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PubMed1997

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism.

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.

Cost-Benefit Analysis↗
PubMedDate not supplied

Cost and reimbursement for three fibroid treatments: abdominal hysterectomy, abdominal myomectomy, and uterine fibroid embolization.

PURPOSE: To compare costs and reimbursements for three different treatments for uterine fibroids. METHODS: Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n = 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. RESULTS: The mean total hospital cost (US dollar) for UFE was 2,707 dollars, which was significantly less than for hysterectomy (5,707 dollars) or myomectomy (5,676 dollars) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was 57 dollars, which was significantly greater than for hysterectomy (-572 dollars) or myomectomy (-715 dollars) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were 1,306 dollars, 979 dollars, and 1,078 dollars, respectively. CONCLUSION: UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions.

Adult↗
PubMed1979

Point of view: readings for the chairperson of your board.

The chairperson of the board and the hospital's chief executive officer need to read about the forces threatening their hospital's survival and growth. These suggested readings cover such vital issues as National Health Insurance, hospital rate settings and health care access.

Bibliographies as Topic↗
PubMedDate not supplied

Effects of Medicare BBA spending reductions on the profitability of general acute care hospitals.

The Balanced Budget Act of 1997 was intended to reduce spending by about $115 billion from the Medicare Hospital Insurance trust fund over a five-year period. Several studies were funded by the hospital industry that indicated that the actual reductions would be far greater than $115 billion and that these reductions would have a devastating effect on U.S. hospital finances. In 1999, Congress passed the Balanced Budget Refinement Act, which added back about $11 billion in spending for fiscal years 2000 through 2002. In 2000, Congress passed the Benefits Improvement and Protection Act, which restored another $37 billion in spending over a five-year period. These cutbacks were going into effect at the same time as a cyclical decline in hospital operating margins occurred. This study was designed to determine if any separate effect of the Balanced Budget Act could be detected in the operating margins of general acute care hospitals in Tampa Bay, Florida. Operating margins were analyzed for 25 hospitals for a 12-year period (1990 through 2001), and a regression model was tested in which the dependent variable was the difference in mean operating margins for each hospital between the 1990 through 1997 period and the 1998 through 2001 period. The mean percentage of hospital revenue derived from Medicare, five other revenue source variables, and three hospital structural variables were used as the predictor variables. A statistically significant decline in operating margins was seen between these two periods, but Medicare revenue did not account for a significant amount of the variance. Thus, it was concluded that the Balanced Budget Act of 1997 did not significantly affect the operating margins of the study hospitals. Implications for Medicare policy are addressed.

Acute Disease↗
PubMedDate not supplied

Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers.

OBJECTIVES: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals. METHODS: A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals. RESULTS: A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer interest in CAM, although hospitals can only offer CAM therapies for which local, licensed practitioners are available. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. CONCLUSIONS: Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.

Complementary Therapies↗
PubMed1980

Current development in Social Security financing.

The current financial outlook for the old-age, survivors, disability, and health insurance (OASDHI) program indicates several problems. During 1980-84, income and outgo for the OASDI and hospital insurance (HI) trust funds combined are roughly in balance, according to the annual report of the Board of Trustees. The OSI program, however, is running out of funds as automatic benefit increases exceed the growth in payroll tax revenues. Clearly, additional financing will be needed throughout the 1980's. Funds now earmarked for the DI and HI trust funds could serve this purpose, although more short-range financing will be needed if real wages continue to show losses instead of the usual gains. The 1977 amendments that strengthened social security financing provided only a thin margin of safety against unfavorable experience during the early 1980's. The short-range economic picture has darkened considerably since 1977, with adverse consequences for social security financing. Only the DI experience has improved. Based on tax rates in the present law, a large buildup of OASDI trust funds is expected over the next 25 years. HI financing, however, is projected to become inadequate after 1990. Projections over the next 75 years indicate severe financing problems for the OASDI program early in the 21st centruy, as the aged population grows relative to the work force.

Actuarial Analysis↗
PubMed1990

Practice guidelines: a new reality in medicine. I. Recent developments.

There is growing interest in the use of practice guidelines for physicians as a means of reducing inappropriate care, controlling geographic variations in practice patterns, and making more effective use of health care resources. Recent developments at the national health policy level suggest that practice guidelines will play an increasingly prominent role in the practice of medicine. The federal government has created a new US Public Health Service agency with responsibility for practice guidelines. Guidelines have been developed by more than 35 physician organizations and specialty societies. The American Medical Association and the Council of Medical Specialty Societies have endorsed practice guidelines and are organizing specialty societies to set policy on the subject. Academic medical centers have formed a research consortium on practice guidelines. Independent research centers (eg, the RAND Corporation and the Institute of Medicine) are developing methods for assessing appropriateness and setting guidelines. Other groups, such as hospitals, insurers, managed care plans, and private enterprises, are also directly involved. The implications of these developments are far reaching.

Academies and Institutes↗
PubMed1996

Medicare's mental health benefits: coverage, use, and expenditures.

Estimates of the proportion of persons aged 65 and older with diagnosable mental disorders, residing both in the community and in institutions, range from 13.5% to 22%. Mental health services, both inpatient and outpatient, short and long term, are necessary for the well-being of these older Americans. Mental health benefits are covered under Medicare. However, less than 3% of the $90.5 billion Medicare budget in 1988 was spent on mental health services. Of that 3%, $2.2 billion was used for Part A (hospital insurance) and $300 million for Part B (medical insurance). In contrast, in the same year, payments for mental health services represented 20% to 30% of total health expenditures made by private insurers. Differences in payments abound when comparing freestanding psychiatric facilities with both exempt and nonexempt psychiatric units in general hospitals. This article describes these differences and how they influence the use of mental health services by Medicare beneficiaries.

Aged↗
PubMed1982

Medicare program; inpatient hospital deductible for 1983--HHS. General notice.

This notice announces the inpatient hospital deductible and coinsurance amounts for calendar year 1983 under Medicare's Hospital Insurance Program. The Medicare statute specifies the formula to be used to determine these amounts. The inpatient hospital deductible will be $304. The daily coinsurance amounts will be: (a) $76 for the 61st through 90th days of hospitalization; (b) $152 for lifetime reserve days; and (c) $38 for the 21st through the 100th days of extended care services in a skilled nursing facility. Each figure represents an increase of approximately 17 percent over the corresponding 1982 figure.

Deductibles and Coinsurance↗