scholarly journals Changes in the activity levels and financing sources of Israel’s private for-profit hospitals in the wake of reforms to the public-private divide

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Royi Barnea ◽  
Adi Niv-Yagoda ◽  
Yossi Weiss
Keyword(s):  
Health Insurance ◽  
Surgical Procedures ◽  
Health Expenditure ◽  
Medical Center ◽  
Waiting Times ◽  
Publicly Funded ◽  
Private Hospitals ◽  
The Public ◽  
For Profit ◽  
Elective Surgical Procedures

Abstract Background The Israeli National Health Insurance Law provides permanent residents with a basket of healthcare services through non-profit public health insurance plans, independently of the individual’s ability to pay. Since 2015, several reforms and programs have been initiated that were aimed at reinforcing public healthcare and redressing negative aspects of the health system, and specifically the constant rise in private health expenditure. These include the “From Reimbursement-to-Networks Arrangement”, the “Cooling-off Period” program and the program to shorten waiting times. The objectives of this study were to identify, describe, and analyze changes in private hospitals in 1) the volume of publicly and privately funded elective surgical procedures; and 2) private health expenditure on surgical procedures. Methods Data on the volume and funding of surgical procedures during 2013–2018 were obtained from Assuta Medical Center, Hertzelia Medical Center, the Israeli Ministry of Health and the Central Bureau of Statistics. The changes in the volume and financing sources of surgical activities in private hospitals, in the wake of the reforms were analyzed using aggregate descriptive statistics. Results Between 2013 and 2018 the volume of surgical activities in private for-profit hospitals increased by 7%. Between 2013 and 2017, the distribution of financing sources of surgical procedures in private hospitals remained stable, with most surgical procedures (75–77%) financed by the voluntary health insurance programs of the health plans (HP-VHI). In 2018, following the regulatory reforms, a significant change in the distribution of financing sources was observed: there was a sharp decline in the volume of HP-VHI-funded surgical procedures to 26%. Concurrently, the share of publicly-funded surgical procedures performed in private hospitals increased to 56% in 2018.,. During the study period, private spending on elective surgical procedures in private hospitals declined by 53% while public funding for them increased by 51%. Conclusions and policy implications In the wake of the reforms, there was a substantial shift from private to public financing of elective surgical activity in private hospitals. Private for-profit hospitals have become important providers of publicly-funded procedures. It is likely that the reforms affected the public-private mix in the financing of elective surgical procedures in those hospitals, but due to the absence of a control group, causality cannot be proven. It is also unclear whether waiting times were shortened. Health reforms must be accompanied by a clear and comprehensive set of indicators for measuring their success.

scholarly journals Kedudukan Badan Hukum Rumah Sakit Privat Dihubungkan Dengan Fungsi Sosio Ekonomi

2018 ◽  
Vol 15 (2) ◽  
pp. 231
Author(s):  
Wahyudi Wahyudi
Keyword(s):  
Legal Aspect ◽  
Limited Liability ◽  
Literature Study ◽  
Private Hospitals ◽  
Legal Entity ◽  
The Public ◽  
For Profit ◽  
Library Research ◽  
To Receive ◽  
Economic Function

Society as users of health services organized by hospitals are entitled to receive services in plenary by not getting any difference of legal entity of hospital managers. The main goal of health care hospitals include the preventive, curative, rehabilitative and promotive to all levels of society in accordance with the socio-economic function that prioritizes social functioning compared with economic function. The legal entity of hospital management in the form of foundations, associations and limited liability companies. Research in this paper is a normative juridical research, which studied the approach of legislation (the statute approach) means that a problem will be seen from the legal aspect by studying the legislation. And also the method by way of literature study (library research). The research concludes that there are three (3) legal entity that manages private hospitals are more widely used by the public, namely foundations, associations and limited liability companies. Limited liability company that manages the hospital has the main purpose for profit or economic function takes precedence while legal entities of foundations and associations in managing hospitals prioritize socio-economic functions.

scholarly journals Analysis of waiting time for elective surgical procedures in neurosurgery department at a tertiary care teaching hospital in NCT, India

2017 ◽  
Vol 5 (10) ◽  
pp. 4538
Author(s):  
Sapna Ramani Sardana ◽  
Shakti Kumar Gupta ◽  
D. K. Sharma ◽  
Aarti Vij ◽  
S. S. Kale
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Tertiary Care ◽  
Operating Time ◽  
Healthcare Providers ◽  
Publicly Funded ◽  
Clinical Criteria ◽  
Elective Surgical Procedures ◽  
Patient Prioritization ◽  
A Prospective Study

