1
|
Desai A, Scheckel C, Jensen CJ, Orme J, Williams C, Shah N, Leventakos K, Adjei AA. Trends in Prices of Drugs Used to Treat Metastatic Non-Small Cell Lung Cancer in the US From 2015 to 2020. JAMA Netw Open 2022; 5:e2144923. [PMID: 35076701 PMCID: PMC8790662 DOI: 10.1001/jamanetworkopen.2021.44923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Oncology drug prices are a determinant of health disparities in the US and worldwide. Several new therapeutic agents for non-small cell lung cancer (NSCLC) have become available on the US market over the past decade. Although increased competition typically produces lower prices, competition among brand-name oncology drugs has not resulted in lower prices. OBJECTIVE To assess price changes in class-specific brand-name medications used to treat metastatic NSCLC in the US from 2015 to 2020. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study, conducted from August 13, 2015, to August 13, 2020, used data from the Micromedex Red Book and Medi-Span Price Rx databases. The study sample was limited to 17 brand-name medications used to treat metastatic NSCLC that were available for purchase before January 1, 2019. MAIN OUTCOMES AND MEASURES The main outcomes were trends over time in average wholesale prices and wholesale acquisition cost unit prices and the correlation in price among the multiple brand-name medications within each therapeutic class (immune checkpoint inhibitors, epidermal growth factor receptor inhibitors, anaplastic lymphoma kinase inhibitors, ROS1 inhibitors, BRAF inhibitors, and MEK inhibitors), measured using the Pearson correlation coefficient. The compounded annual growth rates of different medication costs were compared with the annual inflation rate and the consumer price index for prescription drugs. RESULTS For all drug classes, the Pearson correlation coefficient approached 1.0, indicating an increase in drug list prices despite within-class drug competition. The median Pearson correlation coefficient values were 0.964 (range, 0.951-0.994) for immune checkpoint inhibitors, 0.898 (range, 0.665-0.950) for epidermal growth factor receptor inhibitors, 0.999 (range, 0.982-0.999) for anaplastic lymphoma kinase inhibitors, and 0.999 for BRAF and MEK inhibitors. The median compounded annual growth rates for most drug costs were higher than the annual inflation rate and consumer price index for prescription drugs: 1.81% (range, 1.29%-2.13%) for immune checkpoint inhibitors, 2.56% (range, 2.38%-5.26%) for epidermal growth factor receptor inhibitors, 2.46% (range, 1.75%-4.66%) for anaplastic lymphoma kinase and ROS1 inhibitors, and 3.06% (range, 0%-3.06%) for BRAF and MEK inhibitors. CONCLUSIONS AND RELEVANCE In this cross-sectional study, prices of brand-name medications for treatment of NSCLC increased in the US from 2015 to 2020 without evidence of price competition, raising concern about the affordability of promising oncology drugs. These findings suggest that drug pricing reform is needed.
Collapse
Affiliation(s)
- Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Caleb Scheckel
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Jacob Orme
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Colt Williams
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nilay Shah
- Department of Finance, Mayo Clinic, Rochester, Minnesota
| | | | - Alex A. Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Woo H, Lim SW, Sohn SY. Recommending blue ocean technologies for subcontractors: A framework based on business reports of prime contractors and patents. PLoS One 2021; 16:e0256157. [PMID: 34407130 PMCID: PMC8372943 DOI: 10.1371/journal.pone.0256157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Subcontractors depend heavily on their prime contractor and thus find it very risky to enter a new business on their own. This study proposes a framework for these subcontractors to develop blue ocean technologies related to their prime contractor. First, the primary technologies predicted to be promising are extracted from the business reports of the prime contractor. Sub-technologies are then selected through a patent-based search using keywords and International Patent Classification codes of the primary technologies. From them, blue ocean technologies are proposed by optimizing the weighted mean of the min-max normalized market value, degree of competition in the technology market, and subcontractors' potential technological capabilities for each sub-technology. This study shows that subcontractors can enhance their technology competitiveness by finding a low-risk blue ocean technology. Our empirical research on the subcontractors of a semiconductor firm identified technological patent fields for them to pursue. From our framework, subcontractors can identify blue ocean technologies by considering their prime contractor's future industrial areas and technologies of interest as well as their own technological capabilities. Furthermore, the prime contractors can gain the synergy effect of technology expansion through cooperation.
