Hospital managers' perspectives on pregnancy policy and work adjustments: A cross-sectional study

BACKGROUND

Risk assessment and work adjustment according to EU legislation may safeguard pregnant employees and their offspring. Knowledge on management perspectives in relation to implementation of protective measures is limited.

OBJECTIVES

The primary aim was to describe Danish hospital managers' engagement in pregnancy policy and work adjustment for pregnant employees. The secondary aim was to investigate how managers' characteristics and the setting affect engagement and behaviour.

METHODS

This was a cross-sectional study of survey data from 212 managers. Outcomes were within dimensions of health promotion, pregnancy policy, work adjustment, collaboration, manager support, and sick leave. Logistic and ordinal logistic regression models were applied to identify associations between background information and outcomes.

RESULTS

Of the managers included, 84% arranged meetings and 76% conducted occupational risk assessment. Most managers (96%) engaged in dialogue with the employees before sick leave. Most managers felt competent in providing guidance for pregnant employees and 99% considered work adjustment important, mainly to safeguard mothers and children. The self-reported data showed positive associations between female managers and feeling competent to guide the employee. Further, management training was associated with meetings with pregnant employees. Seniority was associated with feeling competent to guide and dialogue. Midwifery support was associated with competence in guiding employees about risk factors.

CONCLUSION

Work adjustment and risk assessment for pregnant employees are considered a priority by Danish hospital managers. Overall, managers feel competent guiding pregnant employees. However, managers experience midwifery support beneficial for the guidance of pregnant employees.

Seven Steps to Financial Health

Physicians and dentists have a very limited exposure to personal financial management and yet find themselves in the top 10% of earners in the United States of America. Education loans, practice expenses, and high standards of living obligate them to be good financial stewards to succeed financially. Anecdotal personal experience and review. The article establishes seven steps to implement as medical/dental students, interns, residents, or practicing doctors to move towards financial health and security. The steps include (1) saving enough; (2) good debt management; (3) being tax savvy; (4) obtaining the correct insurance; (5) making wise investments; (6) if choosing to marry, avoid divorce; and (7) keeping track with periodic progress assessment. Each of these steps contains several components that can aid and guide physicians and dentists in their financial arc of development over their professional career and into retirement, considering generational wealth transfer or charitable donation as ultimate goals. This brief guide is based on my own financial journey to achieve long-term financial independence: start early, use simple tax deferred investments without chasing trends while keeping fees down, live within your means, and adequately insure your income.

Association of mobile device proficiency and subjective cognitive complaints with financial management ability among community-dwelling older adults: a population-based cross-sectional study

BACKGROUND

Mobile devices have been used by many older adults and have the potential to assist individuals with subjective cognitive complaints (SCCs) in daily living tasks. Financial management is one of the most complex daily activity for older adults, as it is easily impaired in the prodromal stage of dementia and cognitive impairment.

AIM

To investigate financial management ability among older adults from SCCs and mobile device proficiency.

METHODS

A self-administered questionnaire was sent to 529 participants who were ≥ 65 years and regularly use mobile devices. Participants were divided into four groups based on SCC prevalence and scores of the Mobile Device Proficiency Questionnaire (MDPQ-16). Financial management abilities were compared between groups using the Process Analysis of Daily Activities for Dementia subscale. Regression model and crosstabulation table were used to investigate associations in detail.

RESULTS

A significant difference in financial management ability was observed among the four groups (p < 0.001), with the dual impairment group showed significantly lower than the robust and SCC groups (p < 0.001). Educational history, sex, and MDPQ-16 score were significantly associated with participants' financial management ability (p ≤ 0.01). The proportion of participants who could use ATMs and electronic money independently was significantly lower among those with low proficiency in mobile devices (LPM), regardless of SCC (p < 0.05).

CONCLUSION

The LPM group showed an impaired ability to manage their finances, particularly in situations where they would use information devices. Therefore, healthcare professionals should assess not only the SCC but also their proficiency with mobile devices to predict their impairment in activities of daily living.

How many sites should an orthopedic trauma prospective multicenter trial have? A marginal analysis of the Major Extremity Trauma Research Consortium completed trials

BACKGROUND

Multicenter trials in orthopedic trauma are costly, yet crucial to advance the science behind clinical care. The number of sites is a key cost determinant. Each site has a fixed overhead cost, so more sites cost more to the study. However, more sites can reduce total costs by shortening the study duration. We propose to determine the optimal number of sites based on known costs and predictable site enrollment.

METHODS

This retrospective marginal analysis utilized administrative and financial data from 12 trials completed by the Major Extremity Trauma Research Consortium. The studies varied in size, design, and clinical focus. Enrollment across the studies ranged from 1054 to 33 patients. Design ranged from an observational study with light data collection to a placebo-controlled, double-blinded, randomized controlled trial. Initial modeling identified the optimal number of sites for each study and sensitivity analyses determined the sensitivity of the model to variation in fixed overhead costs.

RESULTS

No study was optimized in terms of the number of participating sites. Excess sites ranged from 2 to 39. Excess costs associated with extra sites ranged from $17K to $330K with a median excess cost of $96K. Excess costs were, on average, 7% of the total study budget. Sensitivity analyses demonstrated that studies with higher overhead costs require more sites to complete the study as quickly as possible.

