Assignment: Issues in Healthcare Management

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Assignment: Issues in Healthcare Management

Assignment: Issues in Healthcare Management

Assignment: Issues in Healthcare Management

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Week 8 – Assignment: Summarize Key Finance Issues in Healthcare Management

Assignment: Summarize Key Finance Issues in Healthcare Management Instructions

For this assignment, select a healthcare organization with which you are familiar. It could be your current place of employment, past place of employment, or another organization.

Prepare a comprehensive presentation to share with fellow employees, senior leadership, and potentially your patients that distinguishes your firm from the competition. Explain how your organization is remaining competitive. Articulate how quality service is being maintained for both medical providers and patients.

Your presentation must focus on healthcare concepts, financial analysis, and decision-making concepts that were presented in this course (e.g., accounting information, billing and coding, pricing and revenue determination with third parties, healthcare accounting terminology, comparative financial and operating benchmark values, cost finding and break-even analysis, working capital management, and budgeting). Provide detailed examples to support your findings.

Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists.

Support your presentation with at least five scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included.

Length: 15-20 slides (with a separate reference slide)

Notes Length: 150-200 words for each slide

Be sure to include citations for quotations and paraphrases with references in APA format and style where appropriate.

Watch Video for additional information: United States White House. (2013). President Obama and President Clinton discuss healthcare [Video file]. President Obama and President Clinton Discuss Health Care, New York, NY, September 24, 2013 produced by United States. White House (District of Columbia: United States. White House, 2013), 55 mins. Assignment: Summarize Key Finance Issues in Healthcare Management

Assignment: Summarize Key Finance Issues in Healthcare Management

CriteriaContent (15 points) Points Evaluated how the selected organization remains competitive (5). Assessed how quality service is maintained for both medical providers and patients (5). Presentation focused on healthcare concepts, financial analysis, and decision-making concepts that were presented in this course (5). Organization (5 points) Included speaker notes for each slide, animations, transitions, and graphics. Included a minimum of five scholarly references, with appropriate APA formatting applied to citations and paraphrasing. Presentation is 15-20 slides long (5). Total 20 points.