Collapse
Affiliation(s)
- Hyunwoo Woo
- Department of Industrial Engineering, Yonsei University, Shinchon-dong, Seoul, Republic of Korea
| | - Sun Woo Lim
- Department of Applied Statistics, Yonsei University, Shinchon-dong, Seoul, Republic of Korea
| | - So Young Sohn
- Department of Industrial Engineering, Yonsei University, Shinchon-dong, Seoul, Republic of Korea
| |
Collapse
|
3
|
Rome BN, Lee CC, Gagne JJ, Kesselheim AS. Factors Associated With Generic Drug Uptake in the United States, 2012 to 2017. Value Health 2021; 24:804-811. [PMID: 34119078 DOI: 10.1016/j.jval.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In the United States, brand-name prescription drugs remain expensive until market exclusivity ends and lower-cost generics become available. Delayed generic drug uptake may increase spending and worsen medication adherence and patient outcomes. We assessed recent trends and factors associated with generic uptake. METHODS Among 227 drugs facing new generic competition from 2012 to 2017, we used a national claims database to measure generic uptake in the first and second year after generic entry, defined as the proportion of claims for a generic version of the drug. Using linear regression, we evaluated associations between generic uptake and key drug characteristics. RESULTS Mean generic uptake was 66.1% (standard deviation 22.1%) in the first year and 82.7% (standard deviation 21.6%) in the second year after generic entry. From 2012 to 2017 generic uptake decreased 4.3% per year in the first year (95% confidence interval, 2.8%-5.8%, P < .001) and 3.2%/year in the second year (95% confidence interval, 1.2%-5.1%). Generic uptake was lower for injected than oral drugs in the first year (38.5% vs 70.0%, P < .001) and second year (50.3% vs 86.9%, P < .001). In the second year, generic uptake was higher among drugs with an authorized generic (86.1 vs 80.1%, P = .045) and those with ≥3 generic competitors (87.7% vs 78.6%, P = .055). CONCLUSION Early generic uptake decreased over the past several years. This trend may adversely affect patients and increase prescription drug spending. Policies are needed to encourage generic competition, particularly among injected drugs administered in a hospital or clinic setting.
Collapse
Affiliation(s)
- Benjamin N Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - ChangWon C Lee
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joshua J Gagne
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Towse A, Chalkidou K, Firth I, Kettler H, Silverman R. How Should the World Pay for a Coronavirus Disease (COVID-19) Vaccine? Value Health 2021; 24:625-631. [PMID: 33933230 PMCID: PMC7892302 DOI: 10.1016/j.jval.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 05/16/2023]
Abstract
The potential health and economic value of a vaccine for coronavirus disease (COVID-19) is self-evident given nearly 2 million deaths, "collateral" loss of life as other conditions go untreated, and massive economic damage. Results from the first licensed products are very encouraging; however, there are important reasons why we will likely need second and third generation vaccines. Dedicated incentives and funding focused explicitly on nurturing and advancing competing second and third generation vaccines are essential. This article proposes a collaborative, market-based financing mechanism for the world to incentivize and pay for the development of, and provide equitable access to, second and third generation COVID-19 vaccines. Specifically, we propose consideration of a Benefit-Based Advance Market Commitment (BBAMC). The BBAMC uses health technology assessment to determine value-based prices to guarantee overall market revenues, not revenue for any specific product or company. The poorest countries would not pay a value-based price but a discounted "tail-price." Innovators must agree to supply them at this tail price or to facilitate technology transfer to local licensees at low or zero cost to enable them to supply at this price. We expect these purchases to be paid for in full or large part by global donors. The BBAMC therefore sets prices in relation to value, protects intellectual property rights, encourages competition, and ensures all populations get access to vaccines, subject to agreed priority allocation rules.
