HEN: Hospitals (Topic)最新文献

{"title":"Financial Meltdown in Swing Hospitals during the COVID-19 Outbreak","authors":"R. Takaku, Izumi Yokoyama","doi":"10.1101/2021.06.06.21258442","DOIUrl":"https://doi.org/10.1101/2021.06.06.21258442","url":null,"abstract":"Hospitals in Japan have complete autonomy in deciding whether to admit COVID-19 patients, similar to that of the US. Taking this into account, we estimated the effect of admitting COVID-19 patients on hospital profits, using instrumental variable (IV) regression. Using IVs related to government intervention enabled us to not only estimate the effect of admitting COVID-19 patients among \"swing hospitals,\" where both options (to admit or to not admit COVID-19 patients) could potentially be realized but to also evaluate the effect of government intervention on such hospitals. Our empirical results revealed that monthly profits per bed decreased by approximately JPY 600,000 (USD 6,000) among swing hospitals, which is 15 times the average monthly profits in 2019. This overwhelming financial damage indicates that it would be costly for swing hospitals to treat COVID-19 patients because of their low suitability for admitting such patients. Given the implications of our main results, we propose an alternative strategy to handling surges in patients with new infectious diseases.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130647389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Telemedicine Reduce Emergency Room Congestion? Evidence from New York State","authors":"Shujing Sun, S. F. Lu, Huaxia Rui","doi":"10.2139/ssrn.3504291","DOIUrl":"https://doi.org/10.2139/ssrn.3504291","url":null,"abstract":"Overcrowding in emergency rooms (ERs) is a common yet nagging problem. It not only is costly for hospitals but also compromises care quality and patient experience. Our paper provides solid evidence that telemedicine can significantly improve ER care delivery, especially in the presence of demand and supply fluctuations. We believe such findings are critical for ERs, due to the special setting of unscheduled arrivals leading to high unpredictability of patient traffic. Additional evidence suggests that the efficiency gained from telemedicine does not come at the expense of lower care quality or higher medical expenditure, which points to telemedicine as a feasible solution to the ER overcrowding problem. For healthcare practitioners, our paper highlights the general applicability of telemedicine through the “hub and spoke” architecture. Besides increasing patients’ access to more immediate care from specialists who were not available otherwise, telemedicine enables flexible resource allocation for any hospitals, regardless of where hospitals are located. Our research also provides ground for policymakers to incentivize hospitals to adopt telemedicine in ER, which we believe is critical given the relatively low adoption rate, the lack of direct evidence on its effectiveness, and the current inflexibility of reimbursement policies regarding the application of ER telemedicine.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128335680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Integration between Hospitals and Insurers","authors":"José Ignacio Cuesta, Carlos Noton, B. Vatter","doi":"10.2139/ssrn.3309218","DOIUrl":"https://doi.org/10.2139/ssrn.3309218","url":null,"abstract":"The welfare effects of vertical integration are ambiguous. Cost efficiencies and the elimination of double marginalization may offset increases in market power and incentives to raise rivals' costs. To study the effects of vertical integration between insurers and hospitals, we develop a model of bargaining and competition. Integrated firms have incentives to increase hospital prices to rivals to steer demand to integrated partners. We estimate the model using administrative data on claims and plans from Chile, where vertically integrated hospitals account for half of all admissions. Our estimates imply that steering incentives are significant and that vertical integration decreases welfare.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123215955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consolidation in Provider and Insurer Markets: Enforcement Issues and Priorities","authors":"T. Greaney, Barak D Richman","doi":"10.2139/ssrn.3195331","DOIUrl":"https://doi.org/10.2139/ssrn.3195331","url":null,"abstract":"The U.S. healthcare sector is undergoing rapid change, with providers and payers adopting new organizational forms as payment methods and delivery models transform. Many of these forces have created strong financial incentives for assorted healthcare entities to join forces, some opportunistically to aggregate market power, and some to bring greater value to an inefficient delivery system. Though there is little empirical doubt that competitive markets generate enormous benefits for patients and consumers, reducing the cost of healthcare while improving its quality, the need for swift and predictably pro-competitive policies may never be more pressing than it is today. Unfortunately, the current policy environment has inherited healthcare markets that for many years suffered from inadequate antitrust attention. Among policymakers’ most pressing challenges is to confront the market harms stemming from unchallenged transactions that now bestow many market participants with monopoly power. Attentive antitrust enforcement—with a particular focus on merger review—is therefore critical to assure that the pro-competitive benefits of financial and clinical integration are not thwarted by excessive concentration, collusion, or abuse of dominant positions. Pervasive market concentration stemming from inadequate enforcement in