scholarly journals Economies of Scale and Scope in Hospitals: An Empirical Study of Volume Spillovers

2020 ◽  
Author(s):  
Michael Freeman ◽  
Nicos Savva ◽  
Stefan Scholtes
Keyword(s):  
Emergency Care ◽  
Operations Management ◽  
Economies Of Scale ◽  
Spillover Effects ◽  
Growth Strategies ◽  
Care Needs ◽  
Emergency Admissions ◽  
Hospital Systems ◽  
The Cost ◽  
Individual Hospital

General hospitals across the world are becoming larger (i.e., admitting more patients each year) and more complex (i.e., offering a wider range of services to patients with more diverse care needs). Prior work suggests that an increase in patient volume in a hospital service is associated with reduced costs per patient in that service. However, it is unclear how volume changes in one service affect the costs of the other services in the same hospital. This paper investigates such volume-cost spillover effects between elective and emergency admissions and across specialties, using condition-level panel data comprising all acute hospital trusts in England over a period of 10 years. We provide evidence that increased elective volume at a hospital is associated with an increase in the cost of emergency care (a negative spillover). Furthermore, for emergency admissions, we find evidence that increased emergency activity in one specialty is associated with lower costs of emergency care in other specialties (a positive spillover). By contrast, we find no evidence of spillover effects across specialties for elective admissions. We discuss the implications of these findings for individual hospital growth strategies and for the regional organization of hospital systems. This paper was accepted by David Simchi-Levi, operations management.

The Technology and Knowledge Spıllover Effects of FDI on Labour Productıvıty—Evıdence from Medıum-Hıgh Industry in Malaysıa

2020 ◽  
Vol 11 (1) ◽  
pp. 110-110
Author(s):  
Norhanishah Mohamad Yunus ◽  
Noraida Abdul Wahob
Keyword(s):  
Developing Country ◽  
Multinational Corporations ◽  
Knowledge Spillovers ◽  
Labour Productivity ◽  
Spillover Effects ◽  
International Technology Transfer ◽  
Technology Acquisition ◽  
Productivity Function ◽  
Short Run ◽  
The Cost

A plethora of studies have revealed the importance of new knowledge transfer from foreign multinational corporations (MNCs) in encouraging higher labour productivity and sustainable competitive advantages. However, less attention is given to low labour productivity issue despite the presence of FDI, especially in the developing country context. Most of the studies only heavily emphasised on 'technology' effects rather than 'knowledge' effects on the host country as a result of the presence of foreign technology. As Malaysia is one of the major FDI recipients in Southeast Asia, the specific spillover effects of each FDI investor country in Malaysia, need to be studied. With an abundance of MNCs, international technology transfer is considered as an imported mode for technology acquisition in a developing country like Malaysia. However, the benefits of FDI spillovers on labour productivity function in Malaysia remain ambiguous, even when classified according to specific investor countries. Globalisation and liberalisation have seen trade and investment activities booming, thus increasing multilateral relations between Malaysia and other countries regardless of their level of development. Thus, this study may help the Malaysian government to justify the cost that should be invested to attract more FDI inflows towards the manufacturing industries in the short run. Keywords: spillover effects, Foreign Direct Investment, labour productivity, technology spillovers, knowledge spillovers

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

2021 ◽  
pp. 205715852110069
Author(s):  
Åsa Falchenberg ◽  
Ulf Andersson ◽  
Birgitta Wireklint Sundström ◽  
Anders Bremer ◽  
Henrik Andersson
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Emergency Care ◽  
Quality Evaluation ◽  
Evaluation Study ◽  
Evidence Based ◽  
Patient Assessment ◽  
Care Needs ◽  
Home Based

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals A Case-Mix System for Children and Youth With Developmental Disabilities

2020 ◽  
Vol 13 ◽  
pp. 117863292097789
Author(s):  
Shannon L Stewart ◽  
Angela Celebre ◽  
Michael J Head ◽  
Mary L James ◽  
Lynn Martin ◽  
...  
Keyword(s):  
Developmental Disabilities ◽  
Prospective Payment System ◽  
Individual Characteristics ◽  
Children And Youth ◽  
Case Mix ◽  
Care Needs ◽  
Payment Reform ◽  
Home Setting ◽  
Service Programs ◽  
The Cost

Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which has led to the development of case-mix systems. The present study sought to develop a new approach to allocate resources among children and youth with intellectual and developmental disabilities (IDD) as part of a system-wide Medicaid payment reform initiative in Arkansas. To develop the system, assessment data collected using the interRAI Child and Youth Mental Health-Developmental Disability instrument was matched to paid service claims. The sample consisted of 346 children and youth with developmental disabilities in the home setting. Using automatic interactions detection, individuals were sorted into unique, clinically relevant groups (ie, based on similar resource use) and a standardized relative measure of the cost of services provided to each group was calculated. The resulting case-mix system has 8 distinct, final groups and explains 30% of the variance in per diem costs. Our analyses indicate that this case-mix classification system could provide the foundation for a future prospective payment system that is centered around stability and equitability in the allocation of limited resources within this vulnerable population.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

A Public Health Perspective on Child Care

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 1116-1118
Author(s):  
Kathleen F. Gensheimer
Keyword(s):  
Child Care ◽  
Collective Responsibility ◽  
Care Needs ◽  
Public Health Perspective ◽  
Care Services ◽  
Personal Level ◽  
Child Care Services ◽  
To Come ◽  
The Cost ◽  
Young Life