Background: Reported increases in waiting times for publicly-funded elective surgeries have intensified the need to decrease wait by healthcare providers and hence the study.Methods: Descriptive study done in neurosurgery department, to ascertain waiting times for its elective surgeries, included a retrospective analysis of admitted post-surgical patients and a prospective study using interviews with relevant stakeholders to do a process mapping.Results: Median time from decision of surgery to actual date of surgery was found to be 110.5 days. It was calculated that for optimum utilization of present available OTs, 19 extra beds are required and to address the existing load of patients waiting for their respective surgeries there is a need of 63 additional beds with 2 additional OTs functioning per day.Conclusions: The most common cause of waiting time was unavailability of vacant beds due to mismatch in demand-supply. The reason for postponement of surgery after admission was found to be lack of availability of theatre time followed by patient not being fit for surgery. Shortage of operating time was due to delayed start of operation theatre time. The study recommends improving admission process, restricting OPD time, standardized patient prioritization depending on relevant clinical criteria.

scholarly journals Trends in hospital service provision

2002 ◽  
Vol 25 (5) ◽  
pp. 2 ◽  
Author(s):  
Jenny Hargraves ◽  
Narelle Grayson ◽  
Ian Titulaer
Keyword(s):  
Service Provision ◽  
Health Expenditure ◽  
Average Length ◽  
Public Hospitals ◽  
Hospital Service ◽  
Private Hospitals ◽  
For Profit ◽  
Average Length Of Stay ◽  
Acute Hospitals ◽  
Using Data

In this paper,trends in hospital service provision are measured using data on the numbers and nature of hospitals,on hospital expenditure and on hospital activity over recent years.The number of public acute care hospitals was fairly stable,however,bed numbers decreased.Hospital numbers rose for private hospitals,as did numbers of beds,particularly for group for-profit private hospitals.Recurrent health expenditure on hospitals as a proportion of all recurrent health expenditure fell,although it rose for private hospitals, and real increases in expenditure occurred for both public acute and private hospitals.Population rates for separations and patient days rose for private hospitals and were stable and fell, respectively,for public acute hospitals. Average length of stay decreased for both public acute and private hospitals, with increasing numbers of separations occurring on a same day basis.Increasing proportions of procedures were undertaken during same day stays,and in private hospitals.Separation rates varied geographically, with highest rates overall,and for public hospitals and overnight separations,for patients resident in remote centres and other remote areas.Highest rates for private hospitals were for patients resident in capital cities,other metropolitan centres and large rural centres.

scholarly journals Why it is time to review the role of private health insurance in Australia

2004 ◽  
Vol 27 (1) ◽  
pp. 3 ◽  
Author(s):  
Leonie Segal
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care System ◽  
Private Health Insurance ◽  
Private Provider ◽  
Private Hospitals ◽  
The Public ◽  
Universal Health ◽  
Care System

The role of private health insurance (PHI) within the Australian health-care system is urgently in need ofcomprehensive review. Two decades of universal health cover under Medicare have meant a change in the function ofPHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasingevidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promotethe efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure offthe public hospital system' and to 'facilitate choice of insurer and private provider', and the incentives have indeedincreased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospitaladmissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of thepolicies. The Commonwealth share of the health care budget has increased and the relative contribution from privatehealth insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population,compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes whoare more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hocpolicy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental changein its role and significance in the context of universal health coverage.

13. The impact of government regulation of ambulatory surgical facilities on access to elective surgical procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 34
Author(s):  
E. Fric-Shamji ◽  
M. Shamji
Keyword(s):  
Health Care ◽  
Surgical Procedures ◽  
Government Regulation ◽  
Ambulatory Surgery ◽  
The United States ◽  
Lumbar Discectomy ◽  
Rapid Expansion ◽  
For Profit ◽  
Elective Surgical Procedures ◽  
The Impact

