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PubMed1986

Use of computerized information systems in U.S. health maintenance organizations and hospitals.

A comparison was made between the use of data processing in hospitals and Health Maintenance Organizations (HMOs). Findings indicate that the HMO and hospital data processing markets are currently quite distinct. As expected, the functions automated reflect the uses of the different care delivery systems. The hardware and software vendors to these markets are also different. A high percentage (50%) of HMOs are using software they developed in-house. In this respect, current HMO data processing is similar to the hospitals of a decade ago. The hospital market (for hardware and total systems) is highly concentrated. A few firms have a combined market share of over 50% and there are a large number of firms with very small shares. In the HMO market, there is a high concentration ratio for hardware but not for software or systems. HMOs and hospitals are almost uniformly satisfied with their hardware. Satisfaction with most applications is between 80 and 90% but there is a need, at least within HMOs, for improvements in support of the software supplied.

Data Collection↗
PubMed1989

Allergic contact dermatitis from glutaraldehyde exposure.

A hospital maintenance employee developed an airborne contact dermatitis when cleaning respiratory therapy equipment. Patch-testing determined that she is allergic to glutaraldehyde, an ingredient in a popular commercial germicidal product. The increasing concern over acquired immunodeficiency syndrome (AIDS) and other infectious diseases has resulted in more intensive cleaning, sterilizing, and disposal procedures in health care facilities. This, in turn, may lead to an increased risk of contact dermatitis among health care workers. Glutaraldehyde is commonly used as a sterilizing agent in medical facilities. It is effective against most micro-organisms, including viruses, and is generally harmless to medical equipment. This report concerns a case of airborne allergic contact dermatitis caused by glutaraldehyde.

Aldehydes↗
PubMed1990

Contracts between hospitals and health maintenance organizations.

This article describes the contractual relations that are emerging between health maintenance organizations (HMOs) and hospitals. Six HMOs in four large metropolitan areas provided information on 102 hospital contracts. The authors found that the HMOs are becoming more aggressive in placing hospitals in competition with each other for HMO patients. Staff and network HMOs are able to obtain a higher concentration of patients and substantially larger discounts for inpatient services than are individual practice association (IPA) plans in this study.

Competitive Bidding↗
PubMed1983

Hospitals and health maintenance organizations: an analysis of the Minneapolis-St. Paul experience.

Minneapolis-St. Paul is recognized as a prime example of health care competition. Policymakers and others have been asked to look to the Twin Cities as a model upon which to base new competitive initiatives in the health care sector. Yet little is known about the impact of Health Maintenance Organizations (HMOs) on other health care providers. This study examines the effects of the area's seven health maintenance organizations on the local hospital community. Three questions are addressed. First, is the situation in the Twin Cities unique? A comparison of case study findings and the available literature together with hospital data from similarly HMO-penetrated markets suggests that the Twin Cities' hospital market is indeed different. Second, what is the nature of hospital-HMO interaction? The flexibility of contracting apparently allows hospitals to affiliate successfully with an HMO under a variety of service and reimbursement agreements. Third, what effect has HMO activity had on community-wide utilization? While HMO enrollees clearly use fewer hospital days and the trend in the community is toward fewer days, attributing the change to HMOs is difficult. A large portion of the differences between HMO and community-wide utilization levels is attributable to differences in population.

Economic Competition↗
PubMed2006

The risk of hepatitis A infection among healthcare workers: a review of reported outbreaks and sero-epidemiologic studies.

All reports of hepatitis A (HA) outbreaks in healthcare settings published between 1975 and 2003 were studied to determine the background immunity or susceptibility of healthcare workers (HCWs) to HA. Twenty-six reports were found. The number of infected personnel ranged from one to 66 and, in most outbreaks, nurses accounted for the majority of personnel infected, reflecting high attack rates reaching 15-41%. In addition, we found 23 sero-epidemiological studies for HA among HCWs that had been performed in 13 different countries. Seroprevalence rates of HCWs with anti-HA antibody ranged between 4% among paramedical workers in Germany to 88% among hospital maintenance workers in Portugal. Effective infection control of HA outbreaks in hospitals demands early recognition, including awareness of atypical presentations of the infection, and strict adherence to universal infection control measures. Education programmes are of special importance for HCWs in neonatal, paediatric and intensive care units. The findings of the current study suggest that a pre-employment screening policy and administration of active vaccination to susceptible HCWs, particularly nurses, should be seriously considered in high-risk settings.

Adolescent↗
PubMed1986

The competitive impact of health maintenance organizations on hospital finances: an exploratory study.

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggest that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend. This study concludes that if competition is to succeed it must encompass more than HMOs. HMOs may be important, but they are only one agent in the market. Thus, public policy created to induce competition must go beyond the simple stimulus of HMO growth.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Patient work programs a decade after Souder v Brennan: a survey of selected private psychiatric hospitals.

This paper reports the results of a survey of 13 private psychiatric hospitals conducted in the summer and fall of 1984. The survey, which consisted of separate, structured interviews with each hospitals chief psychiatrist (or designee), rehabilitation or work activities specialist, and patient rights advocate (or equivalent), sought to determine professional opinion as to the value of work programs for hospitalized psychiatric patients and the impact of Souder v Brennan on hospital programs and patient treatment. The survey revealed that most respondents believed work programs to be beneficial; that they insisted that the purpose of such programs should be patient treatment, not hospital maintenance; and that they felt that the Souder decision had hampered the ability of hospitals to provide treatment and consequently should be modified to allow for expanded work programs and opportunities for patients. The survey also indicated that shorter hospital stays and more intensive treatments had shifted the dominant focus of work treatment from symptom relief and chronic occupation to training for discharge; and it pointed to the existence of subtle differences in the perception of patient work programs between psychiatric and rehabilitative staff members.

Data Collection↗
PubMed1979

Hospital equipment management, maintenance and quality control in the Netherlands.

Before 1970, equipment maintenance and quality control in Dutch hospitals were not organised. There was little or no cooperation between physicians, hospital employees and instrument suppliers. Health services which are not nationalised are funded by non-profit making foundations. There were few regulations covering the supply and maintenance of equipment. However, the country is small enough for there to be considerable contact between instrument engineers. In the past eight years a new situation has arisen where rules are being formulated based on collective experiences. A better understanding has to grow between physicians, nurses and engineers, of each others' needs and possibilities in relation to the use of instruments and the necessity of maintenance. To keep quality on an acceptable level, exaggeration in one direction or another has to be avoided.

Equipment and Supplies, Hospital↗