A child care provider is the mother of young life. She nourishes the children, brings them up—gives them energy, her resources, her nerve and all the possibilities to come true—when needed or ready. To not pay her a decent wage is undervaluing the care. To over-regulate her can decrease the supply and raise the cost. To under-regulate her can harm the quality. To zone her out of residential neighborhoods does not fit in a society that "values" children. And yet, all these misdeeds are committed state-wide. Nobody is made really and effectively responsible. Yet we all are! That's why the misdeeds can go on and even increase. Collective responsibility is hidden by our ignorance and greed. At present we live in a world out of balance. We work with no support for family and child care needs. We live lives of turmoil because of a system unable to care. We live lives that call for another way of living. Can biotechnologists build a child who requires less nurturing, less loving? or Can we foster conditions that help, rather than hurt, families using child care? It will oblige all of us to assign a new value to families, children and child care. It will oblige us to establish a strong public policy so that children and child care are valued as more than a mere "life style" option.1 On a personal level, as a mother of four young children and as a consumer of child-care services, I can well relate to the issue of child care.

An Efficient Single-Screw 11 000 TEU Containership: The Suez Max SS

2001 ◽  
Vol 38 (04) ◽  
pp. 219-232
Author(s):  
B. J. Rosello ◽  
A. N. Perakis
Keyword(s):  
Cost Analysis ◽  
Economies Of Scale ◽  
Suez Canal ◽  
Efficient Design ◽  
Single Screw ◽  
Economical Design ◽  
Initial Stability ◽  
Twin Screw ◽  
Cost Efficient ◽  
The Cost

The ability to transport containers with the least cost at currently required service speeds of approximately 25 knots to maintain a regular operating schedule is the goal of every post-panamax containership operator. The desire to carry more containers is driven by several economies of scale and their implications, which allow for significant savings. A single-screw containership, the Suez Max SS, is designed and evaluated against existing designs that include the P & O Nedlloyd Southhampton, Maersk S-Class, and the twin-screw Suez Max, which is a concept vessel. The containerships are compared using several different ratios and a cost per 20-ft equivalent unit (TEU) evaluation. The design of the Suez Max SS was built to the maximum draft currently allowed by the Suez Canal Authority. An initial stability analysis is performed that utilizes five different container loading conditions. A cost analysis that involves capital, operating, port, and fuel costs and Suez Canal fees is also completed. The four vessels are evaluated on a round-trip schedule between the ports of Rotterdam and Singapore with the same voyage characteristics and conditions. The Suez Max SS is found to be a more economical design with savings of approximately 25% over the existing vessels and a 15% savings over the concept vessel evaluated in the cost analysis. The Suez Max SS utilizes its economies of scale and the advantages of a two-port schedule that allow it to be such a cost-efficient design.

Investment Strategies for Sourcing a New Technology in the Presence of a Mature Technology

2021 ◽  
Author(s):  
Wei Zhang ◽  
Hsiao-Hui Lee
Keyword(s):  
Operations Management ◽  
New Technologies ◽  
New Technology ◽  
Investment Strategy ◽  
Profit Sharing ◽  
Development Effort ◽  
Investment Strategies ◽  
Cost Shifting ◽  
The One ◽  
The Cost

To stay competitive, high-technology manufacturers not only frequently source new technologies from their suppliers, but also financially support the development of these new technologies into component products or production tools. We consider a manufacturer that can either source a new but immature technology from a financially constrained supplier, or source a mature technology from an existing supplier if and only if the development of the new technology fails. To support the new technology, the manufacturer can choose to inject capital in the form of an equity or loan. The investment strategy not only affects the new supplier’s development effort and the probability of technical success (PTS), but also affects the existing supplier’s effort to improve the mature technology, which presents the manufacturer with a trade-off. Following the debt financing literature, we find that a loan contract is associated with a cost-shifting effect and often leads to a higher PTS. However, because the manufacturer not only maintains an investment but also a procurement relationship with the new supplier, we find a profit-sharing effect associated with an equity investment, which does not exist in the traditional equity issuance literature. In particular, we show that the profit-sharing effect can dominate the cost-shifting effect and lead to a higher PTS when the new supplier’s technological capability is sufficiently high. Nonetheless, we also show that the strategy that derives a higher PTS does not necessarily generate a higher payoff for the manufacturer. On the one hand, a loan can be preferred even when it leads to a lower PTS because the cost-shifting effect allows the manufacturer to offer a sufficiently low procurement payment while maintaining a sufficiently high PTS. On the other hand, when the existing supplier is very capable of reducing its costs, a loan can over-incentivize the new supplier to exert excessive effort and backfire. This paper was accepted by Charles Corbett, operations management.

Student Laptop Ownership Requirement and Centralization of Information Technology Services at a Large Public University

2011 ◽  
pp. 201-212 ◽  
Author(s):  
Gregory B. Newby
Keyword(s):  
Information Technology ◽  
Economies Of Scale ◽  
Cost Savings ◽  
Leading Edge ◽  
Chief Information Officer ◽  
Public University ◽  
General Purpose ◽  
Information Technology Services ◽  
Technology Services ◽  
The Cost

A large, highly ranked public university implemented a requirement for all incoming undergraduates to own a laptop computer starting in fall, 2000. To control increased expenditures for information technology, this requirement has shifted some of the cost of technology to students by decreasing the need for centralized general-purpose computing laboratories. At the same time, a shift towards centralized academic computing support occurred. This shift was away from information technology resources, services and support based in individual departments. This shift, engineered by the newly formed office of the Chief Information Officer (CIO), was envisioned to generate cost savings through economies of scale. The educational impact of the laptop requirement is starting to be felt, but adoption is not widespread in daily classroom use. Envisioned cost savings have not yet become apparent. However, laptop ownership has enabled some new classroom activities and helped to reinforce the leading-edge image of the university.

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