The corporatization of American hospitals

Unsanitized and Unfair: How COVID-19 Bailout Funds Refuel Inequity in the US Health Care System

CONTEXT

The CARES Act of 2020 allocated provider relief funds to hospitals and other providers. We investigate whether these funds were distributed in a way that responded fairly to COVID-19-related medical and financial need. The US health care system is bifurcated into the "haves" and "have nots." The health care safety net hospitals, which were already financially weak, cared for the bulk of COVID-19 cases. In contrast, the "have" hospitals suffered financially because their most profitable procedures are elective and were postponed during the COVID-19 outbreak.

METHODS

To obtain relief fund data for each hospital in the United States, we started with data from the HHS website. We use the RAND Hospital Data tool to analyze how fund distributions are associated with hospital characteristics.

FINDINGS

Our analysis reveals that the "have" hospitals with the most days of cash on hand received more funding per bed than hospitals with fewer than 50 days of cash on hand (the "have nots").

CONCLUSIONS

Despite extreme racial inequities, which COVID-19 exposed early in the pandemic, the federal government rewards those hospitals that cater to the most privileged in the United States, leaving hospitals that predominantly serve low-income people of color with less.

Countries' experiences in reforming hospital administration structure based on the Parker and Harding model: A systematic review study

In recent years, many reforms have been made on the structure of hospital administration, most of which are proposed by Parker-Harding models. Therefore, the purpose of this study is to systematically review global relevant experiences in reforming the hospital governance structure with emphasis on the Parker-Harding model. Required information was collected using keywords autonomization, corporatization, privatization, decentralization, reform, hospital autonomy, governance model, and structural reform in databases such as EMBASE, PubMed, Scopus, SID, MagIran, and other resources. Information on the subjects under study was collected from 1990 to 2020. The content extraction method was used for data extraction and data analysis. Thirty-nine sources were included in the study. Results of searching for relevant evidence on a variety of hospital governance models (government, board, corporate, and private) based on the Parker-Harding model in four categories including strengths (31), weaknesses (30), outcomes (26), and interventions (21) are outlined. In this study, strengths, weaknesses, outcomes, and corrective interventions were presented for different models of hospital administration that could be used by healthcare policymakers. Also, According to the results of this study, governmental model less recommended.

Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven’s (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners’ work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

Enhancing physician engagement: an international perspective

The purpose of this article is to provide specific recommendations to enhance physician engagement in health care organizations. It summarizes the evidence on physician engagement, drawing on peer-reviewed articles and reports from the gray literature, and suggests an integrative framework to help health care managers better understand and improve physician engagement. While we examine some other international examples and experiences, we mainly focus on physician engagement in Canada, the United States, and the United Kingdom. Physician engagement can be conceptualized as an ongoing two-way social process in which both the individual and organizational/cultural components are considered. Building on several frameworks and examples, we propose a new integrative framework for enhancing physician engagement in health care organizations. We suggest that in order to enhance physician engagement, organizations should focus on the following strategies: developing clear and efficient communication channels with physicians; building trust, understanding, and respect with physicians; and identifying and developing physician leaders. We propose that the time is now for health care managers to set aside traditional differences and historical conflicts and to engage their physicians for the betterment of their organizations.

Health Care Management Training Needs in Pakistan

The management of health care organisations (HCOs) significantly determines the quality and efficiency of health care delivery in developing countries like Pakistan. HCO managers are needed to plan and execute expansion and corporatisation of private HCOs and to transform public sector charity hospitals to self-sustaining efficient organisations and private clinics into profitable ventures. The objective of this study was to assess the need for health care management training in Pakistan using semi-structured interviews of key informants in different cities. We asked experts about the existing HCO management training opportunities, demand for such skills and its impact on the future of health services delivery. Unanimous support for HCO management training emerged in the wake of dissatisfaction with limited opportunities for such training in the country. The participants agreed that trained HCO managers can help introduce modern management practices in health care service delivery, thereby making the HCOs more efficient and effective. We conclude that well-reputed management schools would be performing an important service to the improvement of the health sector in Pakistan if they can design and offer effective management training programmes for HCOs.

Redes de atenção à saúde: contextualizando o debate

A proposta de organização de redes de atenção à saúde tem sido incluída no grande campo do "cuidado integrado", denominação genérica que agrupa intervenções que variam muito em objetivos e escopo, tendo em comum a busca por mecanismos e instrumentos de integração do cuidado. Entre as experiências consideradas centrais, estão os sistemas integrados americanos e as redes regionalizadas dos sistemas nacionais de saúde, especialmente após a adoção de novos mecanismos de cooperação. No entanto, ainda que possam ser observadas semelhanças nas estratégias e arranjos organizacionais, é fundamental contextualizar o debate. Não considerar a natureza distinta dos sistemas de saúde tende a obscurecer diferenças centrais do âmbito da política, que condicionam as possibilidades de aplicação em um dado sistema de instrumentos desenvolvidos em outro contexto. Este artigo tem por objetivo buscar referências na literatura e na experiência internacional que possam contribuir para o debate da constituição de redes no SUS. Busca contextualizar a discussão da organização de serviços de saúde "em redes" em dois casos, o sistema nacional de saúde britânico e o sistema privado americano, focalizando especificamente no recorte da organização de serviços.

Hospital Performance Reports: Impact On Quality, Market Share, And Reputation

This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. The findings indicate that making performance data public results in improvements in the clinical area reported upon. An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.