Hospital specialization: product-line planning during the market reformation.

Rational expectations theory dictates that firms respond to shifts in the demand function as a result of substantial reforms in the insurance marketplace. Federal health reform has enhanced the benefits of specialization. Hospital product-line specialization trends are studied using multiple regression analysis for the period 2001-2010. The observed 32.8 percent rise in specialization was associated with a 9.8 percent decline in unit cost per admission. The number of specialized hospitals has grown by 174 percent in the past decade. Other hospitals are getting more specialized by reducing their product lines. Specialization has been highest in competitive West Coast markets and lowest in the rate-regulated states (New York and Massachusetts). Hospitals have less incentive to contain costs by decreasing the array of services offered in stringent rate-setting states. The term "underspecialization" is advanced to capture the inability of some hospitals to selectively prune out product lines in order to specialize. Such hospitals spread resources so thinly that many good departments suffer. Unit cost per case (DRG-adjusted) is higher in the less specialized hospitals.

Who owns the long term? Perspectives from global business leaders.

Day-to-day management is challenging enough for CEOs. How do they manage for the long term as well? We posed that question to four top executives of global companies. According to Maurice Levy, chairman and CEO of Publicis Groupe, building the future is really about building the present and keeping close to the front line--those who deal with your customers and markets. He also attributes his company's success in large part to knowing when to take action: In a market where clients' needs steer your long-term future, timing is everything. UPS Chairman and CEO Mike Eskew emphasizes staying true to your vision and values over the long run, despite meeting obstacles along the way. It took more than 20 years, and many lessons learned, to produce consistent profits in what is today the company's fastest-growing and most profitable business: international small packages. Wulf H. Bernotat, CEO of E.ON, examines the challenges facing business leaders and politicians as they try to balance energy needs against potential environmental damage. He calls for educating people about consumption and waste, and he maintains that a diverse and reliable mix of energy sources is the only way to ensure a secure supply while protecting our environment. Finally, Marianne Barner, the director of corporate communications and ombudsman for children's issues at IKEA, discusses how the company is taking steps to improve the environment and be otherwise socially responsible. For example, it's partnering with NGOs to address child labor issues and, on its own, is working to help mitigate climate change. IKEA's goals include using renewable sources for 100% of its energy needs and cutting its overall energy consumption by 25%.

The Italian market: procurement update.

The procurement process in Italy is becoming more complex and expensive. In a complete overhaul of the system, there are new product classifications and new procedures to adopt.

Competition keeps getting hotter for ambulatory surgery.

With fast-paced advances in medicine and technology, certain types of surgery that could once only be performed on an inpatient basis are now moving to ambulatory surgery centers. Hospitals are exploring a variety of strategies to hold on to--and even expand--their share of the few profitable areas of health care today.

Specialty-service lines: salvos in the new medical arms race.

Hospitals and physicians are developing and marketing discrete and profitable specialty-service lines. Although closely affiliated specialist physicians are central to hospitals' service-line products, other physicians compete directly with hospitals via physician-owned specialty facilities. Specialty-service lines may be provided in a variety of settings, both inside and outside traditional hospital walls. Thus far, the escalating battle between hospitals and physicians for control over specialty services has not affected hospital profitability. However, as the scope of care that can be safely performed in the outpatient arena expands, physician competition for control over specialty services may threaten hospitals' financial health.

Are consumers reshaping hospitals? Complementary and alternative medicine in U.S. Hospitals, 1999-2003.

All types of acute care hospitals across the U.S. are becoming increasingly involved in offering CAM services. Hospitals appear to be responding to consumer demand, CAM specific market forces, and their organizational missions but not to regulatory mandates.

Look to the future and embrace the changes.

The positive aspects of change can be found using scenario-planning techniques. This article explores how these techniques can be a useful tool for establishing and testing a company's product development pipeline.

The real new economy.

During the soar-and-swoon days of the late 1990s, many people believed that information technology, and the Internet in particular, were "changing everything" in business. A fundamental change did happen in the 1990s, but it was less about technology than about competition. Under director Diana Farrell, the McKinsey Global Institute has conducted an extensive study of productivity and its connection to corporate IT spending and use during that period. The study revealed that information technology is important--but not central--to the fate of industries and individual companies. So if information technology was not the primary factor in the productivity surge, what was? The study points to competition and innovation. In those industries that saw increases in competitive intensity, managers were forced to innovate aggressively to protect their revenues and profits. Those innovations--in products, business practices, and technology--led to the gains in productivity. In fact, a critical dynamic of the new economy--the real new economy--is the virtuous cycle of competition, innovation, and productivity growth. Managers can innovate in many ways, but during the 1990s, information technology was a particularly powerful tool, for three reasons: First, IT enabled the development of attractive new products and efficient new business processes. Second, it facilitated the rapid industrywide diffusion of innovations. And third, it exhibited strong scale economies--its benefits multiplied rapidly as its use expanded. This article reveals surprising data on how various industries in the United States and Europe were affected by competition, innovation, and information technology in the 1990s and offers insights about how managers can get more from their IT investments.

Luxury for the masses.

Increasingly wide income disparities, higher levels of education, and greater awareness of other cultures' ideas of the good life have given rise to a new class of American consumer. And a new category of products and services, including automobiles, apparel, food, wine, and spirits, has sprung into being to cater to it. That category is called new luxury. America's middle-market consumers are trading up to higher levels of quality and taste than ever before. Members of the middle market (those earning $50,000 and above annually) collectively have around $1 trillion of disposable income. And they will pay premiums of 20% to 200% for well-designed, well-engineered, and well-crafted goods that can't be found in the mass middle market and that have the artisanal touches of traditional luxury items. Most important, even when they address basic necessities, such goods evoke and engage consumers' emotions while feeding their aspirations for a better life. Supply-side forces are essential to the rise of new luxury. Like the consumers of their goods, entrepreneurs are better educated and more sophisticated about their customers than ever before. In addition, global sourcing, falling trade barriers and transportation costs, and rising offshore manufacturing standards are making possible the economical production of alluring products of high quality. Unlike old-luxury goods, new-luxury products can generate high sales volumes despite their relatively high prices. As a result, new-luxury companies are achieving levels of profitability and growth beyond the reach of their conventional competitors. Whether the item in question is a $6 Panera sandwich or a $30,000 Mercedes, new luxury is a formula that middle-market companies, facing erosion of their market share by high-end and low-end producers, can ill afford to ignore.

Navigating the niche. Three markets respond to the influx of specialty facilities--Indianapolis, Phoenix, Columbus.

Specialty centers that focus on lucrative services such as cardiology and orthopedics pose a challenge to full-service hospitals in already crowded health care markets. We examine how hospitals in three markets have responded, from aggressively working to keep niche facilities from gaining a foothold to partnering with physicians on their own centers.

Dr. Discontent.

Physicians are angry, that that's bad news for hospitals. Increasingly, doctors are unable to pay soaring liability insurance premiuyms, are refusing to accept new Medicaid and Medicare patients, and are balking at taking ED calls. What's more, many physicians are setting up niche facilities that compete directly with hospitals in the most lucrative service lines.

All pumped up over cardiology.

Cardiovascular services are one of the few remaining profit centers for hospitals, and as baby boomers age, the need for such care is skyrocketing. A good cardiology program enhances a hospital's reputation and patient volume. However, the pressures to expand and the cost of swiftly changing technology put hospitals that are trying to keep up in a tight squeeze, which raises the question: is the pulse of change in cardiology too rapid?