Collapse
Affiliation(s)
- Adrian Towse
- Office of Health Economics, London, England, UK.
| | - Kalipso Chalkidou
- Center for Global Development, London, England, UK; Imperial College, London, England, UK
| | | | | | | |
Collapse
|
5
|
Mandeville B, Rahman M, Gardner RL. Consolidation in the Electronic Health Record Market, 2009-2017. R I Med J (2013) 2020; 103:75-79. [PMID: 32752573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND To quantify changes to the electronic health record (EHR) market in Rhode Island and to assess the degree of EHR market consolidation between 2009 and 2017. METHODS The EHR market in Rhode Island is represented by three measures: the proportion of physicians who have adopted an EHR, the number of EHR vendors in use, and EHR market competitiveness, captured by the Herfindahl-Hirschman Index (HHI). RESULTS The EHR market became more consolidated overall between 2009 and 2017. Among outpatient physicians, the market has remained competitive, despite ongoing consolidation. In contrast, the EHR market among inpatient physicians crossed into the "highly concentrated" zone in 2015. DISCUSSION While consolidation in the EHR market may facilitate the exchange of data across health systems, potentially reducing duplicative testing and facilitating timely diagnosis, limiting competition may affect vendors' responsiveness to calls for improved usability and innovation.
Collapse
Affiliation(s)
| | - Momotazur Rahman
- Associate Professor of Health Services, Policy and Practice at Brown University
| | - Rebekah L Gardner
- Senior Medical Scientist at Healthcentric Advisors, Associate Professor of Medicine at the Alpert Medical School of Brown University and a practicing internist at Rhode Island Hospital
| |
Collapse
|
6
|
Osipovič D, Allen P, Sanderson M, Moran V, Checkland K. The regulation of competition and procurement in the National Health Service 2015-2018: enduring hierarchical control and the limits of juridification. Health Econ Policy Law 2020; 15:308-324. [PMID: 31488231 PMCID: PMC7525100 DOI: 10.1017/s1744133119000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/03/2019] [Accepted: 06/16/2019] [Indexed: 11/17/2022]
Abstract
Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as 'juridification'). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified.
Collapse
Affiliation(s)
- Dorota Osipovič
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Pauline Allen
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Marie Sanderson
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Valerie Moran
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Kath Checkland
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| |
Collapse
|
7
|
Miller HI. The Feds Act to Boost Competition in the Biosimilars Market. Mo Med 2020; 117:196-198. [PMID: 32636543 PMCID: PMC7302035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Henry I Miller
- Physician and molecular biologist, is a Senior Fellow at the Pacific Research Institute in San Francisco, California. He was the founding director of the FDA's Office of Biotechnology
| |
Collapse
|
8
|
Abstract
In this cohort study, pricing data from January 2007 to June 2018 from SSR Health were used to determine how list prices, net prices, and discounts for the originator biologics changed with biosimilar competition.
Collapse
Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Chester B. Good
- Center for High-Value Health Care, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| |
Collapse
|
9
|
Sarpatwari A, DiBello J, Zakarian M, Najafzadeh M, Kesselheim AS. Competition and price among brand-name drugs in the same class: A systematic review of the evidence. PLoS Med 2019; 16:e1002872. [PMID: 31361747 PMCID: PMC6667132 DOI: 10.1371/journal.pmed.1002872] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some experts have proposed combating rising drug prices by promoting brand-brand competition, a situation that is supposed to arise when multiple US Food and Drug Administration (FDA)-approved brand-name products in the same class are indicated for the same condition. However, numerous reports exist of price increases following the introduction of brand-name competition, suggesting that it may not be effective. We performed a systematic literature review of the peer-reviewed health policy and economics literature to better understand the interplay between new drug entry and intraclass drug prices. METHODS AND FINDINGS We searched PubMed and EconLit for original studies on brand-brand competition in the US market published in English between January 1990 and April 2019. We performed a qualitative synthesis of each study's data, recording its primary objective, methodology, and results. We found 10 empirical investigations, with 1 study each on antihypertensives, anti-infectives, central nervous system stimulants for attention deficit/hyperactivity disorder, disease-modifying therapies for multiple sclerosis, histamine-2 (H2) blockers, and tumor necrosis factor (TNF) inhibitors; 2 studies on cancer medications; and 2 studies on all marketed or new drugs. None of the studies reported that brand-brand competition lowers list prices of existing drugs within a class. The findings of 2 studies suggest that such competition may help restrain how new drug prices are set. Other studies found evidence that brand-brand competition was mediated by the relative quality of competing drugs and the extent to which they are marketed, with safer or more effective new drugs and greater marketing associated with higher intraclass list prices. Our investigation was limited by the studies' use of list rather than net prices and the age of some of the data. CONCLUSIONS Our findings suggest that policies to promote brand-brand competition in the US pharmaceutical market, such as accelerating approval of non-first-in-class drugs, will likely not result in lower drug list prices absent additional structural reforms.