CONCLUSIONS

Our data support that this model may be used by clinical researchers to achieve future study goals in a more cost-effective manner.

TRIAL REGISTRATION

Please see Table 1 for individual trial registration numbers and dates of registration.

Advancing sustainable financial management in greening companies through big data technology innovation

Incorporating sustainability into financial management procedures has emerged as a critical component in the modern business landscape for organizations looking to strengthen their environmental stewardship while guaranteeing financial viability. The study "Advancing Sustainable Financial Management in Greening Companies through Big Data Technology Innovation" explains the crucial role that big data technologies play in empowering businesses to incorporate environmental sustainability into their financial management strategies. The research the strong link between big data analytics and the optimization of sustainable financial management in businesses from year 1990 to 2022. The study's findings show that big data analytics enables firms to make data-driven decisions, significantly increasing the effectiveness of their sustainability activities. With the enormous amounts of data that big data technologies can analyze, businesses can access actionable insights that make it easier to identify and reduce environmental impacts, use resources more efficiently, and streamline supply chains to support sustainability. To emphasizes the businesses can match their financial goals with sustainability objectives through big data technology without sacrificing profitability. Big data analytics may help businesses assess environmental risks and find possibilities for sustainable investment, enabling them to make well-informed financial decisions consistent with their commitment to environmental stewardship. The conclusion emphasizes the businesses to adopt big data technology focusing on long-term financial management strategically. The growing environmental problems that endanger the world's ecosystems underscore even more how crucial it is to include these advancements. Therefore, integrating sustainability into financial management using big data technology is not just a choice but a requirement for businesses to succeed in this century. The study demonstrated that the businesses, decision-makers, and other stakeholders to understand and use big data technologies' potential to advance sustainable financial management and build more resilient and sustainable corporate environments.

Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units

BACKGROUND

Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate.

AIM

To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach.

METHODS

A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative.

RESULTS

The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%.

CONCLUSION

Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study

OBJECTIVE

To quantify the value of maternity health care - the relationship of outcomes to costs - in Queensland during 2012-18.

STUDY DESIGN

Retrospective observational study; analysis of Queensland Perinatal Data Collection data linked with the Queensland Health Admitted Patient, Non-Admitted Patient, and Emergency Data Collections, and with the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) databases.

SETTING, PARTICIPANTS

All births in Queensland during 1 July 2012 - 30 June 2018.

MAIN OUTCOME MEASURES

Maternity care costs per birth (reported in 2021-22 Australian dollars), both overall and by funder type (public hospital funders, MBS, PBS, private health insurers, out-of-pocket costs); value of care, defined as total cost per positive birth outcome (composite measure).

RESULTS

The mean cost per birth (all funders) increased from $20 471 (standard deviation [SD], $17 513) during the second half of 2012 to $30 000 (SD, $22 323) during the first half of 2018; the annual total costs for all births increased from $1.31 billion to $1.84 billion, despite a slight decline in the total number of births. In a mixed effects linear analysis adjusted for demographic, clinical, and birth characteristics, the mean total cost per birth in the second half of 2018 was $9493 higher (99.9% confidence interval, $8930-10 056) than during the first half of 2012. The proportion of births that did not satisfy our criteria for a positive birth outcome increased from 27.1% (8404 births) during the second half of 2012 to 30.5% (9041 births) during the first half of 2018.

CONCLUSION

The costs of maternity care have increased in Queensland, and many adverse birth outcomes have become more frequent. Broad clinical collaboration, effective prevention and treatment strategies, as well as maternal health services focused on all dimensions of value, are needed to ensure the quality and viability of maternity care in Australia.

Financial challenges in the family physician programme in Iran: A systematic review of qualitative research

Introduction

The family physician programme (FPP) was implemented nearly two decades ago as a major health reform. Since the health system and FPP function in a rapidly changing social and economic environment, successful expansion of the programme requires a detailed analysis of its multiple major challenges, including the crucial aspect of its funding system. This systematic review aimed to assess the challenges in the FPP relative to its financing.

Method

All published articles related to the FPP in Iran were included in this study. In particular, original qualitative studies published in English or Persian from 2011 to 2021 were included. In January 2022, international credible scholarly databases and Persian databases were searched. All selected articles were carefully studied, and the data were extracted using the sample, phenomenon of interest, design, evaluation and research type technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in preparing the study report.

Results

Among 491 articles retrieved from the search strategy, 50 met the inclusion criteria after their titles and abstracts were screened. Twenty-nine studies were excluded after their full texts were reviewed. A total of 11 eligible empirical studies were finally included. Based on the results, six broad categories (budget and funding, insurance system, tariffs, payments, accountability and injustice) were identified as financial challenges.

Conclusion

This study identified the challenges associated with financing among family physicians, and the results could provide guidance for policy-making in the expansion of the FPP.

