The economics of kidney transplantation versus hemodialysis.

Using 1998 data for 8 transplantation centers located in New York City, this study found that kidney transplantation was a more cost-effective treatment than hemodialysis for the Medicare program. The initially higher costs of transplantation were fully recouped by Medicare 2 years and 10 months after surgery. For persons who are eligible for Medicare solely due to their end-stage renal disease status, transplantation would generate average monthly savings of $3800 over dialysis for the 2 years following the break-even point. For those eligible for reasons other than end-stage renal disease, for example, the aged, the average savings would be $2400. The savings difference arises because Medicare coverage for immunosuppressants for the former group ends 36 months after transplantation.

Hospital selection by managed care insurers.

This article focuses on which factors influence the ability of hospitals to attract managed care patients. Data for the analysis were obtained from a national sample of 235 acute care hospitals in 1996. The results indicate that the costs of inpatient care, participation in an integrated delivery system network, and hospital size were the critical factors in determining the ability of hospitals to obtain managed care business.

Exploration of the barriers to bicycle helmet use among 12 and 13 year old children.

Despite the fact that bicycle helmet usage reduces the risk of bicycle-related head injuries, only a small percentage of children routinely wear helmets. The aim of this study was to qualitatively explore the barriers to bicycle helmet usage among 12 and 13 year old children. The study is based on four focus groups with 31 children from schools is an urban New York City area. A majority of both boys and girls did not perceive a need for wearing helmets for routine riding or short trips, and felt that helmet usage was uncomfortable and made them appear dumb. Also, students could not recall any health promotion efforts by a variety of health providers and felt local legislation had little impact on usage rates. The qualitative findings of this study provide valuable material for researchers seeking to understand the factors associated with non-use of bicycle helmets.

Risk-sharing integration efforts in the hospital sector.

The extent of hospital involvement in integrated delivery systems (IDSs) during 1996 was assessed by a national sample of 235 short-term private general hospitals. Two out of five hospitals were participating in networks with some financial risk sharing, and another third reported membership in IDS networks without financial obligations. Managed care's presence was the only significant factor moving hospitals from a stand-alone status to network membership. The decision to share financial risk was influenced not only by managed care pressures, but also by the level of local hospital competition and the severity of the inpatient case mix.

The effect of managed care on hospital marketing orientation.

Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short-term gains by capturing managed care business, but may not be sufficient for long-term success and survival. Understanding consumer needs and perceptions, and using appropriate marketing strategies to ensure greater customer satisfaction and repeat business, will be among the key tasks for hospital executives in the future.

Marketing research activities in hospitals. Satisfaction surveys of inpatients and outpatients are the most widely used application.

Virtually unheard of in health care 30 years ago, marketing research by hospitals is expanding at a notable rate, particularly among larger institutions located in highly competitive urban markets. Research applications are particularly pronounced at for-profit institutions, those heavily involved in managed care programs, and hospitals that are part of an integrated delivery system. However, the majority of hospital administrators surveyed indicated they do not invest in marketing research to track the effectiveness of their own institution's advertising.

Any-willing provider laws: point and counter point.

Health care costs in the United States are placing businesses in a competitive disadvantage in the international market. Health Care is now the third highest cost category in US corporations after salaries and raw materials. Alternative Health Care delivery systems in the form of managed care have become popular mechanism to promote cost control. A critical element in most managed care programs is a limitation of freedom of choice of provider. As a result, physicians are being deliberately excluded from some managed care plans. Legislation called "Any Willing Provider Statutes" is being enacted in many areas to prohibit such actions. The authors outline the advantages and disadvantages of such legislation and discuss the economic implications for hospitals and the private practice of medicine. They also examine the impact "any willing provider" legislation will have on patient care and detail how this legislation involves who is going to control the practice of medicine in the years ahead. An examination of the American model should assist others involved with health care planning and regulating medical practice.