prior years leaves current policymakers little room for error and has raised the stakes for today’s enforcement challenges. The current challenges confronting the healthcare markets involve both a recurrence of the familiar horizontal mergers among providers and insurers and also a complex set of new vertical arrangements. Because the policy community cannot afford to continue playing catch-up, realizing the competitive harms of certain industrial realignments only after they win regulatory or judicial approval, antitrust law must be aggressive and decisive. The most recent wave of transactions pose special threats to competition in many geographic markets, in part because the competitive harms are less familiar and because the rate of integration is outpacing what traditional agency resources can police. This White Paper, Part I of a series sponsored by the American Antitrust Institute, identifies and analyzes the major concerns and priorities surrounding consolidation in the markets for delivery and payment of healthcare services. It takes a close look at the myriad competitive issues raised by ongoing consolidation in provider and insurers markets. These are multidimensional issues that raise substantive concerns for enforcers and courts. They also suggest a useful agenda for furthering academic and policy research that supports more vigorous enforcement. Some of the major takeaways from the analysis include: Absent meaningful rivalry, rivals in provider and payment markets will not face incentives to innovate, conserve costs, or pass on savings to consumers. Vigorous antitrust enforcement, with a particular focus on merger review,","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116124898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Fixed Effects: Perfect Prediction and Bias in Binary Response Panel Models, with an Application to the Hospital Readmissions Reduction Program","authors":"Johannes S Kunz, K. E. Staub, R. Winkelmann","doi":"10.2139/ssrn.3074193","DOIUrl":"https://doi.org/10.2139/ssrn.3074193","url":null,"abstract":"The maximum likelihood estimator for the regression coefficients, ?, in a panel binary response model with fixed effects can be severely biased if N is large and T is small, a consequence of the incidental parameters problem. This has led to the development of conditional maximum likelihood estimators and, more recently, to estimators that remove the O(T–1) bias in ?^. We add to this literature in two important ways. First, we focus on estimation of the fixed effects proper, as these have become increasingly important in applied work. Second, we build on a bias-reduction approach originally developed by Kosmidis and Firth (2009) for cross-section data, and show that in contrast to other proposals, the new estimator ensures finiteness of the fixed effects even in the absence of within-unit variation in the outcome. Results from a simulation study document favourable small sample properties. In an application to hospital data on patient readmission rates under the 2010 Affordable Care Act, we find that hospital fixed effects are strongly correlated across different treatment categories and on average higher for privately owned hospitals.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122024804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gains from Specialization with Medical Scribes: Evidence from a Randomized Experiment","authors":"Andrew Friedson","doi":"10.2139/ssrn.2774426","DOIUrl":"https://doi.org/10.2139/ssrn.2774426","url":null,"abstract":"This paper estimates the impact of medical scribes on various measures of physician productivity. Scribes are charting specialists who prepare patient charts in the physician’s stead, potentially creating efficiency gains in productivity via specialization of labor. The scribe industry has grown rapidly in recent years, but relatively little is known about its effects. I use data from a randomized experiment in which scribes were assigned to some, but not all, physician shifts in three emergency rooms over nine months. I find that scribes significantly decrease physician overtime usage and increase the number of relative value units per shift.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123539514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Adaptation of the Implementation of Just In Time Method - A Case Study in Pharmacy of Kemang Medical Care","authors":"A. H. Iswanto","doi":"10.2139/ssrn.2629907","DOIUrl":"https://doi.org/10.2139/ssrn.2629907","url":null,"abstract":"Introduction - The 30%-50% of the hospital’s income comes from pharmacy. The mishandling management can result in waste. If the drug excess, the hospital got loss, because the drugs will not be used. Unavailable drugs (stock out) can miss the chance to get a profit. Therefore, some efforts are made to manage the pharmacy, one of them: implementing JIT method. Some hospitals successfully implement these methods, including: Kemang Medical Care (Indonesia), Seattle Children's Hospital, Cincinnati Children's Hospital Medical Center, Sacre-Coeur Hospital in Montreal, and the Hospital for Sick Children (USA).Methodology - The study was conducted only in two hospitals (Kemang Medical Care and Seattle Children's Hospital). The information is gathered from the research reports from those hospitals. Interviews were conducted with those involved in the design, implementation, and monitoring. Questions related to how the JIT is designed, implemented, monitored, and the effects towards the pharmaceutical supplies.Results - Kemang Medical Care. Cost reduction is calculated from the ratio of purchases to sales. The ratio is increased from 4.39 becomes 8.04; since the purchases are dropped consistently, it is able to compensate the sales. Seattle Children's Hospital. The program takes 18 months and costs $200,000. The implementation of JIT is able to save 23,000 work hours per year and reduce the cost 5% of supply. The costs are equivalent with the ROI for amount $2.5 million in the first year and a profit of 1,200%.Discussion - The JIT method is more focused on the efforts to reduce the variation in the form of a good visual representation. JIT is a cost control method that eliminates the activity of continuous daily scheduling. Controlling is made easier with a good visual representation. Reduction of variation and visual representation are important in the implementation of JIT.