Assessing the relation between financial performance and long-term bank loan interest rates for healthcare providers in the Netherlands: a panel data analysis

The Dutch health system is financed predominantly by commercial bank loans, especially after the market-oriented reform in 2006, when government investment guarantees were abandoned. Commercial capital markets were envisaged to improve efficient capital allocation and management. We analyzed the effects of commercial bank loans on interest rates, investments and allocative efficiency in the Dutch healthcare sector. We aimed to explain variation in interest rates by financial performance of healthcare providers, hypothesizing that the reform reduced interest rates for financially well-performing providers. Using financial data from publicly available annual reports, we explored the effect of financial performance on long-term loan interest rates through pooled linear regressions. Our data showed that financial reserves have steadily increased, although profitability margins have declined since 2011-2013 (depending on the sector). While nominal interest rates have generally declined since 2006, the risk surplus on healthcare loans has steadily increased. Furthermore, we observed no significant relation between the financial performance of healthcare providers and interest rates on capital loans. Maintaining additional financial reserves provided no apparent benefit to capital costs. This suggests that healthcare providers may consider whether financial reserves should be maintained at current levels or can better be used for direct investments. Moreover, healthcare policymakers should evaluate whether the increase in risk surplus combined with an apparent lack of reward for financial scrutiny is a desired outcome of the reform.

Studying financial aspect of green credit and regional heterogeneity on technology innovation in China

This study examines the impact of green credit on digital technology innovation in China, focusing on the influence of financialization and regional heterogeneity. Existing research primarily explores factors like government subsidies, economic growth, and environmental regulations, and there is a lack of critical analysis on the influence of green credit on digital technology innovations. To examine the internal mechanisms linking green credit to digital technology innovation, this study uses panel data from 271 Chinese prefecture-level cities from 2000 to 2020. Our findings suggest that the availability of green credit and the level of financialization have a significant positive effect on technology innovation, particularly in regions with higher economic development. However, we also find that the impact of green credit and financialization on technology innovation varies across different regions of China. Study findings reveal that green credit bolsters both the quantity and quality of digital technology innovation, emerging as a significant driver for green innovations in China. This conclusion holds even after endogeneity tests. The heterogeneous analysis highlights that various aspects of green credit, such as coverage scope, usage intensity, and digitization level, can enhance digital technology innovations. Western cities demonstrate the most considerable positive effects, followed by central cities, while the weakest impact occurs in eastern cities. Green credit primarily promotes digital technology innovation indirectly by alleviating financing constraints. These empirical findings provide valuable policy insights for fostering a harmonious relationship between China's urban green credit facilities and green financial growth, thereby addressing the funding limitations green credit enterprises face.

Data for the project management, life cycle inventory, costings and energy production of a ground-mounted photovoltaic farm in Greece

Data was collected using standard communication equipment and invoices provided by an established civil construction and renewable energy development and operation company. Data referring to the construction, costings, operation and environmental impacts of a photovoltaic farm were recorded into four distinct Excel files namely: i) Project Management Data, ii) Life Cycle Inventory (LCI), iii) Electricity Generation Data and iv) Operational Cost Data. For the project management, the given quantities of the resources used in each activity could be further combined with the costs from different geographical and time regions to estimate overall project implementation costs for similar projects. The LCI data for the materials and transportation used can set the basis for life cycle assessment modelling of ground-mounted photovoltaic farms of that size and type. The electricity generation data along with meteorological parameters and location coordinates can be further enhanced to predict and manage energy generation and cashflow of expectations installations of this type and size over time. Finally, the data referring to a number of cost categories('maintenance costs', 'operational costs', 'insurance costs' and 'any other costs'), especially combined with the previously mentioned types of data could support a holistic technoeconomic and environmental assessment of comparable commercial photovoltaic installations. In addition, these data can be used for a comparative multi-disciplinary evaluation between photovoltaics and among various renewable electricity generation alternatives and traditional fossil fuel-based options as well.

Measuring financial satisfaction of Indonesian young adults: a SEM-PLS analysis

People in Indonesia, particularly members of Generation Z, frequently struggle to manage their financial situation both now and in the future. The problem is brought on by a lack of understanding of financial investments. The purpose of this study is to ascertain the financial standing of Generation Z. A questionnaire with 100 respondents was employed in this investigation. In this study, financial attitudes serve as the independent variable, financial management serves as the intervention variable, and financial satisfaction serves as the dependent variable. A Likert scale was utilized as the measurement in the quantitative research technique. In this work, structural equation modeling (SEM) and SmartPLS software were utilized to process the data. The financial attitude variable has a positive and significant impact on financial happiness that is mediated by financial management. We also offer some recommendations and future research directions related to this topic.

Design and analysis of management platform based on financial big data

Traditional financial accounting will become limited by new technologies which are unable to meet the market development. In order to make financial big data generate business value and improve the information application level of financial management, aiming at the high error rate of current financial data classification system, this article adopts the fuzzy clustering algorithm to classify financial data automatically, and adopts the local outlier factor algorithm with neighborhood relation (NLOF) to detect abnormal data. In addition, a financial data management platform based on distributed Hadoop architecture is designed, which combines MapReduce framework with the fuzzy clustering algorithm and the local outlier factor (LOF) algorithm, and uses MapReduce to operate in parallel with the two algorithms, thus improving the performance of the algorithm and the accuracy of the algorithm, and helping to improve the operational efficiency of enterprise financial data processing. The comparative experimental results show that the proposed platform can achieve the best the running efficiency and the accuracy of financial data classification compared with other methods, which illustrate the effectiveness and superiority of the proposed platform.

