PubMed Health⌕ Search

Biomedical subjects

J M Rayburn

Publications and source records attributed to J M Rayburn.

9 recordsLinked to original sources
PubMed1997

The changing power equation in hospitals.

This research traces the origins, development, and reasons for change in the power equation in the U.S. hospitals between physicians, administrators and accountants. The paper contains three major sections: a review of the literature concerning authority, power, influence, and institutional theory; a review of the development of the power of professions, especially physicians, accounting and healthcare administrators, and the power equilibrium of a hospital; and, a discussion of the social policy implications of the power struggle. The basis for physicians' power derives from their legal ability to act on which others are dependent, such as choosing which hospital to admit patients, order tests and procedures for their patients. The Federal Government's prospective payment system and the hospitals' related case-mix accounting systems appear to influence the power structure in hospitals by redistributing that power. The basis of the accountants' power base is control of financial information. Accountants have a definite potential for influencing which departments receive financial resources and for what purpose. This moves hospital accountants into the power equation. The basis of the hospital administrators' power is their formal authority in the organization. Regardless of what actions federal government agencies, hospital accountants, or hospital administrators take, physicians are expected to remain the dominant factor in the power equation. Without major environmental changes to gain control of physician services, only insignificant results in cost containment will occur.

Financial Management, Hospital↗
PubMed1996

Shift in power to hospital accountants.

With the introduction of the Prospective Payment System, hospital accountants' role changed from reimbursement maximizers to an important role in decision making. Faced with increased competition, many hospitals are installing financial controls. Many hospitals are engaging in promotion and health awareness campaigns and expanding their services to stabilize income and reduce the effects of a changing environment. Thus, hospitals operate in a more competitive environment with much uncertainty. When faced with uncertainty, organizations often believe that they must convince society that their existence is legitimate. Increasing specialization and organizational complexity in healthcare professions have made the expert important. Experts, such as the role assumed by hospital accountants, maintain power because the organization depends on them for their special skills and information. Scarce resources coupled with uncertainty move hospital accountants as experts into the power equation in the changing control of the U.S. healthcare system. Since accountants often serve as monitors of scarce resources, information about the resource allocation directly affects the distribution of power. This places hospital accountants in a critical role of assisting their institutions in adapting to a new environment.

Accounting↗
PubMed1995

Marketing implications of the shift in power of the hospital.

With the introduction of the Prospective Payment System, hospital accountants' role changed from reimbursement maximizers to an important role in decision making. Faced with increased competition, hospitals are installing financial controls. Hospital marketers are also engaging in external promotional and health awareness campaigns and expanding their services to stabilize income and reduce the effects of a changing environment. Thus, hospitals operate in a more competitive environment with increasing uncertainty. When faced with uncertainty, organizations often believe that they must convince society that their existence is legitimate. Increasing specialization and organizational complexity in health care professions have made the expert important. Experts, such as the role assumed by hospital accountants and physicians, maintain power because the organization depends on them for their special skills and information. Marketing should also develop an internal marketing program to reach these power influencers. Scarce resource coupled with uncertainty move hospital accountants as experts into the power equation in the changing control of the U.S. healthcare system. Previously, the physician was the major source of hospital power. Since accountants often serve as monitors of scarce resources, information about the resource allocation directly affects the distribution of power. Marketers should acknowledge that this places hospital accountants in a critical role of assisting their institutions in adapting to a new environment.

Accounting↗
PubMed1993

Study indicates mixed cost containment-efficiency results from PPS implementation.

The prospective Payment System (PPS) has put the nation's hospital industry at extreme risk of financial failure and closure. With the PPS in effect, hospital incentives changed from Medicare reimbursement maximizers to the development of programs and the implementation of organization changes which would control cost and encourage efficiency. Specifically, the Federal Government wanted to reduce or at least maintain at a constant level their cost for the Medicare program.

Cost Control↗
PubMed1991

PPS implementation effects on efficiency and cost control in the hospital industry.

Empirical evidence is provided concerning the impact of Public Law 98-21 on the operation of United States hospitals. The Box-Jenkins autoregressive integrated moving average model was used to analyze the impact of the law on efficiency and cost containment practices over a 24-year time period. Four cost containment variables and three efficiency variables were studied. Public Law 98-21 was the intervention and 1984 was the intervention year in which to evaluate impact assessment. Children's hospitals were used as a control group. Results of the research indicated no impact on cost containment practices and a significant impact on efficiency of hospital operations.

Cost Allocation↗