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Adoption of alternative financing strategies to increase the diffusion of picture archiving and communication systems into the radiology marketplace

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 108-113页

作者： Reiner, B Siegel, E McKay, P Univ Maryland Amer Radiol Serv Leonardtown MD 20650 USA Vet Affairs Med Ctr Baltimore MD USA Univ Maryland Sch Med Baltimore MD 21201 USA Amer Radiol Serv Baltimore MD USA Natl Vet Affairs Headquarters Washington DC USA

The objective of the study was to evaluate current marketplace conditions and strategies employed by major picture archiving and communication systems (PACS) vendors in the creation of alternative financing strategies, to enhance the diffusion of filmless imaging. Data were collected from the major PACS vendors in the forms of survey questionnaires and review of existing leases. Topics evaluated in the survey included current financing options available, foreseeable changes in PACS financing, role of third-party financiers, and creation of risk-sharing arrangements. Generic leases were also reviewed evaluating the presence or absence of several key variables including technology obsolescence protection, hardware/software upgrades, end-of-term options, determination of fair market value, functionality/acceptance testing, uptime guarantees, and workflow management consulting. Eight of the 10 PACS vendors surveyed participated in the data collection. The vast majority of current PACS implementations (60% to 90%) occur through direct purchase, with conventional leasing (operating or capital) accounting for only 5% to 30% of PACS installations. The majority of respondents view fee-for-lease arrangements and other forms of risk sharing as increasing importance for future PACS financing. The specific targets for such risk-sharing arrangements consist of small hospital and privately owned imaging centers. Leases currently offered range in duration from 3 to 5 years and frequently offer technology obsolescence protection with upgrades, multiple end-of-term options, and some form of acceptance testing. A number of important variables frequently omitted from leases include uptime guarantees, flexibility in changing financing or vendors, and incorporation of expected productivity/operational efficiency gains. As vendors strive to increase the penetration of PACS into the radiology marketplace, there will be a shift from conventional financing (loan or purchase) to leasing. Fee-

关键词：费用分担成本及成本分析/统计学和数值数据经济学医院/统计学和数值数据筹资组织/经济学租赁财产/经济学卫生服务使用研究/经济学采购科医院/经济学放射科医院/经济学放射学信息系统/经济学人类

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COST OF INNOVATION IN THE PHARMACEUTICAL-INDUSTRY

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JOURNAL OF HEALTH ECONOMICS 1991年第2期10卷 107-142页

作者： DIMASI, JA HANSEN, RW GRABOWSKI, HG LASAGNA, L UNIV ROCHESTER WILLIAM E SIMON GRAD SCH BUSINESS ADMROCHESTERNY 14627 DUKE UNIV DEPT ECONDURHAMNC 27706

The research and development costs of 93 randomly selected new chemical entities (NCEs) were obtained from a survey of 12 U.S.-owned pharmaceutical firms. These data were used to estimate the pre-tax average cost of new drug development. The costs of abandoned NCEs were linked to the costs of NCEs that obtained marketing approval. For base case parameter values, the estimated out-of-pocket cost per approved NCE is $114 million (1987 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a 9% discount rate yielded an average cost estimate of $231 million (1987 dollars).

关键词：成本及成本分析/统计学和数值数据数据收集数据说明统计药物评价/经济学药物评价临床前/经济学制药工业/经济学美国人类

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Consumers' perceptions and opinions of health care challenges - case study by the virginia hospital association

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Journal of Hospital Marketing 1990年第2期4卷 49-56页

作者： McDermott, Dennis R. School of Business Virginia Commonwealth University 1015 Floyd Avenue Richmond 23284-4000 VA United States

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Plan for revenue production in nutrition care at banning memorial hospital: A case study

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Journal of Hospital Marketing 1992年第2期6卷 37-83页

作者： Oumlil, A. Ben Rao, C.P. University of Dayton United States University of Arkansas United States

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THE EFFECTS OF HOSPITAL COMPETITION AND THE MEDICARE PPS PROGRAM ON HOSPITAL COST BEHAVIOR IN CALIFORNIA

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JOURNAL OF HEALTH ECONOMICS 1988年第4期7卷 301-320页

作者： ZWANZIGER, J MELNICK, GA UNIV CALIF LOS ANGELES SCH PUBL HLTH LOS ANGELES CA 90024 USA

Previous studies of hospital competition have found that greater competition leads to higher hospital costs. In this paper we report how the behavior of California's hospitals has changed since the introduction of programs intended to contain the rate of increase of hospital costs. Using data that cover the period proceeding and following the introduction of these programs, we found that hospitals in more competitive markets have lowered their costs significantly.