Big data applications with theoretical models and social media in financial management

This study presents big data applications with quantitative theoretical models in financial management and investigates possible incorporation of social media factors into the models. Specifically, we examine three models, a revenue management model, an interest rate model with market sentiments, and a high-frequency trading equity market model, and consider possible extensions of those models to include social media. Since social media plays a substantial role in promoting products and services, engaging with customers, and sharing sentiments among market participants, it is important to include social media factors in the stochastic optimization models for financial management. Moreover, we compare the three models from a qualitative and quantitative point of view and provide managerial implications on how these models are synthetically used along with social media in financial management with a concrete case of a hotel REIT. The contribution of this research is that we investigate the possible incorporation of social media factors into the three models whose objectives are revenue management and debt and equity financing, essential areas in financial management, which helps to estimate the effect and the impact of social media quantitatively if internal data necessary for parameter estimation are available, and provide managerial implications for the synthetic use of the three models from a higher viewpoint. The numerical experiment along with the proposition indicates that the model can be used in the revenue management of hotels, and by improving the social media factor, the hotel can work on maximizing its sales.

Risk of hospital insolvency and its relationship with income and borrowings from banks: a case-control study with large-scale financial data in Japan

Considering the variety of stakeholders surrounding hospitals, hospital financial distress should be understood as a social issue, rather than just a matter involving the hospital owners. The present study aimed to assess Japanese hospital insolvency and related factors based on a nationwide financial dataset, and to identify indicators of the risk of insolvency. The legal financial reports used included a balance sheet and a profit-and-loss statement of hospitals owned by healthcare corporations, representing about 70% of all Japanese hospitals. This case-control study with descriptive analyses was conducted to clarify the financial status of healthcare corporations and to assess associations between specific factors and insolvency. Insolvency was found in 5.9% of healthcare corporations in 2016. Insolvency was significantly associated with operational income per sales (odds ratio, 0.16), and both short- and long-term borrowings per sales (odds ratios: 1.46 and 1.22 in this order). The present study found that 5.9% of Japanese healthcare corporations were insolvent, and hospital profitability and borrowing (both short- and long-term) could be key factors related to preventing hospital insolvency in Japan. To maintain sustainable healthcare services by hospitals, decision makers should consider the risk of insolvency, and balance the amount of borrowings against sales.

New financial management system for Iran public health sector: A qualitative study

BACKGROUND

Financial management system acts as a driving force and the first important principle of health sector reform. This study aimed to prepare a framework for new financial management system in Iran health sector.

MATERIALS AND METHODS

This qualitative study was conducted by content analysis approach and 15 key informant participants selected through purposive sampling consisted of three minsters of Ministry of Health and Medical Education (MOHME), three vice-chancellors in the Center of Resource Development and Management, Two members of the Health Assembly of the Islamic Consultative, four Medical Sciences university's presidents, and three managers in Budgeting and performance Monitoring Center of MOHME in 2017. Data were collected through semi-structured interviews and they were analyzed using Atlas T₆ software.

RESULTS

Six main themes were emerged as follow: "legal reform," "removing barriers to set up accrual accounting," "cost price calculation," "operational planning and budgeting," "human resources' organization, recruitment, and moderation," and "financial system output utilization (management accounting techniques) as the base for evidence-based policymaking and decision-making practices."

CONCLUSION

Any efforts for improving the current situation and reducing of mentioned limitations could be useful in providing required space for future phases of reforms and calculation of unit cost, operational budgeting, and management of cost and productivity. This can be achieved through an integrated system of recording and producing standard and accrual financial information. Furthermore, changing the accounting process and the financial system that complies with one single encoding in the country is a key issue.

Financial investment of United States pharmacy schools on international activities

INTRODUCTION

The primary objective of this study was to determine the financial resources that United States (US) pharmacy schools spend and receive for international activities, as well as the future direction of expenditures and revenue.

METHODS

An online survey was sent in April 2019 to the chief financial or administrative officer at each accredited pharmacy school (N = 141) to ask about average annual budget for international activities and areas of expenditure (student travel, partnership development, faculty salary, staff salary, training programs) and revenue (dean's office, university, student tuition and fees, alumni, grants and contracts, other) associated with their budget. Participants were asked whether they anticipated spending or receiving more, the same, or less on the aforementioned expenditure and revenue areas.

RESULTS

Sixty-three programs (45%) responded, with 61 (43%) complete responses used for data analysis. Thirty-eight schools (62%) had an annual budget for international activities with an average of $77,327, a median of $18,750, and a range from $2000 to $615,000. Public schools averaged $102,129 compared to $43,225 for private schools. The largest expenditure source was split evenly between student travel and faculty salaries while the largest revenue source was student tuition and fees. The most common response for future trends was to spend or receive the same amount of support.

CONCLUSIONS

There is wide variance regarding the amount each US pharmacy school spends on international activities, with most programs anticipating spending or receiving the same amount in the future.

