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Opinions of hospital administrators toward the prevalence of patient dumping in Taiwan.

BACKGROUND: The purposes of this paper were to examine whether patient dumping has occurred under the National Health Insurance and to explore hospital administrators' attitudes toward the practice of patient dumping in Taiwan. METHODS: The study subjects were administrators in general hospitals that were accredited by the Taiwan Joint Commission on Hospital Accreditation as medical centers, regional hospitals, or district teaching hospitals in the years 2000 and 2001. A self-administered postal survey was conducted using a structured questionnaire mailed to 128 administrators in general hospitals. RESULTS: Of the respondents, 83 of 99 (83.8%) administrators perceived that patient dumping did occur in their service areas to a certain degree regardless of their hospital location, hospital level, or hospital ownership. A total of 67 of 74 (90.5%) administrators who attempted to answer the question on the prevalence of patient dumping perceived that different percentages (mean=13.27%) of hospitals transferred patients solely on economic considerations in their service areas. In addition, this study found that no statistically significant relationships existed between the administrators' perceived percentage of emergency patients received by their hospitals and hospital characteristics. However, there was a statistically significant relationship between the perceived percentage of inpatients received and hospital level (p = 0.007). CONCLUSION: According to the results of this study, we concluded that patient dumping is a serious and widespread problem in the healthcare industry in Taiwan. Patient dumping can jeopardize patient health and impair the financial integrity of receiving hospitals. Implementation of a case payment system may worsened the situation in Taiwan.

Attitude of Health Personnel↗

Kindly technicians: hospital administrators immediately before the NHS.

Presents the results of a qualitative analysis of copies of The Hospital, a journal for UK hospital administrators, from 1946-1948: immediately prior to the establishment of the NHS. Characterises administrators in that period as kindly technicians. Analyses administrators' ways of thinking; spheres of influence and level of education. Also notes their concern for the running of support services; their implicit and unexamined deference to medical staff and an explicit belief in the need to carry out their role with kindliness. Concludes by highlighting the changes in managerial thinking between the 1940s and today and speculates that these changes may be best understood, following Foucault, as phenomena of rupture and discontinuity rather than as linear progression.

Bibliometrics↗

Experience of transferring an integrated hospital-administration system from a CODASYL data-base to a standard MUMPS file structure.

University College Hospital, a teaching hospital situated in Central London, has been using computers since 1964. Development of an integrated on-line hospital administration computer system was started in 1974. By mid 1977, the components of the system which had been implemented included a patient Master Index, Registration of new patients, Waiting Lists, Bed State, Out-patient Appointments, X-ray, Microbiology and Disease Index. The system was implemented using the Rank Xerox Data Systems (CODASYL based data-base management software, with the majority of applications running on a terminal network supported by transaction processing programs. The experience gained during three years of using such a system is reviewed, with particular emphasis on the ways in which the system matched up in practice to the expected benefits of data-base management facilities. In early 1977, it was decided to replace the Rank Xerox mainframe with a minicomputer which was considered to be a more cost-effective solution to the hospital's computing requirements. The machine selected a PDP 11-70, is running the Digital Equipment Corporation's implementation of Standard MUMPS, an interpretive language developed in a hospital environment, with its own file management software. The decisions which were made in redesigning the existing computer systems for the new machine are discussed. The progress made to date in the transfer of applications from the mainframe to the mini is reviewed, and some of the features of the software available on each machine and its suitability for the implementation of on-line data management and retrieval systems are compared.

Computers↗

Medical staff and hospital administration uses of discharge abstract data.

In summary, this article suggests several useful approaches whereby physicians and hospital administrators can efficiently sort through large amounts of discharge abstract data to identify problem areas, particularly those concerning quality of care and utilization of services, and to formulate strategies for improvement. Approaches and steps suggested include: . Review objectives-determining variables of greatest concern; . Standards-determining acceptable values or levels of performance; . Focus of review-determining the unit of review, such as specific departments, diseases, or physicians; and . Quality and reliability of discharge abstract data-determining the data to use by undertaking four levels of edits: technical edits, logical edits, ratio edits, and categorical edits. A model flowchart provided in this article serves as a conceptual framework by which potential problem areas can be studied during a patient's hospitalization to precisely identify the interaction, the time, and the cause/association of the problem.

Decision Making↗