It Is Time to Liberate Hospitals from Profit-Centered Care

Wolfe, Sidney M.; Woolhandler, Steffie; Himmelstein, David U.

doi:10.1007/s11606-018-4448-0

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Among all hospital characteristics studied, for‐profit status and southern location were associated with higher negotiated rates for adenotonsillectomy among hospitals. These findings may be explained by hospital profit motives and regional differences in hospital market power, respectively 35–38 . The overall impact of public disclosure of negotiated rates is not yet elucidated—it remains to be seen whether hospital prices converge up (due to hospital benchmarking competitor rates for a given payer) or down (due to payer benchmarking against competitor rates at a given hospital).…”

Section: Discussionmentioning

confidence: 99%

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

et al. 2022

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Objectives: Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures.Methods: We performed a cross-sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer-specific prices for M&T and T&A. We additionally characterized the extent of variation in payer-specific prices both across and within hospitals.Results: Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across-center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.82 versus 90th percentile: $9,209.88). Median within-center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure. Conclusion:The majority of hospitals serving pediatric patients were non-compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer-specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions.

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Section: Discussionmentioning

confidence: 99%

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

et al. 2022

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“…For instance, of the 5,534 hospitals in the United States in 2018, 87% were community hospitals, with investors owning only 21% of the latter. 37 If the profit-imperative imposed on hospitals by the market-driven policies generally is to blame in their warped behavior, 38 their medical practice was also submitted to the rationale of insurance companies (for-profit “managed care”) by the virtue of ad hoc contracts, “preferred provider” status, and integration in HMOs.…”

Section: Discussionmentioning

confidence: 99%

Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?

Unger

Paepe

2019

Int J Health Serv

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This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of “managed care” on care quality are its tight constraints on physicians’ professional autonomy; a large reliance on the physicians’ material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.

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“…Higher markup can lead to greater profitability, thus reducing a health care program’s risk of closing [ 33 ]. However, high markups of the price for health care services may reduce access to care for clients with less financial resources [ 41 , 45 , 48 ] without necessarily leading to a higher quality of care [ 4 , 17 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding the role of financial capacity in the delivery of opioid use disorder treatment

Guerrero¹,

Amaro

Kong

et al. 2023

BMC Health Serv Res

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Opioid treatment programs must have adequate financial capacity to sustain operations and deliver a high standard of care for individuals suffering from opioid use disorder. However, there is limited consistency in the health services literature about the concept and relationship of organizational financial capacity and key outcome measures (wait time and retention). In this study, we explored five common measures of financial capacity that can be applied to opioid treatment programs: (a) reserve ratio, (b) equity ratio, (c) markup, (d) revenue growth, and (e) earned revenue. We used these measures to compare financial capacity among 135 opioid treatment programs across four data collection points: 2011 (66 programs), 2013 (77 programs), 2015 (75 programs), and 2017 (69 programs). We examined the relationship between financial capacity and wait time and retention. Findings from the literature review show inconsistencies in the definition and application of concepts associated with financial capacity across business and social service delivery fields. The analysis shows significant differences in components of financial capacity across years. We observed an increase in average earned revenue and markup in 2017 compared to prior years. The interaction between minorities and markup was significantly associated with higher likelihood of waiting (IRR = 1.077, p < .05). Earned revenue (IRR = 0.225, p < .05) was related to shorter wait time in treatment. The interaction between minorities and equity ratio is also significantly associated with retention (IRR = 0.796, p < .05). Our study offers a baseline view of the role of financial capacity in opioid treatment and suggests a framework to determine its effect on client-centered outcomes.

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It Is Time to Liberate Hospitals from Profit-Centered Care

Cited by 4 publications

References 8 publications

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?

Understanding the role of financial capacity in the delivery of opioid use disorder treatment

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