Let's Talk About it: Discussing Retirement with Multiple Sources is Associated with Retirement Preparation in Young Adults

Although young adults are interested in finance, their financial competence, especially about the topic of retirement, is fairly thin. With a large sample of members of Generation Z (ages 18-25, n = 1,311), I explored whether young adults talk about retirement with others; and the correlates between talking about retirement and retirement preparation. Participants reported whether they have spoken about retirement with nine sources: parents, siblings, other family members (non-parent; non-sibling), friends, significant others, co-workers, financial advisors, people on internet forums, and "other sources." All participants reported to have discussed retirement with at least one source, with parents being the most common. Young adults' attitudes towards retirement preparation were largely positive. For example, participants acknowledged the importance of learning about retirement and experienced more positive than negative affect when thinking about retirement. Behavioral measures of retirement preparation did not yield any effects, showing a potential gap between young adults' retirement preparation attitudes and behavior. Multiple regression analyses revealed that the effect of retirement conversations on retirement preparation varied by source. I tie the findings into past research and discuss practical implications.

Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time

STUDY OBJECTIVE

Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas.

DESIGN

Observational cohort study.

SETTING

The 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019.

SUBJECTS

The providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis.

MEASUREMENTS

The primary endpoint was the mean among facilities in percentages of surgeon-day combinations ("lists") containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to "most" (>50%) used Student's two-sided one-group t-test.

MAIN RESULTS

Averaging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%-67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%-47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days.

CONCLUSIONS

Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.

Predictors of Financial Distress Among Private U.S. Hospitals

BACKGROUND

Hospitals are closing after poor financial performance leaving many patients without access to medical care. Identifying the factors associated with financial distress offers hospitals avenues for potential intervention to avoid bankruptcy and closure.

MATERIALS AND METHODS

We performed a retrospective analysis of private U.S. hospitals' financial information from 2011 to 2018. A mixed effects logistic regression model was used with the primary outcome of hospital financial distress (based on the Altman Z-score).

RESULTS

Our sample included 2,720 private hospitals contributing a total of 20,022 hospital-year observations. The proportion of hospitals experiencing financial distress each year ranged from 22.0% to 24.3%. For-profit status was associated with an increased odds of financial distress (adjusted odds ratio (aOR), 4.36 [95% Confidence Interval (CI) 3.05 - 6.24]) as compared to non-profit status. A higher share of hospital revenue from Medicaid was also associated with increased odds of financial distress (aOR for the highest quartile, 2.28 [95% CI 1.73 - 3.00]) as compared to the lowest quartile. A higher case mix index (aOR for the highest quartile, 0.32 [95% CI 0.23 - 0.46]) and an increased share of hospital revenue from outpatient services (aOR for the highest quartile, 0.34 [95% CI 0.23 - 0.49]) were associated with decreased odds of financial distress as compared to their respective lowest quartiles.

CONCLUSIONS

A significant proportion of private U.S. hospitals experience financial distress. Increasing case complexity and the proportion of patient revenue from outpatient services may represent avenues to avoid financial distress.

[Reforming Biosciences and Health Research: Part I, Funding]

The COVID-19 pandemic occurred in the context of a dramatic decline in support for biological and health research in France. An analysis of resources allocated to this sector shows that the credits in 2020 correspond to only 17.2 % of the total credits allocated to research, the lowest ratio inat least 15 years. Another weakness in the system of support for hospital research is the way funds from the health insurance system are allocated. To bring it into line with international best practices, the task of allocating these funds should be entrusted to a "Hospital Research Orientation Council", which should also be involved in the implementation of national research programming. Another article deals with the organization of research. Recommendations are also made to improve the functioning of the research system at the local level, particularly in university hospitals, and at the national level.

From training to implementation: Improving contraceptive practices in South Carolina

OBJECTIVE

Capacity building and training to improve contraceptive care is essential for patient-centered care and reproductive autonomy. This study assessed the feasibility of translating the knowledge and skills gained from contraception trainings into improvements in practice.

STUDY DESIGN

Participants completed surveys following contraceptive care trainings provided to family planning clinic and hospital obstetric providers and staff as a part of the Choose Well contraceptive access initiative in South Carolina. Surveys assessed participants' intent to change their practice post-training and anticipated barriers to implementing change. A mixed-methods approach was utilized including descriptive analysis of Likert scale responses and thematic content analysis to synthesize open-ended, qualitative responses.

RESULTS

Data were collected from 160 contraceptive training sessions provided to 4814 clinical and administrative staff between 2017 and 2019. Post-training surveys were completed by 3464 participants (72%), and of these, 2978 answered questions related to the study outcomes. Most respondents (n = 2390; 80.7%) indicated intent to change their practice and 35.5% (n = 1044) anticipated barriers to implementing intended changes. Across all training categories, organizational factors (time constraints, policies and practices, infrastructure/resources) were the most frequently perceived barrier to improving contraceptive services. Structural factors related to cost for patients were also identified as barriers to IUD and implant provision.

CONCLUSION

The trainings were successful in influencing family planning staff and providers' intent to improve their contraceptive practices, yet some anticipated barriers in translating training into practice. Improvements in organizational and structural policies are critical to realizing the benefits of trainings in advancing quality contraceptive care.

IMPLICATIONS

In addition to training, coordinated efforts to address organizational practices and resources, coupled with system-level policy changes are essential to facilitate the delivery and sustainability of patient-centered contraceptive care.