Advances in medical technology have made free-standing ambulatory surgery centres a cost-effective method of delivering health care in the United States. One: Rapid expansion of such centres and duplication of services have raised concerns over rising health care costs, two: leading to government regulation of facilities via a Certificate of Need (CON) law in many states. Three: Such regulation may decrease access to elective procedures. This study investigates access to elective surgical procedures in selected states with and without CON laws. Results of the Health Care Utilization Project were analyzed. Per capita rates of elective carpal tunnel release (CTR) and lumbar discectomy were evaluated in 16 states with CON laws and 5 states without CON laws over the years 2004-2005. Distribution of CTR and lumbar discectomy were analyzed by facility ownership and teaching status, using rates of emergent procedures as a control. Student’s t-tests compared rates of CTR and discectomy as a function of CON legislation. Two-factor ANOVA extended this analysis to account for teaching environment and facility ownership. Fewer CTR cases were performed in states with CON laws (p=0.014), specifically in government-owned (p=0.012) and non-teaching facilities (p=0.01). No difference was observed in lumbar discectomy rates in states with respect to CON regulation. Distribution of both procedures among teaching and non-teaching centers was independent of CON laws. Facility ownership predicts fraction of these cases performed at an institution,(p < 0.01) and this distribution is influenced by CON regulation, increasing fractions of both types of procedures performed at private, not-for-profit centers (p=0.001, p=0.003 respectively). We conclude that CON laws restrict access to certain procedures, specifically in government-owned and non-teaching facilities. These laws may limit the supply of surgical care, notably by redistributing away from government and for-profit centres. Potential solutions include reinvestigating the need for CON laws, or examining the CON methodology to accurately reflect need. Small NC, Bert JM. Office Ambulatory Surgery Centers: Creation and Management. J Am Acad Orthop Surg 2003; 11:157-62. Casalino LP, Devers KJ, Brewster LR. Focused Factories? Physician-Owned Specialty Facilities. Health Affairs 22(6):56-67. Lanning JA, Morrisey MA, Ohsfeldt RL. “Endogenous hospital regulation and it’s effects on hospital and non-hospital expenditures” Journal of Regulatory Economics1991 (June); 3(2):137-54.

scholarly journals Effects of increased private health insurance on hospital utilisation in Victoria

2004 ◽  
Vol 28 (3) ◽  
pp. 320 ◽  
Author(s):  
Vijaya Sundararajan ◽  
Kaye Brown ◽  
Toni Henderson ◽  
Don Hindle
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Severe Disease ◽  
Public Hospitals ◽  
Private Hospitals ◽  
Public And Private ◽  
The Public ◽  
Number Of Patients ◽  
Hospital Utilisation ◽  
Two Sectors

The proportion of Victorians and Australians generally with private health insurance (PHI) increased from 31% in 1998 to 45% in 2001. We analysed a dataset containing all hospital separations throughout Victoria to determine whether changes in the level of private health insurance have had any impact on patterns of public and private hospital utilisation in Victoria. Total utilisation of private hospitals grew by 31% from 1998?99 to 2002?03, whereas utilisation of public hospitals increased by 18%. Total bed-days have increased in both private hospitals and public hospitals by 12%. The proportion of all separations at private hospitals has remained relatively stable between these 2 years, with 33% of all separations being private patients in private hospitals in 1998? 99, increasing slightly to 35% by 2002?03. Analysis of a number of specific DRGs shows that patients with more severe disease are more likely to be seen at public hospitals; notably this trend has strengthened between 1998?99 and 2002?03. The number of patients treated in Victorian public hospitals has continued to grow, despite a rapid increase in the utilisation of private hospitals. Given the limited extent of the shift in caseload share between the two sectors, the effectiveness of the Commonwealth?s subsidy of private health insurance as a mechanism to reduce pressure on the public sector needs to be carefully examined.

scholarly journals A comparison of costs in Australian public teaching, public non-teaching and private hospitals

1995 ◽  
Vol 18 (4) ◽  
pp. 116 ◽  
Author(s):  
James S Lawson
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Hospital Stay ◽  
Surgical Procedures ◽  
Teaching Hospitals ◽  
Private Hospitals ◽  
The Public ◽  
Common Diagnosis ◽  
Alternative Approaches

This paper compares costs for caring for patients according to common diagnosis groupsin Australian public teaching, public non-teaching and private hospitals. Generally,the costs for general surgical procedures are highest in public teaching hospitals, followedby public non-teaching hospitals, and are lowest in private hospitals. However, theprivate sector is more expensive than the public sector for obstetric activities. The reasonsfor the differences appear to be the much higher ?overheads? in the public sector thanin the private sector, and the longer hospital stay for obstetric patients in privatehospitals. Managers of individual hospitals should examine the data in detail todetermine if alternative approaches are appropriate.Introduction

Hospitals: N.Y. Appellate Court Denies Move to Privatize Public Hospital

1999 ◽  
Vol 27 (2) ◽  
pp. 202-203
Author(s):  
Robert Chatham
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Public Health System ◽  
Municipal Hospital ◽  
The Public ◽  
Public Benefit ◽  
For Profit ◽  
Benefit Corporation ◽  
The City

