PubMed · 16217416
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Cathy A Klein. 2005. Damage caps--another view.. https://doi.org/10.1097/00006205-200510000-00003
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In this paper we attempt to identify behavioral differences between public and private not-for-profit hospitals, by exploiting the introduction of the DRG-based payment system in the Italian NHS during the second half of the 1990s. We estimate the technical efficiency of a sample of hospitals for the period 1995-2000 considering an output distance function, and adopting both parametric (COLS and SF) and nonparametric (DEA) approaches. Our results show a convergence of mean efficiency scores between not-for-profit and public hospitals, and seem to suggest that differences in economic performances between competing ownership forms are more the result of the institutional settings in which they operate than the effect of the incentive structures embedded in the different proprietary forms. We also observe a decline in technical efficiency, probably due to policies aimed at reducing hospitalization rates.
Many childless couples would like to have access to in vitro fertilization (IVF) through public-sector programs, but such programs are scant because of the high costs that IVF entails today. A solution for health departments worldwide might be to leave IVF methods requiring expensive equipment and ovarian stimulating hormones - such as human recombinant gonadotropins, plus gonadotropin-releasing hormone analogues to prevent a surge of luteinizing hormone - to the private sector. Rather, health departments could focus on methods using less equipment and no ovarian stimulating agent at all if possible. If not possible, inexpensive clomiphene citrate could be used, combined with human menopausal gonadotropin if needed. Before embryo transfer, oocyte maturation could occur in vitro or in a makeshift incubator: a tube closed, wrapped, and left in the woman's vagina for 24 h. To prevent short- and long-term costs as well as possible lifelong problems, the transfer of multiple embryos should not be performed.