Contributors to Independent Research Funding Success from the Perspective of K12 BIRCWH Program Directors

INTRODUCTION

Faculty training awards are an important means of advancing early career faculty in research. The National Institutes of Health (NIH) Building Interdisciplinary Research Careers in Women's Health (BIRCWH) is a long-running K12 career development program and has been integral in promoting the research success of faculty nationally. We surveyed BIRCWH program directors to understand factors likely to influence long-term research careers and funding success.

MATERIALS AND METHODS

We developed an online survey containing open-ended questions about individual and programmatic attributes and activities that promote success in achieving independent research funding. Domains of interest included: 1) strategies for funding success; 2) traits for predicting success; 3) groups considered vulnerable to attrition; and 4) existing resources and means of support.

RESULTS

Fifteen institutions (75%) were included in the final analysis. Passion for research, persistence, resilience, and strong mentorship relationships were identified by all directors as factors important to scholar success. Responses also revealed an important pattern: program directors attributed attrition either to individual or organizational characteristics. This distinction has meaningful consequences for framing efforts to diminish attrition. Faculty who were clinicians, women, parents and underrepresented minorities were identified as vulnerable to attrition from the research careers. Common perceived challenges in these groups included isolation/feeling alienated, juggling numerous priorities, inadequate research time, lack of role models, and work-life balance issues.

CONCLUSION

K12 BIRCWH directors identified persistence and resilience and developing community, networks, and other support opportunities as elements of scholar success. Programs and mentors can help early career faculty by teaching skills and providing tools they can use to maximize the value of these opportunities and expand their mentees' research relationships. Our study also highlights the importance of social factors, particularly isolation, on clinicians, women, and minoritized scholars on career success.

Financial Management

This chapter deals with financial management in healthcare institutions. Topics which will be covered in this chapter include the function of financial management in a company and elements of financial management. We also discuss types of ownership and related organizational forms of healthcare institutions, which influence financial functions. We are trying to identify the general role and objectives of financial management in healthcare institutions. Having in mind the fact that financial management is based on the information provided through company's accounting we will give an overview of basic accounting concepts. They influence financial reporting, which is also covered in the chapter through a presentation of different types of financial statements and their content.

[Risk sharing contracts in the national health care system: Perceptions of health care professionals]

OBJECTIVE

Risk-sharing contracts (RSC) present a novel management tool, which link the payment to the pharmaceutical company to health outcomes. The objective of this work was to know the perception of health professionals about the utility of these agreements in the Spanish National Health System.

METHODS

A questionnaire was designed to conduct a series of semi-structured interviews with hospital pharmacy, laboratory and oncology professionals from Spanish hospitals in Madrid, Aragón, Castilla-La Mancha, Castilla y León, Cataluña, La Rioja, País Vasco and Navarra. The selection criteria was for convenience. The interview period was from April to November 2017. A qualitative analysis was performed based on the responses from 14 interviews.

RESULTS

All the surveyed affirmed that the CRCs allow to improve the economic and administrative management of the hospital, emphasizing as main advantages the budgetary control, the obtaining of funding and the savings possibilities. CRCs are perceived (13 of 14 respondents) as agreements with positive health implications because they increased the portfolio of treatments and had greater efficacy. The need for CRCs to register patients, involved monitoring and control, also contributed to the improvement of their health. In addition, CRCs were believed (8 out of 14 respondents) to facilitate the introduction of personalized medicine (MP) as both depend on diagnostic tests, one for screening reasons (MP) and the other for obtain clinical evidences that improve economic outcomes (CRC). However, it was considered that signing the CRCs entails the need to modify certain regulations (5 out of 14 respondents) as well as to increase the number of staff to handle bureaucratic tasks and to increase laboratory tests, which can complicate health management.

CONCLUSIONS

Qualitative social research techniques have proven to be useful for gathering information on a new topic and understanding the perception of the advantages and disadvantages of CRCs, as well as their association with the MP. In addition, synergies were detected between the CRCs and the MP. Respondents had positive opinions on CRCs about its application, although work must be done in order to improve the normative and organizational context so that the additional complexity that they incorporate does not constitute an obstacle to extend its use.

Essential managerial skills for financial and budgetary management in medical universities: The top managers' perspective

Background: Achieving organizational objectives depends on the effectiveness of administrators. However, managerial efficacy largely depends on the knowledge and skills of managers. This study aimed at assessing the skills of financial and budget management of the Ministry of Health from the perspective of resource development assistants of universities of medical sciences nationwide.

Methods: This cross- sectional study was conducted in 2012. Study participants were resource development assistants of universities of medical sciences in Iran. We adopted simple random sampling method in locating participants. Data were collected using pretested questionnaires and analyzed using descriptive statistics and Mann-Whitney test (as a non-parametric test) and Friedman test.

Results: The highest mean recorded under financial management skills was technical skills (3.58±0.50), followed by human skills (3.50±.048), and perceptual skills (3.32±0.52). With regards to financial and budget management and performance monitoring, the means of technical skills, as prioritized by directors, was 3.72±0.71, followed by human skills (3.72±0.70), and perceptual skills (3.66±0.75). A significant association was found between perceptual skills of financial managers and budgeting and performance monitoring managers (p= 0.014).