Collapse
Affiliation(s)
- Ameet Sarpatwari
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jonathan DiBello
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marie Zakarian
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mehdi Najafzadeh
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
10
|
Lábaj M, Silanič P, Weiss C, Yontcheva B. Market structure and competition in the healthcare industry : Results from a transition economy. Eur J Health Econ 2018; 19:1087-1110. [PMID: 29445942 DOI: 10.1007/s10198-018-0959-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
The present paper provides first empirical evidence on the relationship between market size and the number of firms in the healthcare industry for a transition economy. We estimate market-size thresholds required to support different numbers of suppliers (firms) for three occupations in the healthcare industry in a large number of distinct geographic markets in Slovakia, taking into account the spatial interaction between local markets. The empirical analysis is carried out for three time periods (1995, 2001 and 2010) which characterise different stages of the transition process. Our results suggest that the relationship between market size and the number of firms differs both across industries and across periods. In particular, we find that pharmacies, as the only completely liberalised market in our dataset, experience the largest change in competitive behaviour during the transition process. Furthermore, we find evidence for correlation in entry decisions across administrative borders, suggesting that future market analysis should aim to capture these regional effects.
Collapse
Affiliation(s)
- Martin Lábaj
- University of Economics in Bratislava, Dolnozemska cesta 1, 852 35, Bratislava, Slovakia
| | - Peter Silanič
- University of Economics in Bratislava, Dolnozemska cesta 1, 852 35, Bratislava, Slovakia
| | - Christoph Weiss
- Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Vienna, Austria
| | - Biliana Yontcheva
- Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Vienna, Austria.
| |
Collapse
|
11
|
Lord J, Davlyatov G, Thomas KS, Hyer K, Weech-Maldonado R. The Role of Assisted Living Capacity on Nursing Home Financial Performance. Inquiry 2018; 55:46958018793285. [PMID: 30141704 PMCID: PMC6109846 DOI: 10.1177/0046958018793285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupancy. This research utilized publicly available secondary data, for the state of Florida from 2003 through 2015. General descriptive statistics were used to assess the relationships among financial performance, assisted living capacity, and occupancy. To explore the relationships among financial performance, assisted living capacity and occupancy, and test potential mediation of occupancy, we followed Baron and Kenny's approach and estimated 3 models examining the relationships between (1) assisted living capacity and nursing home financial performance, (2) assisted living capacity and nursing home occupancy, and (3) nursing home occupancy and financial performance after assisted living capacity is included in the model. We used generalized estimating equations, to adjust for repeated measures and to model the above relationships. Year fixed effects control for time trend. The independent variable, assisted living beds, was lagged for 1 year to account for the potential influence on financial performance. The final analytic sample consisted of 7688 nursing home-year observations from 657 unique nursing homes. Our findings suggest that assisted living capacity does have a negative impact on nursing homes' financial performance. Even though, assisted living capacity seems not to significantly decrease nursing home occupancy. The relationship between assisted living capacity and financial performance was not mediated through occupancy. These findings suggest that assisted living communities may not be able to significantly reduce nursing home occupancy; however, the presence of assisted living communities may create additional financial/competitive pressures that result in decreased nursing home financial performance.