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128210357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lean Approach To Improve Human Productivity in Maternity Ward: A Case Study in Kemang Medical Care (KMC)","authors":"A. H. Iswanto","doi":"10.2139/ssrn.2629967","DOIUrl":"https://doi.org/10.2139/ssrn.2629967","url":null,"abstract":"Introduction – Human productivity is not only considered how the human gives service based on SOP, but also how it gives its own service. Many efforts have been conducted to improve HRD productivity of inpatient. One of maternity human productivity improvements is Lean.Methodology – This research used a case study approach. This approach was organized into three methods of data collection: documentary, survey, and observation. Survey was conducted to know the lean effects towards individual and the correlation. 61 respondents was recruited to participate in this study. There were four variables studied: positive feedback, emotional intellegence, organizational culture, and lean effects on individual. The questionnaire was adopted from Beale.Results – The study results were distinguished based on nurses and midwives, and it was found no significant difference. One way ANOVA test showed no lean effect difference between nurses and midwives. Three variables (positive feedback, organizational culture, and emotional intellegence) described 14,5% of lean effect variations. The significant influential variable was organizational culture. It indicated the lean effects on individual was affected by supporting organizational culture.Conclusion – The lean implementations at individual level: smarter, time effective, work motivation, and work load reduction. Nonetheless, these effects should be encouraged by organizational cultures, for instances, organization environment tolerating diversity, organization objectives that are easy to be understood, level of reciprocal trusting among organization members, conflict management in organization, competence-based human utilization, volunteer management control method, free and opened communication in organization, and everyone supporting each others.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121296440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did the Butler Really Do It? Examining the Impact of Technology on Hospital Cost Growth","authors":"S. Daidone, L. Baker","doi":"10.2139/ssrn.1905429","DOIUrl":"https://doi.org/10.2139/ssrn.1905429","url":null,"abstract":"We examine the extent to which hospital technologies are associated with growth in U.S. hospital costs. We create an index capturing the availability of a range of technologies in 2214 hospitals and track over the period 1996-2007, along with financial information from Medicare Cost Reports. We find that our measures of technology availability are positively correlated with hospital costs, consistent with the view that technology is an important driver of costs. However, we find that even controlling for a large number of technologies leaves a significant portion of the growth in U.S. hospital costs unexplained. While this may at least in part reflect effects of technology not captured by our measures, it suggests that the drivers of hospital cost growth go significantly beyond commonly conceptualized measures of technological change. Finally, we identify innovations that are cost increasing or cost-saving, and the time pattern of these effects.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"75 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131190373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service","authors":"M. Gaynor, C. Propper, R. Moreno-Serra","doi":"10.2139/ssrn.1880692","DOIUrl":"https://doi.org/10.2139/ssrn.1880692","url":null,"abstract":"The effect of competition on the quality of health care remains a contested issue. Most empirical estimates rely on inference from non experimental data. In contrast, this paper exploits a pro-competitive policy reform to provide estimates of the impact of competition on hospital outcomes. The English government introduced a policy in 2006 to promote competition between hospitals. Patients were given choice of location for hospital care and provided information on the quality and timeliness of care. Prices, previously negotiated between buyer and seller, were set centrally under a DRG type system. Using this policy to implement a difference-in-differences research design we estimate the impact of the introduction of competition on not only clinical outcomes but also productivity and expenditure. Our data set is large, containing information on approximately 68,000 discharges per year per hospital from 160 hospitals. We find that the effect of competition is to save lives without raising costs. Patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had shorter length of stay and were treated at the same cost.","PeriodicalId":304394,"journal":{"name":"HEN: Hospitals (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129922447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}