Conclusion: Operational level managers, such as financial and budgetary managers, need to acquire more technical skills. Therefore, we support activities that promote technical skills and awareness of managers within organizations, such as organizational training courses and distribution of educational materials like brochures.

Financial management of large, multi-center trials in a challenging funding milieu

BACKGROUND

Randomized clinical trials that have public health implications but no or low potential for commercial gain are predominantly funded by governmental (e.g., National Institutes of Health (NIH)) and not-for-profit organizations. Our objective was to develop an alternative clinical trial site funding model for judicious allocation of declining public research funds.

METHODS

In the Vitamin D and Type 2 Diabetes (D2d) study, an NIH-supported, large clinical trial testing the effect of vitamin D supplementation on incident diabetes in 2423 participants at high risk for diabetes, a hybrid financial management model for supporting collaborating clinical sites was developed and applied. The funding model employed two reimbursement components: Core (for study start-up and partial efforts throughout the study, ~40% of the total site budget), invoiced by sites, and Performance-Based Payments (for successful enrollment of participants and completion of follow-up visits, ~60% of the total site budget), automatically issued to the sites by the Coordinating Center based on actual recruitment and visits conducted. Underperforming sites transitioned to Performance-Based Payments only.

RESULTS

Recruitment occurred from October 2013 through December 2016, requiring one additional year than the 2-year projection. Median enrollment at each site was 88 participants (range 29-318; 20 to 205% of the site target). At the end of year 1, study-wide recruitment was at 12% of the target (vs. 50% projected) and 12% of the total grant award was invested. The model constantly evaluated sites' needs and re-allocated resources to meet the study enrollment goal. If D2d had issued cost reimbursement subaward agreements and sites invoiced for their entire budget, 83% of the award would have been spent for all study activities over the first 4 years of the trial compared to 65% of the award spent (US$26M) under the hybrid model used by D2d.

CONCLUSIONS

It is feasible to foster a hybrid financial management approach to steward limited available public funds for research in a dynamic and consistent way that does not compromise the trial's scientific integrity and ensures conservation of funds to complete recruitment and continue to follow up participants.

The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study

Background

Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients.

Methods

This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis.

Results

The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction.

Conclusion

To increase affordability and satisfaction and expand private community-based nursing.

Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2934-z) contains supplementary material, which is available to authorized users.

Financial risk of increasing the follow-up period of breast cancer treatment currently covered by the Social Protection System in Health in México

Background

The objective of this work is to estimate the financial impact of increasing the monitoring period for breast cancer, which is financed by the Sistema de Protección Social en Salud (SPSS—Social Protection System in Health).

Methods

A micro-simulation model was developed to monitor a cohort of patients with breast cancer, and also an estimation was made on the probability of surviving the monitoring period financed by the SPSS. Using the Monte Carlo simulation, the maximum expected cost was estimated to broaden such monitoring. Morbimortality information of the Ministry of Health and cases of breast cancer treated by the SPSS were used.

Results

Between 2013 and 2026, the financial resources to provide monitoring during 10 years to women diagnosed with breast cancer would reach up to $3607.40 million pesos on a base scenario, $4151.79 million pesos on the pessimistic scenario and $3414.85 million pesos on an optimistic scenario. In the base scenario, additional expenditure represents an annual increase of 9.1% of resources allocated to treating this disease, and 3.0% of the availability of the resources for the Fondo de Protección contra Gastos Catastróficos (FPGC—Fund for Protection against Catastrophic Expenditure).

Conclusions

Increasing monitoring for patients with breast cancer would not represent a financial risk to the sustainability of the FPGC, and could increase patients survival and life quality.

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment

OBJECTIVES

To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments.

DATA SOURCES

Seven databases were searched in May 2015.

STUDY SELECTION

Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected.

DATA EXTRACTION

This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis.

DATA SYNTHESIS

The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments.

CONCLUSIONS

Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

The Global Fund's paradigm of oversight, monitoring, and results in Mozambique

Background

The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients’ misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique.

Methods

We conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing.

Results

Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund’s structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement.

Conclusions

To date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique’s in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.

Electronic supplementary material

The online version of this article (10.1186/s12992-017-0308-7) contains supplementary material, which is available to authorized users.

How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya

Background

A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and technical efficiency in resource management. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, and a substantial transfer of responsibility for healthcare from the central government to these counties.

Methods

This study analysed the effects of this major political decentralization on health sector planning, budgeting and overall financial management at county level. We used a qualitative, case study design focusing on Kilifi County, and were guided by a conceptual framework which drew on decentralisation and policy analysis theories. Qualitative data were collected through document reviews, key informant interviews, and participant and non-participant observations conducted over an eighteen months’ period.

Results

We found that the implementation of devolution created an opportunity for local level prioritisation and community involvement in health sector planning and budgeting hence increasing opportunities for equity in local level resource allocation. However, this opportunity was not harnessed due to accelerated transfer of functions to counties before county level capacity had been established to undertake the decentralised functions. We also observed some indication of re-centralisation of financial management from health facility to county level.