Collapse
|
12
|
Erickson KF, Zheng Y, Winkelmayer WC, Ho V, Bhattacharya J, Chertow GM. Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition. Clin J Am Soc Nephrol 2017; 12:536-545. [PMID: 27831510 PMCID: PMC5338708 DOI: 10.2215/cjn.06340616] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients' ability to choose among competing dialysis providers. We identified patients receiving in-center hemodialysis at the start of 2001 and 2011 from the national ESRD registry and ascertained dialysis facility ownership. For each hospital service area, we determined the maximum distance within which 90% of patients traveled to receive dialysis in 2001. We compared the numbers of competing dialysis providers within that same distance between 2001 and 2011. Additionally, we examined the Herfindahl-Hirschman Index, a metric of market concentration ranging from near zero (perfect competition) to one (monopoly) for each hospital service area. Between 2001 and 2011, the number of different uniquely owned competing providers decreased 8%. However, increased facility entry into markets to meet rising demand for care offset the effect of provider consolidation on the number of choices available to patients. The number of dialysis facilities in the United States increased by 54%, and patients experienced an average 10% increase in the number of competing proximate facilities from which they could choose to receive dialysis (P<0.001). Local markets were highly concentrated in both 2001 and 2011 (mean Herfindahl-Hirschman Index =0.46; SD=0.2 for both years), but overall market concentration did not materially change. In summary, a decade of consolidation in the United States dialysis industry did not (on average) limit patient choice or result in more concentrated local markets. However, because dialysis markets remained highly concentrated, it will be important to understand whether market competition affects prices paid by private insurers, access to dialysis care, quality of care, and associated health outcomes.
Collapse
Affiliation(s)
- Kevin F. Erickson
- Section of Nephrology and
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston, Texas
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | | | - Vivian Ho
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston, Texas
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jay Bhattacharya
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| |
Collapse
|
13
|
|
14
|
Herman B, Sandler M. Rate battle peaks as Advantage plans grow. Mod Healthc 2015; 45:12. [PMID: 25823204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
15
|
Frey T. The great barrier backlash. J Environ Health 2014; 77:42-43. [PMID: 25619027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
16
|
Knopf A. Price transparency in healthcare: a movement takes hold. Behav Healthc 2014; 34:42-43. [PMID: 25065152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
17
|
Sorek G. Price controls for medical innovations in a life cycle perspective. Health Econ 2014; 23:108-116. [PMID: 23339083 DOI: 10.1002/hec.2903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/25/2012] [Accepted: 12/10/2012] [Indexed: 06/01/2023]
Abstract
We study the market for new medical technologies from a life cycle perspective, incorporating the fact that healthcare utilization is biased towards old age. Contrary to conventional wisdom, we find that price controls on medical innovations can expand investment in medical R&D and results in Pareto superior social outcomes, a consequence of the price controls' ability to increase saving. Importantly, this finding occurs only when the price cap regime is extensive: selective regulation on few technologies - such as pharmaceuticals alone - have the conventional negative effect on innovation.
Collapse
Affiliation(s)
- Gilad Sorek
- Department of Economics, Auburn University, Auburn, AL, USA
| |
Collapse
|
18
|
Threat of new entrants. Vet Rec 2014; 174 Suppl 1:4-5. [PMID: 24470613 DOI: 10.1136/vr.g340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
19
|
|
20
|
Vest JR, Yoon J, Bossak BH. Changes to the electronic health records market in light of health information technology certification and meaningful use. J Am Med Inform Assoc 2013; 20:227-32. [PMID: 22917839 PMCID: PMC3638173 DOI: 10.1136/amiajnl-2011-000769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/29/2012] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Health information technology (HIT) certification and meaningful use are interventions encouraging the adoption of electronic health records (EHRs) in the USA. However, these initiatives also constitute a significant intervention which will change the structure of the EHR market. OBJECTIVE To describe quantitatively recent changes to both the demand and supply sides of the EHR market. MATERIALS AND METHODS A cohort of 3447 of hospitals from the HIMSS Analytics Database (2006-10) was created. Using hospital referral regions to define the local market, we determined the percentage of hospitals using paper records, the number of vendors, and local EHR vendor competition using the Herfindahl-Hirschman Index. Changes over time were assessed using a series of regression equations and geographic information systems analyses. RESULTS Overall, there was movement away from paper records, upward trends in the number of EHR vendors, and greater competition. However, changes differed according to hospital size and region of the country. Changes were greatest for small hospitals, whereas competition and the number of vendors did not change dramatically for large hospitals. DISCUSSION The EHR market is changing most dramatically for those least equipped to handle broad technological transformation, which underscores the need for continued targeted support. Furthermore, wide variations across the nation indicate a continued role for states in the support of EHR utilization. CONCLUSION The structure of the EHR market is undergoing substantial changes as desired by the proponents and architects of HIT certification and meaningful use. However, these transformations are not uniform for all hospitals or all the country.
