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When our reporter read that his hometown hospital--Ottumwa Regional Health Center in Iowa--was on a list of the nation's hospitals most vulnerable to cuts in Medicare and Medicaid spending, he went to see why. What he found were executives coping with the future, not avoiding it. Here's what they did, how they did it--and why it might save them.
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Like tremors before an earthquake hits, managed care and projected cuts in Medicare and Medicaid are shaking up New York even before they arrive. Many of the city's largest hospitals hope to cushion the shock waves from lost referrals for inpatient care by buying primary care providers, though it's likely many of these efforts will be too little, too late. But a handful of New York's providers have been prepping for managed care's growth, allowing them to address it more on their terms. Mount Sinai Medical Center is so confident its advance work will succeed that it actually is adding a few beds, not closing them. John Rowe, M.D., president of the medical center and the Mount Sinai School of Medicine, spoke recently with H&HN staff writer Jim Montague about Mount Sinai's strategies.
To cope with problems arising from limited economic resources, the pediatric hospital of Ho Chi Minh City, Vietnam, integrated several primary health care concepts into its overall policy: designation of priority diseases, adaptation of therapeutic modalities, decentralisation, and community funding. These concepts have been in use since 1988. Five diseases were designated for priority, i.e. diarrhea, acute pulmonary infection, dengue fever (DF), malaria, and routine pediatric emergencies, malnutrition. Training courses focusing on these diseases have been organized for hospital staff and health care assistants and education programs have been offered to the families of patients. Outpatient treatment is encouraged to lower the number of unnecessary hospitalizations and use of simple, cost-effective therapies has been developed for priority diseases. Responsibility has been delegated to department heads. Treatment is provided at no cost to the poorest but a small fee is requested from others and funding is also obtained from local authorities and non-governmental organizations. In five years, these concepts have achieved a 40% reduction in overall mortality. Funding from non-governmental organizations has been allocated to training and research programs designed to respond to specific community needs. This experience shows that reducing mortality does not depend only on budgetary increases but also to a great extent on rational spending and managing available resources. These can be effective in any developing countries that cannot increase budgetary spending.
In this exclusive panel discussion with H&HN, the CEOs of seven large, integrated health systems take a verbal journey, trekking across country and into inner cities to explore issues ranging from community health to the future of leadership. It's a fictitious journey about the real issues that lie ahead.
This article summarizes a national health care association's exploration into the varying nature of developing organized systems of care among its member hospitals and long-term care facilities. Presented here are some key learnings based on an examination of survey and interview data. The perspective taken on the ensuing results relates more to viewing the "surface activity" surrounding the early evolution of organized systems of care. A longer view and more analytical approach will be taken in a future issue on integrated delivery.
This article chronicles events in 1993-1994 in the small rural town of Clamecy, located in the Burgundy region of France, stemming from proposals of regional planning authorities to close the maternity and emergency services of the local hospital. This possibility engendered a series of protests and maneuvers by town notables, hospital personnel, and local physicians to halt such plans. The situation provided an opportunity for a sociological examination of the role of the hospital in the social and economic life of a rural community. This included a series of unstructured interviews with various townspeople and health professionals conducted within a sociological framework and with the benefit of the author's status as a foreign observer, beholden to no particular French political affiliation or health policy position. The results of the study reveal profoundly held perceptions that the hospital was a key element in the social, cultural, and economic life of the community, far surpassing its "mere" role as a health delivery organization. These findings are placed in the French context of rural development on the one hand, and rationalization of the health delivery system on the other.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sioux Valley Hospital has successfully transformed patient care units to patient-focused care in a well-established Differentiated Practice Model. Marked improvement has resulted as evidenced by increased patient, staff and physician satisfaction, cost savings and overall improvement in efficiency.
Cities across America are grappling with the problem of how to provide care for the indigent and those on Medicaid. All levels of government are reducing their public funding for health care of indigent persons, and the rapid growth of managed care is making traditional cost-shifting more difficult as it transforms the practice of medicine itself. These issues are most acute in cities like Los Angeles and New York, which traditionally have relied on public hospital systems to serve as a safety net. This article focuses on the changes being wrought at the largest health-care system in the country for indigents, the New York City Health and Hospitals Corporation (HHC), on the progress it made during the first 18 months of a major re-engineering process, and on potential options for its future reform.
Current changes in the practice of medicine and the downsizing of the military have resulted in the necessity to look at alternatives to current military hospital structure. Based on business case analysis and other economic factors, Naval Hospital Charleston has undergone a reorganization and introduced a primary care-based health care system. This model provides efficient, high-quality health care and addresses the need to maintain adequate support for operational forces.
Downsizing is a word firmly entrenched in the vocabulary of healthcare institutions. So, nurse managers, will your area be downsized by choice or by mandate? Will you be proactive or reactive? The decision is up to you. Two surgical nurse managers recognized the signs of the times and developed their own downsizing proposal to merge two units. Here are the steps they followed for a proactive approach to combine two clinical units into one.
The Heidelberg University Hospital meets the standards required of medical services in terms of efficiency, optimizing procedures, cost-effectiveness, staff-satisfaction, and reducing infection rates etc., by implementing the Modular concept for quality within hospitals that has now proven its worth in practice. This concept combines a number of functional modules, including the hygiene, nursing, environment, and casualty modules, to name just four of them, within an overall framework incorporating guidelines focusing on quality, strategies, and management policies. Relevant European quality guidelines and the principles of Good Laboratory Practice (GLP), and Good Manufacturing Practice (GMP) are all taken into account to facilitate the required inter-hospital comparison with regard to continuous improvement of quality. It clearly demonstrates that expertise within the hospital and proven practicability in terms of numbers take definite precedence over theoretical approaches from outside experts.
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