Conclusion

We conclude by arguing that, to enhance the benefits of decentralised health systems, resource allocation, priority setting and financial management functions between central and decentralised units are guided by considerations around decision space, organisational structure and capacity, and accountability. In acknowledging the political nature of decentralisation polices, we recommend that health sector policy actors develop a broad understanding of the countries’ political context when designing and implementing technical strategies for health sector decentralisation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0649-0) contains supplementary material, which is available to authorized users.

Financial capacity in dementia: a systematic review

OBJECTIVES

Financial capacity (FC) refers to a set of cognitively mediated abilities related to one's competency to manage propriety and income. Identifying intact from impaired FC in older persons with dementia is a growing concern in geriatric practice, but the best methods to assess this function still need to be determined. This study aims to review data on FC in dementia and on instruments used to assess this domain of capacity.

METHODS

Database search was performed in Medline, ISI Web of Knowledge, LILACS and PsycINFO. Studies that objectively assessed FC in dementia of any etiology were included.

RESULTS

Of a total of 125 articles, 10 were included. Mild Alzheimer's Disease (AD) was associated with impaired complex FC abilities, namely checkbook management, bank statement management and financial judgment, but simple FC skills were preserved. Moderate AD was associated with impairment in all domains of FC. The Financial Capacity Instrument (FCI) was applied in most of the selected studies and correlated with neuropsychological and neuroimaging variables.

CONCLUSIONS

Early dementia is associated with partially preserved FC. More validation studies using objective and evidence-based FC assessment tools, such as the FCI, are still needed.

The challenges that head nurses confront on financial management today: A qualitative study

Aim

To explore challenges that Chinese head nurses confront on financial management from the perspective of different levels of nursing and non-nursing managers and to provide contemporary nurse managers with suitable supports.

Methods

Eighteen nursing leaders in different levels were divided into two groups: Junior Leadership Group (head nurses) and Senior Leadership Group (nurse coordinator, nurse executive, and vice-president of the hospital). All the subjects were invited to participate in a semi-structured interview. The interviews were audio-taped and transcribed, and data were analyzed using a comparative content approach.

Results

The four following challenges that head nurses confront on financial management practice were identified from the research findings: 1) lack of intrinsic motivation; 2) insufficient training and education on financial management and nursing economics; 3) desires for cross-uniting communication and cooperation; 4) insufficient reference managerial tool.

Conclusions

The confusion confronted by head nurses in Changsha include three aspects: managerial roles, managerial training, and managerial tools. Cooperative management model, evidence-based management training, and data-driven tools will contribute to improving the financial management capacity of nurse managers.

Factors Associated with Money Mismanagement Among Adults with Severe Mental Illness and Substance Abuse

People with severe mental illness often have substantial problems with money mismanagement such as losing or lending money to other people and making impulsive or unnecessary purchases, including drugs and alcohol. Money mismanagement in turn affects patients' health and social functioning, and can lead to homelessness and other harm. This cross-sectional study evaluated demographic and clinical predictors of money mismanagement among SSI/SSDI recipients. SSI/SSDI beneficiaries (N = 95) with recent cocaine use initiating a clinical trial were assessed at intake with demographic, cognitive, psychiatric, social/family, substance abuse, and financial measures. In multivariate regression analyses, psychiatric functioning and drug dependence diagnosis were independent predictors of self-reported money mismanagement. Even within individuals whom all had recently used cocaine, those with drug dependence and those with more psychiatric symptomatology had more difficulty managing their funds. Future studies might determine whether people who reduce their drug use and psychiatric symptomatology go on to better manage their funds.

Learning from lawsuits: Ten-years of NHS litigation authority claims against 11 surgical specialities in England

INTRODUCTION

Medico-legal claims are a drain on NHS resources and promote defencive practice. The litigious burden of surgery in England has not been previously described. This paper describes trends over ten years of claims made against the NHS across 11 surgical specialities.

MATERIALS AND METHODS

Data were requested for all claims received by the NHS Litigation Authority (NHSLA) from 2004 to 2014. Surgical specialities included cardiothoracic, general, neurosurgery, obstetric, oral and maxillofacial (OMFS), orthopaedic, otorhinolaryngology, paediatric, plastic, urology and vascular surgery. A literature review of peer-reviewed publications was performed with search terms 'NHSLA' and 'Surgery'.

RESULTS

The NHS paid out approximately £1.5 billion across 11 surgical specialities from 2004 to 2014. Orthopaedic, obstetric and general surgery received the largest number of claims per year, and paediatric surgery the least. The mean time from registration of claim with the NHSLA to settlement was 25.5 months (range 17.8 months-35 months). Neurosurgery was responsible for the highest average amount paid per claim, and OMFS the lowest. Failure/delay in treatment and/or diagnosis and failure to warn/adequately consent were the three leading types of claim. 806 never events were successfully claimed for during the ten-year period.

DISCUSSION AND CONCLUSION

Sharing information and good practice should be a priority for surgical professionals. Lessons learnt from medico-legal claims are transferrable in strategic planning. This pan-speciality report has demonstrated considerable burden on the NHS and should promote improvement in practice on an individual level in addition to providing systems based recommendations to NHS and international organisations.