The Court of Appeals of New York held, in Council of the City of New York u. Giuliani, slip op. 02634, 1999 WL 179257 (N.Y. Mar. 30, 1999), that New York City may not privatize a public city hospital without state statutory authorization. The court found invalid a sublease of a municipal hospital operated by a public benefit corporation to a private, for-profit entity. The court reasoned that the controlling statute prescribed the operation of a municipal hospital as a government function that must be fulfilled by the public benefit corporation as long as it exists, and nothing short of legislative action could put an end to the corporation's existence.In 1969, the New York State legislature enacted the Health and Hospitals Corporation Act (HHCA), establishing the New York City Health and Hospitals Corporation (HHC) as an attempt to improve the New York City public health system. Thirty years later, on a renewed perception that the public health system was once again lacking, the city administration approved a sublease of Coney Island Hospital from HHC to PHS New York, Inc. (PHS), a private, for-profit entity.

Incidence of Completed and Attempted Suicide in Trabzon, Turkey

Crisis ◽  
2002 ◽  
Vol 23 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Mustafa Bilici ◽  
Mehmet Bekaroğlu ◽  
Çiçek Hocaoğlu ◽  
Serhat Gürp&inodot;nar ◽  
Cengiz Soylu ◽  
...  
Keyword(s):  
Suicide Risk ◽  
Attempted Suicide ◽  
Medical Center ◽  
Study Data ◽  
Public Prosecutor ◽  
Suicide Method ◽  
Hospital Data ◽  
State Institute ◽  
The Public ◽  
Completed Suicide

Summary: Objective: Studies of completed and attempted suicide in Turkey are based on data of State Institute of Statistics (SIS) and emergency clinics of the large hospitals. This study seeks (1) to find, independent of the SIS and hospital data, the annual incidences of completed and attempted suicide in Trabzon, Turkey; (2) to examine the associated factors between the incidence of completed and attempted suicide. Method: The data are derived by using a method specially designed for this study. Data sources include emergency clinics in all hospitals, village clinics, the Forensic Medical Center of Trabzon, the Governorship of Trabzon, “mukhtars” (local village representatives) of neighborhoods, the Office of the Public Prosecutor of Trabzon, the Police Headquarters and Gendarmerie, and the local press organs. Results: The incidences of completed and attempted suicide per 100,000 inhabitants turned out to be 2.60 and 31.5, respectively, whereas the SIS reported the incidence of completed suicide to be 1.11 per 100,000 inhabitants in Trabzon in 1995. Conclusion: Our results demonstrate that SIS data are inadequate for suicide research in Turkey. Our findings show that the risk of completed and attempted suicide is high in young, unmarried, and unemployed persons, and that these groups must be carefully evaluated for suicide risk. The study highlights the need for culture-specific research on suicidal behavior in Turkey.

Empirical analysis of factors influencing the public health expenditure in Malaysia

2018 ◽  
Vol 6 (3) ◽  
pp. 1
Author(s):  
Kok Wooi Yap ◽  
Doris Padmini Selvaratnam
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Infant Mortality ◽  
Health Expenditure ◽  
Price Index ◽  
Infant Mortality Rate ◽  
Public Health Expenditure ◽  
The Public ◽  
Empirical Results ◽  
Per Capita

This study aims to investigate the determinants of public health expenditure in Malaysia. An Autoregressive Distributed Lag (ARDL) approach proposed by Pesaran & Shin (1999) and Pesaran et al. (2001) is applied to analyse annual time series data during the period from 1970 to 2017. The study focused on four explanatory variables, namely per capita gross domestic product (GDP), healthcare price index, population aged 65 years and above, as well as infant mortality rate. The bounds test results showed that the public health expenditure and its determinants are cointegrated. The empirical results revealed that the elasticity of government health expenditure with respect to national income is less than unity, indicating that public health expenditure in Malaysia is a necessity good and thus the Wagner’s law does not exist to explain the relationship between public health expenditure and economic growth in Malaysia. In the long run, per capita GDP, healthcare price index, population aged more than 65 years, and infant mortality rate are the important variables in explaining the behaviour of public health expenditure in Malaysia. The empirical results also prove that infant mortality rate is significant in influencing public health spending in the short run. It is noted that macroeconomic and health status factors assume an important role in determining the public health expenditure in Malaysia and thus government policies and strategies should be made by taking into account of these aspects.

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