El proceso de fusión hospitalaria en la ciudad de Tarragona (1464) / The Merging Process of the Hospitals in Tarragona (1464)

Los hospitales, en cataluña, se inscribieron desde la Baja edad Media hasta nuestros días dentro un modelo de gobierno específico que dio lugar a la creación y mantenimiento de una densa red de nstituciones asistenciales en prácticamente todos los municipios, incluso en los más pequeños, cuyo marco legal fue el derecho privado o civil. dicho modelo tiene sus fundamentos, en primer lugar, en la constatación de cómo los individuos legaban al hospital no sólo por la filantropía o caridad, sino también por la necesidad de aportar algo a la comunidad después de su muerte, en una suerte de consigna con el fin de devolver parte de los activos que los testadores habían acumulado durante su vida como instrumento para asegurar la reproducción social de la comunidad. En segundo lugar, se observa que a partir de los procesos de fusión del siglo XV las pequeñas instituciones asistenciales locales privadas –laicas o religiosas– se fu sionaron con los hospitales de titularidad municipal, y los activos patrimoniales resultantes de dicha fusión se gestionaron por separado de los de la municipalidad a través de una estructura administrativa propia y, a priori, autónoma respecto de los poderes políticos. en tercer lugar, además de la función de cuidado, el hospital era también un agente económico que operaba de manera similar a los Monte dei paschi italianos. por consiguiente, el significado de la institución resultó ser más complejo que la simple prestación de servicios asistenciales. Adquirió un valor específico en la identidad de la comunidad, se convirtió en uno de los centros de debate en la vida pública y adquirió un significado económico y financiero que contribuyó a fortalecer la construcción de la identidad colectiva de los ciudadanos, tal y como refleja el presente artículo a partir del ejemplo de la ciudad de tarragona (AU)

The aim of this paper is to highlight how hospitals in catalonia, from the late Middle Ages to the present, adopted a governance model which resulted in the creation and preservation of hospitals or care institutions in virtually all municipalities, even the smallest, whose legal framework was private or civil law. Firstly, we observed how individuals were motivated not only by philanthropy or charity, but also by a need to contribute something to the community after their death, to give back part of the assets they had accumulated during their lifetimes, as citizens who had benefitted from their positions. Secondly, we observed that, from the XVth century, small local private care institutions –secular or religious– merged with Municipal hospitals, but managed the resulting assets separately from those of the municipality. thirdly, as well as its care function, the hospital was also an economic agent that operated along similar lines to the Italian Monte dei paschi. It provided loans to working class citizens at a modest interest rate. the significance of the institution was more complex than the simple provision of care services. It acquired a specific value in the identity of the community, it became one of the centres of debate in public life and it took on an economic and financial meaning that strengthened the building of the citizens’ collective identity as shown in this article which uses the city of tarragona as its example (AU)

Do mergers really reduce costs? Evidence from hospitals.

In this paper, we compare potential and realized cost savings from hospital mergers. Our approach isolates changes in realized cost savings due to different output mixes from systematic changes due to time and also provides a measure of the potential cost savings due to scale economies. Our findings suggest that economies of scale are present for merging hospitals and they realize these cost savings immediately following a merger. However, we also show that over time, cost savings from the merger decrease and the proportion of hospitals experiencing positive cost savings declines.

The evolution of a contemporary academic health care system.

The story I wish to tell today is of the emergence, over the last two centuries, of an integrated academic health care delivery system from the foundations of this country's fourth medical school, New Hampshire's first major hospital, and a multidisciplinary practice group, unique in its time. I will trace the covergence of each of these into a system that we offer as an answer to the contemporary puzzle of how to provide the best available care at value and still support the academic missions of education and research. We believe this to be the current delemma of American medicine, and while our answer may not be either successful or universally applicable, we are committed to the attempt. As background, let me provide some perhaps familiar details of the growth of these Hanover [NH] and Lebanon [NH] institutions.

[35th anniversary of surgical activities at the Otolaryngology Department of the District Merged Hospital in Zielona Góra 1953-1987]. / 35-lecie dzialalnosci operacyjnej Oddzialu Laryngologii Wojewódzkiego Szpitala Zespolonego w Zielonej Górze 1953-1987.

40,506 patients were treated at the Laryngology Department in the last 35 years. 30,787 surgical interventions were performed. The type and number of operations were analysed as well as their upward and downward tendencies. A considerable decrease in radical operations of the ears, antrotomies, antromastoidectomies and intracranial, ear and sinusal complications was noted; whereas the number of tracheotomies, laryngectomies and radical neck lymphadenectomies due to larynx neoplasm was increased.