Collapse
Affiliation(s)
- Joshua R Vest
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
| | | | | |
Collapse
|
21
|
Spero D. Showcasing bioscience in Rhode Island. R I Med J (2013) 2013; 96:15. [PMID: 23641419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There are a number of well-recognized bioscience companies located in the greater Providence area. They represent a significant and growing source of jobs and future revenue, which promises to play a role in the revitalization and expansion of Rhode Island's economy. In an effort to support these companies and to showcase their research, the Rhode Island Medical Journal is highlighting five of these innovative enterprises in this issue. The companies selected are members of the Rhode Island BioScience Leaders organization, and their research spans a wide range of science, from biologics and informatics to innovative coatings for medical devices. They include ProThera Biologics, EpiVax, Tivorsan Pharmaceuticals, BioIntraface, and VeroScience.
Collapse
Affiliation(s)
- Denice Spero
- Research professor and co-director of the Institute for Immunology and Informatics at the University of Rhode Island (URI) and a founder of Rhode Island BioScience Leaders
| |
Collapse
|
22
|
|
23
|
Executive summary. Changes in the economy, the labor market, and expectations for the future: What might Europe and the United States look like in twenty-five years. New Dir Youth Dev 2012; 2012:11-6. [PMID: 23097359 DOI: 10.1002/yd.20024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
24
|
Lee J. Meeting resistance. Express Scripts-Medco deal called anti-competitive. Mod Healthc 2011; 41:10-11. [PMID: 21879692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
25
|
|
26
|
Fresh K, Friend D. Surgical hospitalist: can this be a program for your group? J Med Pract Manage 2011; 26:382-384. [PMID: 21815557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A shortage of general surgeons is creating issues for the coverage of many emergency departments. This article outlines a new way of thinking about how to diagnosis and treat this problem. Learn the basics behind the possible creation of a surgical hospitalist program from assessing the need; reviewing physician issues; computing the financial analysis; understanding the political and bureaucratic issues; and, finally, recruiting to fill the positions.
Collapse
|
27
|
Winterhalter SJ. Economic factors converge: force hospitals to review pricing strategies. J Health Care Finance 2011; 37:15-35. [PMID: 21812352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The US hospital service price structures are complex and tend to be significantly higher than the actual cost to provide the service. Health care consumers have been given more authority to drive health care decisions. Transparency in health care is forcing hospitals to critically review and substantiate service prices. It is vital that US hospitals review their pricing strategies in order to continue as strong leaders in the health care market.
Collapse
|
28
|
Tataw D. The second market failure phenomenon in safety-net health systems: the case of a municipal academic medical center from 1980 to 2000. Soc Work Public Health 2011; 26:294-321. [PMID: 21534126 DOI: 10.1080/19371918.2011.528736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The specific aim of this analysis is to demonstrate how the trade-off between efficiency and equity policy approaches affects the ability of at-risk children to access quality health care services at the King/Drew Medical Center of Los Angeles County from 1980 to 2000. The concept of a second market phenomenon is used as a framework to illustrate how efficiency-seeking behaviors of federal, state, and local government actors affected government intervention efforts initiated to remedy health care access hardships created by market failure in low-income communities. A second market failure occurs when government failure results from the reintroduction of market protocols in an environment where the market had originally failed to facilitate the distribution of basic goods and services. The review suggest that financial austerity at the Los Angeles County Department of Health Services in the context of federal, state, and local government policies that emphasized allocative efficiencies, compromised equity values by undermining access to quality pediatric services at the King/Drew Medical Center which was a municipal academic medical center.
