While hospitals continue to join multi-institutional systems, empirical data on the benefits of system membership are ambiguous. This study examines the same 166 Florida hospitals in 1986 and 1992. System membership, in general, did not enhance financial returns (measured by operating margin, total margin, and return on assets) for the pooled data or for either year. In fact, a significant negative relationship is noted in 1986. However, when only hospitals affiliated with national systems (in this study, American Medical International, Hospital Corporation of America, or Humana) are analyzed, a positive statistically significant association is found for two of the above three profitability indicators for both the pooled data and for 1986. However, there was no statistically significant impact noted for 1992. Reasons for the apparent discrepancy in the impact of national versus local/regional systems on hospital financial performance and the apparent declining ability of national systems to generate above-average returns are explored.

This study analyzed whether a children's hospital urgent care clinic helped increase market share. Patient demographics and utilization patterns between the suburban clinic and urban emergency department were compared over a three-year period (July 1999 to June 2002). Using data from a standardized billing form, all patient visits (clinic: 36,924; emergency department: 160,888) were analyzed. Variables included patient visitation date, age, gender, race, primary insurance carrier, primary diagnosis, and primary residence Zip code. Differences between the after-hours clinic and emergency department included: more private insurance coverage (83% and 35%, respectively); less no insurance/Medicaid/State Children's Health Insurance Program (SCHIP) coverage (16.4% and 55%, respectively); and more Caucasian patients (80% and 35%, respectively) at the off-site clinic; thus usage was more similar with that of a physician's office than an outpatient clinic. Symptoms seen in the after-hours clinic were primarily respiratory, ear, and throat related. In the emergency department, the symptoms were more varied, primarily febrile, respiratory, ear, throat, gastrointestinal, and urinary tract problems. There was a 3.6% increase in the number of visits in the after-hours clinic and a 1.6% decrease in the number of emergency department visits between year one and year three--data combined giving an overall 4.8% increase in the number of visits. Data show that the offsite urgent care clinic located in a suburban area increased the overall number of visits with a large number of well-insured patients. Additionally, this study provided data on where the clinic could expand medical care for the community.

Correctional facilities continue to experience increasing health care demands while resources decrease and costs for services increase. This paper shows changes in health care expenditures over a five-year period, highlighting services vulnerable to fluctuation. Health care costs of a long-term juvenile correctional system housing approximately 525 juveniles were compared between fiscal years 1995 and 2000. Health care expenditure increased 17% over the study period, even with concerted efforts to control spending. This longitudinal comparison suggests that juvenile correctional facilities' health care budgets are highly vulnerable to large fluctuations due to youths' unexpected medical costs.

This retrospective study examined prescription medication records for 1 year in a county-funded juvenile detention facility. Findings show that 7% of the detained youths were prescribed psychotherapeutic agents, which accounted for approximately 83% of the annual medication budget. Of the 799 male and 227 female detained youths, 14% of the males and 27% of the females were prescribed medications, with some prescribed as many as 23 different medications during their short-term stay. More than 93% of the total medication costs were accounted for by psychotherapeutic agents, antibiotics, and allergy/asthma medications at an average monthly cost of $46.50 per youth. Male youths who were prescribed medications cost $324 per month; their female counterparts cost $170 per month.

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