Week 8 – Assignment: Summarize Key Finance Issues in Healthcare Management Instructions For this assignment, select a healthcare organization with which you are familiar. It could be your current place of employment, past place of employment, or another organization. Prepare a comprehensive presentation to share with fellow employees, senior leadership, and potentially your patients that distinguishes your firm from the competition. Explain how your organization is remaining competitive. Articulate how quality service is being maintained for both medical providers and patients. Your presentation must focus on healthcare concepts, financial analysis, and decision-making concepts that were presented in this course (e.g., accounting information, billing and coding, pricing and revenue determination with third parties, healthcare accounting terminology, comparative financial and operating benchmark values, cost finding and break-even analysis, working capital management, and budgeting). Provide detailed examples to support your findings. Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists. Support your presentation with at least five scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included. Length: 15-20 slides (with a separate reference slide) Notes Length: 150-200 words for each slide Be sure to include citations for quotations and paraphrases with references in APA format and style where appropriate. Watch Video for additional information: United States White House. (2013). President Obama and President Clinton discuss healthcare [Video file]. President Obama and President Clinton Discuss Health Care, New York, NY, September 24, 2013 produced by United States. White House (District of Columbia: United States. White House, 2013), 55 mins Criteria Content (15 points) Points Evaluated how the selected organization remains competitive (5). Assessed how quality service is maintained for both medical providers and patients (5). Presentation focused on healthcare concepts, financial analysis, and decision-making concepts that were presented in this course (5). Organization (5 points) Included speaker notes for each slide, animations, transitions, and graphics. Included a minimum of five scholarly references, with appropriate APA formatting applied to citations and paraphrasing. Presentation is 15-20 slides long (5). Total 20 points Eur J Health Econ (2013) 14:515–526 DOI 10.1007/s10198-012-0396-5 ORIGINAL PAPER Inter-regional competition and quality in hospital care Hiroshi Aiura Received: 22 September 2011 / Accepted: 17 April 2012 / Published online: 22 May 2012 Ó Springer-Verlag 2012 Abstract This study analyzes the effect of episode-ofcare payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care. Keywords Patient choice Waiting time Hotelling-type spatial competition model Multi-region model JEL Classification I18 L32 Introduction This study analyzes the effect of inter-regional competition on waiting time and comprehensive quality in hospital care. During the past few decades, several European countries—Norway, Switzerland, the United Kingdom, H. Aiura (&) Faculty of Economics, Oita University, 700, Dannoharu, Oita 870-1192, Japan e-mail: [email protected]; [email protected] etc.—have reformed their health care systems; they have introduced free choice in hospitals (so-called patient choice) instead of limited or no choice, and an episode-ofcare payment to the reimbursement system. These changes aim to improve the quality of health care, especially waiting time, because they provide hospitals with an incentive to compete to acquire patients.1 Since hospital care is differentiated horizontally by geographical location, hospitals experiencing these changes compete geographically in terms of quality of hospital care.2 Several theoretical studies using a Hotelling-type (1929) spatial competition model have attempted to determine the manner in which the incentive to compete for acquiring patients influences the quality of hospital care or waiting time within a health-care system.3 Gravelle and Masiero (2000), Karlsson (2007), and Brekke et al. (2010) focus on how this incentive influences quality within a health-care system.4 Although waiting time is modeled implicitly as a part of quality (as mentioned by Brekke et al. 2007), the abovementioned studies do not provide an answer regarding the effect on waiting time alone, that is, separate from quality. On the other hand, while Xavier (2003), Siciliani (2005), and Brekke et al. (2008) focus on the impact of this 1 Gravelle and Sivey (2010) examine whether better information provides an incentive for hospitals to improve quality when patient choice is introduced. 2 Tay (2003) shows empirically that the demand responses to both distance and quality are substantial. 3 With regard to empirical studies, Gowrisankaran and Town (2003) estimate the effects of competition on the quality decisions of hospitals in southern California. Dawson et al. (2007) estimate the impact on waiting time for ophthalmology in London. 4 For the Hotelling-type spatial competition, see also Alonso (1964) and d’Aspremont et al. (1979). Nuscheler (2003), Montefiori (2005), and Sanjo (2009) deal with medical service quality by using the spatial competition model. 123 516 incentive on waiting time, they do not consider comprehensive quality. Moreover, these studies do not assume that patients undertake trips across provinces with different population sizes. If geographical constraints did not exist, patients would prefer hospitals located in large cities to those in small cities, because the former seems to have highquality health care that is based on economies of scale, due to the sharing of technology and health-care expertise.5 Therefore, when patient choice is introduced, a certain number of patients flow into hospitals located in large cities in preference to those from small cities; the impact of this, primarily on waiting time and secondarily on comprehensive quality, is different for hospitals in both types of cities. Aiura and Sanjo (2010) consider this flow of patients and derive the competitive equilibrium qualities of local public hospitals located in two regions with different population sizes. However, economies