Collapse
Affiliation(s)
- David Tataw
- School of Public and Environment Affairs, Indiana University, Kokomo, Indiana 46904, USA.
| |
Collapse
|
29
|
Gombeski W, Wray T, Blair G. Prepare for the ambush! Mark Health Serv 2011; 31:24-28. [PMID: 21818988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
30
|
Eichmann TL, Santerre RE. Do hospital chief executive officers extract rents from Certificate of Need laws? J Health Care Finance 2011; 37:1-14. [PMID: 21812351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Prior research suggests that Certificate of Need (CON) laws reduce competition in the hospital services industry. As a result, this study empirically investigates if not-for-profit hospital chief executive officers (CEOs) are able to extract rents from CON laws in the form of higher compensation. A sample of 256 not-for-profit hospital CEOs in states with and without CON laws and data for 2007 are used in the empirical analysis. The study considers the endogenous nature of a CON law and allows such a law to indirectly affect CEO compensation through its impact on the number of hospitals and beds. The multiple regression results indicate that special and public interests both motivate the decision of a state to maintain a CON law. CON laws are shown to reduce the number of beds at the typical hospital by 12 percent, on average, and the number of hospitals per 100,000 persons by 48 percent. These reductions ultimately lead urban hospital CEOs in states with CON laws to extract economic rents of $91,000 annually.
Collapse
Affiliation(s)
- Traci L Eichmann
- School of Business, University of Connecticut, Storrs, Connecticut, USA.
| | | |
Collapse
|
31
|
Abstract
BACKGROUND Cosmetic surgery, historically the purview of plastic surgeons, has in recent years seen an influx of practitioners from other fields of training. Many of these new providers are savvy in marketing and public relations and are beginning to control a surprisingly large amount of cosmetic patient care. OBJECTIVES The purpose of this study is to measure the amount of traffic being attracted to the Web sites of individual practitioners and organizations vying for cosmetic patients. This study investigates the trends of the past 12 months and identifies changes of special concern to plastic surgeons. METHODS The Web sites of 1307 cosmetic providers were monitored over a year's time. The Web activity of two million individuals whose computers were loaded with a self-reporting software package was recorded and analyzed. The Web sites were analyzed according to the specialty training of the site owner and total unique visits per month were tallied for the most prominent specialties. The dominant Web sites were closely scrutinized and the Web optimization strategies of each were also examined. RESULTS There is a tremendous amount of Web activity surrounding cosmetic procedures and the amount of traffic on the most popular sites is continuing to grow. Also, a large sum of money is being expended to channel Web traffic, with sums in the thousands of dollars being spent daily by top Web sites. Overall in the past year, the private Web sites of plastic surgeons have increased their reach by 10%, growing from 200,000 to approximately 220,000 unique visitors monthly. Plastic surgery remains the specialty with the largest number of Web visitors per month. However, when combined, the private Web sites of all other providers of aesthetic services have significantly outpaced plastic surgery's growth. The traffic going to non-plastic surgeons has grown by 50% (200,000 visitors per month in September 2008 to 300,000 visitors monthly in September 2009). CONCLUSIONS For providers of aesthetic services, communication with the public is of utmost importance. The Web has become the single most important information resource for consumers because of easy access. Plastic surgeons are facing significant competition for the attention of potential patients, with increasingly sophisticated Web sites and listing services being set up by independent parties. It is important for plastic surgeons to become familiar with the available Internet tools for communication with potential patients and to aggressively utilize these tools for effective practice building.
