitating research on productivity enhancement.

Details

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

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