of scale and scope do not work in their model, and a counterintuitive result—that a rural public hospital always offers higher quality of hospital care than an urban public hospital—is derived. Furthermore, they do not analyze the effect of the incentive to compete. In this study, we assume that the comprehensive quality of hospital care is reflected by several factors, such as waiting time, medical technology, and the skills and experience of medical staff. The model in this study divides these factors into two categories: waiting time and factors irrelevant to waiting time. By this division, we can study the effect not only on the comprehensive quality of hospital care but also on waiting time alone; this was not addressed in the aforementioned studies. Further, we note the difference in the influence of increased demand between waiting time and the factors irrelevant to it. When the demand on hospitals increases, hospitals become crowded, and additional resources are needed to reduce congestion and maintain a certain length of waiting time. Thus, we assume that the costs of maintaining a certain waiting time length would increase with the demand on hospitals. On the other hand, we assume that the quality of hospital care as wrought by factors irrelevant to waiting time does not worsen even if the demands on that hospital increase. For example, the medical technology and the skills and experience of medical staff of a hospital remain at the same quality level, regardless of its number of patients (although improvement in these factors may H. Aiura increase its waiting time by attracting more patients).6 Accordingly, we assume that there are economies of scale in the costs of improving the factors irrelevant to waiting time; this assumption was not made by Aiura and Sanjo (2010). When these assumptions regarding the comprehensive quality of hospitals and costs as well as patient choice across cities are introduced, we derive the competitive equilibrium qualities of hospitals located in two cities with different population sizes. When the difference in the population between large and small cities is sufficiently great, there exists an equilibrium in which a hospital in a large city is superior to a hospital in a small city in terms of comprehensive quality. This equilibrium is intuitive and is not shown by Aiura and Sanjo (2010). Under the conditions in which this equilibrium exists, we analyze the effect of episode-of-care payment and find that, with an increase in this payment, the hospitals in the two cities improve not only in terms of comprehensive quality but also in terms of waiting time; however, the extent of these improvements differs between hospitals. In an actual situation—in which hospitals involve significant labor-intensive work—these improvements are found to be greater for the hospital in the small city than for the hospital in the large city. This result implies that regional disparity in the quality of hospital care decreases with an increase in episode-of-care payment. Since the costs required by a hospital that accepts only a few patients in exchange for a certain decrease in waiting time are lower than those required by a hospital that accepts many patients, the rationale behind this result is that the hospital in the small city, which has a relatively small demand, has a cost advantage in terms of improving in waiting time. Further, on the basis of these assumptions, we can also infer that the reduction in the disparity in waiting time between the two hospitals in the large and small cities is greater than that in comprehensive quality. In other words, when patients are given a free choice of hospitals and episode-of-care payment to hospitals is adequate, regional disparity in waiting time appears to be smaller than that in comprehensive quality. This result within the present study can be interpreted thus: regional disparity in the quality of hospital care would decrease with increasing intensity of competition among regions, because an increase in episode-of-care payment intensifies competition among hospitals for acquiring patients. This implication is supported by the findings in OECD Regions at a Glance 2009, which shows that Japan 6 5 Aletras (1999) suggests that, apparently, economies of scale work effectively in acute care hospitals with 100–200 beds. Preyra and Pink (2006) show that economies of scale and scope through hospital consolidations are almost certainly possible. 123 An increase in the number of patients may put more pressure on medical staff, and their overall level of skill may therefore decrease. However, this impact would be sufficiently smaller than the impact on waiting time as wrought by an increase in the number of patients. Therefore, we neglect the impact on factors irrelevant to waiting time as wrought by an increase in the number of patients. Inter-regional competition has a more balanced regional distribution of physicians than most European countries. The report also shows that the number of physicians in the urban regions of each European country is correlated positively with population share, whereas the number of physicians in the urban regions of Japan is correlated negatively with population share. These findings imply that the disparity in quality of care would be small between urban and rural regions in Japan; these findings can be explained as follows. Japan is geographically small in size and people in Japan—a country that has been permitting patient choice in hospitals since the 1960s—are accustomed to exercising patient choice; thus, Japanese hospitals seem to be more competitive than European countries. In terms of the implications of the present study, this Japanese feature suggests that regional disparity in Japan appears to be small compared to that in European countries. The remainder of this study is organized as follows. ‘‘Model’’ presents the model. ‘‘First-best quality of hospital care’’ shows the properties of the first-best quality of hospital care in maximizing social welfare. ‘‘Inter-regional competition among hospitals’’ derives the equilibrium at which hospitals compete on quality and investigates how this equilibrium changes with an increase in payment per episode of care. ‘‘Numerical analysis’’ uses numerical analysis to support the implications of ‘‘Inter-regional competition among hospitals’’. ‘‘Conclusion’’ presents concluding remarks. Model In this study, we consider an economy extended over a linear segment with length 1. Two cities, city 1 and city 2, are located at the two endpoints of this segment. Geographically speaking, the measure of each city is 0; that is, each city is regarded as a point on the segment.7 The area between the two cites is assumed to be agricultural, and the population in this agricultural area is distributed uniformly. Hereafter, the agricultural area is referred to as the ‘‘village.’’ We indicate the populations in city 1, city 2, and the village as N1, N2, and 1, respectively. Further, we assume that N1 [ N2 [ 1, which implies that the populations of each of the two cities is larger than that of the village, and that the population of city 1 is larger than that of city 2. Only the cities have hospitals; the village does not have a hospital because there is not sufficient demand in the village. Therefore, the people in the village need to travel to either of the two cities in order to receive hospital care. 7 Takahashi (2004) also considers a similar spatial economy. Even if the people in cities are spread over a segment with a certain length, the results do not change within the parameter domain of this study. 517 Residents Residents are endowed with a utility function separable in money and benefits derived from the public goods that government provides and hospital care. Every resident earns the same income, y, pays the same head tax, h, and demands one episode of hospital care. Public goods give each resident benefits equal to g(z), which is an increasing function of government expenditure, z. When a resident takes one episode of hospital care available in city i, he/she gains benefits equal to q(wi, hi), which is a function of two factors: (1) waiting time, denoted by wi, and (2) the amount of such resources that yield benefits of hospital care but do not influence waiting time, denoted by hi. These two factors, wi and hi, are substitutable, but not perfectly. As an extreme example, we would definitely not want a hospital in which the waiting time exceeds 10 years, even if it had the best medical technology in the world. Therefore, we assume that b qðwi ; hi Þ ¼ Awa i hi ; where A, a, and b are constant and greater than 0. The elasticity of the comprehensive quality with regard to waiting time is equal to a; that is, waiting time increases in worth for patients as a increases. Since most patients consult their general practitioners (GPs) before accessing hospital care, they are well informed by their GPs about the hospitals they will access; thus, we assume that the residents know of the benefits gained from hospital care before receiving them.8 Additionally, we identify the benefits, q(wi, hi), with the comprehensive quality of hospital care. The residents of the cities and the village who receive hospital care from another city incur transportation costs for traveling from their homes to the city that provides hospital care. When a resident residing at x 2 ½0; 1 receives hospital care in city 1, we assume that he/she incurs tx as transportation costs, where t is a constant and greater than 0. Similarly, when the resident receives hospital care in city 2, we assume that he/she incurs t(1 – x) in transportation costs.9 Therefore, a resident residing at x, who consumes one unit of hospital care available in city i (= 1, 2) gains a utility—denoted by ui(x)—that is equal to u1 ðxÞ ¼ y h þ gðzÞ þ qðw1 ; h1 Þ sp tx; u2 ðxÞ ¼ y h þ gðzÞ þ qðw2 ; h2 Þ sp tð1 xÞ; 8 If the residents do not know of these benefits beforehand, but the errors that patients make with regard to the information of hospitals are distributed identically and independently, then the results presented in this study would hold qualitatively; however, the effect of episode-of-care payment would weaken. 9 Even if we assume quadratic transportation costs, the results remain unchanged. 123 518 H. Aiura where p and s denote the payment per episode of care to the hospital and the co-payment rate of the patient, respectively, in the medical security system that the government constructs.10 Accordingly, residents go to the city that offers a higher utility and receive hospital care that is available in that city. Let X denote the location of a resident who receives the same amount of surplus from both cities. Thus, we obtain the following equation: qðw1 ; h1 Þ tX ¼ qðw2 ; h2 Þ tð1 XÞ; which yields X¼ 1 qðw1 ; h1 Þ qðw2 ; h2 Þ þ : 2 2t The residents on the left side of X consume one episode of hospital care available in city 1 and gain u1, whereas those on the right side of X consume one episode of hospital care available in city 2 and gain u2.11 Accordingly, we obtain the demand for hospital care in city i (=1, 2), Di, as follows12: 8 if X > < 0; D1 ðqðw1 ; h1 Þ; qðw2 ; h2 ÞÞ ¼ > : N1 þ X; if 0 X 1 ; N1 þ N2 þ 1; if X [ 1 D2 ðqðw1 ; h1 Þ; qðw2 ; h2 ÞÞ ¼ ðN1 þ N2 þ 1Þ D1 ðqðw1 ; h1 Þ; qðw2 ; h2 ÞÞ: regulated by the government; thus, the hospital in city i decides its waiting time (wi) and the amount of resources that do not influence waiting time (hi) in order to maximize its own objective function. The revenue of hospital i is pDi, which depends on the wi and hi of the hospital in city i. On the other hand, the total costs of the hospital in city i; cðÞ; depend on not only wi and hi but also on the number of episodes of care (which is equal to Di), because the hospital in city i that decided a certain waiting time requires resources in proportion to the number of episodes that it has, in order to maintain its waiting time. For example, if the hospital handled k times the demand without increasing its required resources, the waiting time would become k times longer; thus, if the hospital handled k times the demand without increasing waiting time, a k-fold increase in resources would be required. Therefore, we assume the costs to provide Di episodes of hospital care at its decided waiting time (which is wi) as riHDi/wi, where ri and Di/wi denote the pric …

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