Collapse
Affiliation(s)
- Matthew C Camp
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
| | | | | | | |
Collapse
|
32
|
Ciotti V. Vision's 20th anniversary. Healthc Inform 2010; 27:64. [PMID: 20344932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
33
|
Milani F. Public option and private profits: what do markets expect? Appl Health Econ Health Policy 2010; 8:155-165. [PMID: 20201607 DOI: 10.2165/11535510-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The debate on US healthcare reform has largely focused on the introduction of a public health plan option. While supporters stress various beneficial effects that would arise from increased competition in the health insurance market, opponents often contend that a public plan would drive insurers out of the market and potentially lead to the 'collapse' of the private health insurance industry. OBJECTIVE To contribute to the US healthcare reform debate by inferring, from financial market data, the effect that the public option is likely to have on the private health insurance market. METHODS The study utilized daily data on the price of a security that was traded in a prediction market from June 2009 and whose pay-off was tied to the event that a federal government-run healthcare plan - the 'public option' - would be approved by 31 December 2009 (100 daily observations). These data were combined with data on stock returns of health insurance companies (1500 observations from 100 trading days and 15 companies) to evaluate the expected effect of the public option on private health insurers. The impact on hospital companies (1000 observations) was also estimated. RESULTS The results suggested that daily stock returns of health insurance companies significantly responded to the changing probability regarding the public option. A 10% increase in the probability that the public option would pass, on average, reduced the stock returns of health insurance companies by 1.28% (p < 0.001). Hospital company stock returns were also affected (0.9% reduction; p < 0.001). CONCLUSIONS The results reveal the market expectation of a negative effect of the public option on the value of health insurance companies. The magnitude of the effect suggests a downward adjustment in the expected profits of health insurers of around 13%, but it does not support more calamitous scenarios.
Collapse
Affiliation(s)
- Fabio Milani
- Department of Economics, University of California, Irvine, California 92697-5100, USA.
| |
Collapse
|
34
|
Auto industry eyes medical device manufacturing. Biomed Instrum Technol 2009; 43:349-50. [PMID: 19842751 DOI: 10.2345/0899-8205-43.5.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
35
|
|
36
|
[KBV on the way to direct family physician competition?]. MMW Fortschr Med 2008; 150:10. [PMID: 18605633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
37
|
Novelli T. US market: 2008 priorities. Med Device Technol 2008; 19:58. [PMID: 18557412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Thomas Novelli
- Medical Device Manufactures Association, Washington, District of Columbia 20005, USA.
| |
Collapse
|
38
|
Affiliation(s)
- Peter P Budetti
- Department of Health Administration and Policy, College of Public Health, University of Oklahoma, Oklahoma City 73104-5072, USA.
| |
Collapse
|
39
|
Senior K. Pharmaceutical downsizing and oncology drug development. Lancet Oncol 2008; 9:11. [PMID: 18183658 DOI: 10.1016/s1470-2045(07)70395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
40
|
Bender B. [The efforts of the level plain]. Chirurg 2007; Suppl:399. [PMID: 18546561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
41
|
Dunn P. Medical tourism takes fight. Hosp Health Netw 2007; 81:40-44. [PMID: 18175593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
42
|
Affiliation(s)
- Michael E Moran
- Capital Region Urologic Surgeons, PLLC, Albany, New York, USA.
| |
Collapse
|
43
|
Gish RS, Kamholz K. Standing alone. Assessing a hospital's long-term viability. Trustee 2007; 60:16-1. [PMID: 17926633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Given the growing number of hospital/health system affiliations over the past decade, the decision to remain an independent institution requires detailed self-analysis.
Collapse
Affiliation(s)
- Ryan S Gish
- Kaufman, Hall & Associates Inc., Skokie, Ill, USA.
| | | |
Collapse
|
44
|
Schmidt K. [Results of increasing competition. Medical practices and physician associations have to adapt]. MMW Fortschr Med 2007; 149:56. [PMID: 17855845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
45
|
Lubell J. Seeking market dominion. In northern Virginia, it's Inova vs. HCA as they compete for patients in one of the nation's fastest-growing areas. Mod Healthc 2007; 37:38, 40, 42. [PMID: 17824152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
46
|
Abstract
BACKGROUND Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year. METHODS Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores. RESULTS Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores. CONCLUSION As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely.
Collapse
|
47
|
|
48
|
Ginsburg PB. Financing change. Hospital relationships with physicians. Hosp Health Netw 2007; 81:suppl 10. [PMID: 17569455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
49
|
Using technology adoption for growth projections. Healthc Financ Manage 2007; 61:130-1. [PMID: 17514921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
50
|
Evans M, Galloro V. Boom, boom, boom. Systems in Calif, Ill. and Kan. look to drum up new business with expansion! Mod Healthc 2007; 37:14-5. [PMID: 17511307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|