关键词：加利福尼亚卫生服务范围成本及成本分析/统计学和数值数据数据收集经济竞争/立法和法学经济学/立法和法学经济学医院/统计学和数值数据 Medicare 模型统计学预期支付系统

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Libraries, postgraduate medical education and the management of change.

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Health libraries review 1993年第1期10卷 3-9页

作者： Bayley, T.J. Faculty of Medicine University of Liverpool.

The changes surrounding the funding of postgraduate medical and dental education are outlined and the funding implications for libraries considered. The management of this period of change is vital if all players are to appreciate the advantages of implementation, not least cost-effectiveness. In conclusion three problem areas in the post-reform NHS are identified and briefly discussed: the need for access and provision of information to all;development of regional librarian role across all regions to ensure effective co-ordination of resources;a national policy which will integrate national, regional and unit structures for the delivery of health-care information needs to be developed.

关键词：聘任鉴定预算成本及成本分析/统计学和数值数据教育牙科继续/经济学教育医学继续/经济学大不列颠卫生保健改革/组织和管理图书馆医学/经济学图书馆医学/标准组织改革公费医疗/经济学培训资助

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Physician Staffing of Small Rural Hospital Emergency Departments: Rapid Change and Escalating Cost

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The Journal of Rural Health 1992年第3期8卷 171-177页

作者： Williamson, Harold A. Rosenblatt, Roger A. Hart, L. Gary Department of Family Medicine School of Medicine University of Washington Seattle United States

We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee‐for‐service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospitals. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：合同业务/经济学成本及成本分析/统计学和数值数据急诊室医院/经济学急诊室医院/人力急诊室医院/利用医院病床数 100张以下医院乡村/经济学医院乡村/人力人员配备和时间安排/经济学人员配备和时间安排/统计学和数值数据薪金和附加福利/统计学和数值数据华盛顿人类

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Reaching Children of the Uninsured and Underinsured in Two Rural Wisconsin Counties: Findings from a Pilot Project

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The Journal of Rural Health 1993年第1期9卷 40-49页

作者： Clarridge, Brian R. Newman, Kathleen M. Center for Survey Research University of Massachusetts—Boston Boston Massachusetts 02125–3393 100 Morrissey Blvd. Healey Library 10th Floor United States

Abstract: Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties. The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：青少年成年人儿童儿童保健服务/组织和管理儿童保健服务/利用儿童学龄前费用分担/标准成本及成本分析/统计学和数值数据女(雌)性健康状况人类婴儿新生男(雄)性普查/组织和管理普查/利用 Medicaid/组织和管理 Medicaid/利用未参加医疗保险者试点项目方案评价/统计学和数值数据农村卫生美国威斯康星

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The Economic Impact of Hospitals in Rural Communities

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The Journal of Rural Health 1991年第2期7卷 117-133页

作者： McDermott, Richard E. Cornia, Gary C. Parsons, Robert J. Brigham Young University Marriott School of Management Provo Utah 84602 774 Tanner Building United States

ABSTRACT: This article presents how to assess the economic impact of a hospital on a rural community. The economic impact is identified by assessing the direct, induced, and indirect impacts that result because of the presence of a hospital in a rural community. The methodology utilizes survey data and estimation procedures for four rural hospitals. The economic impact estimates are based on microdata. Income multipliers are estimated for each of the rural communities. The research demonstrates that rural hospitals do make significant economic contributions to the communities they serve. Community leaders can use the model presented to evaluate the economic impact of their local hospital. The economics of rural health care have changed dramatically during the 1980s. It is estimated by a staff report to the United States Senate Special Committee on Aging that as many as 600 rural hospitals face the prospect of closure in the next few years (U.S. Congress, 1988). In evaluating the possible closure of a rural hospital, community leaders should consider the impact this closure will have on the health of the residents who live in communities served. Issues to be reviewed include the continued accessibility of residents to emergency, outpatient, and preventive health care services, and the distance that residents will have to travel to access inpatient health care. In addition, community leaders should also evaluate the impact that a hospital's closure will have on the economy of the local community. This is relevant because one of the alternatives to closing a facility that cannot generate revenues sufficient to cover opera ting expenses is to subsidize the facility, either through private contributions or a tax levy. Christenson and Faulkner, (1981) using aggregate secondary data, concluded that rural hospitals contributed an average of $700,000 to $1 million to local rural economies. With a mean size of 43.8 beds per hospital surveyed, this amounts to $15,982 to $22,83

关键词：社区和机构的关系成本及成本分析/统计学和数值数据数据收集决策组织评价研究卫生设施关闭/经济学医院乡村/经济学医院乡村/统计学和数值数据收入/统计学和数值数据模型经济计量学犹他

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The impact of ownership form and regulatory measures on firm behavior: A study of hospices

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Nonprofit Management and Leadership 1994年第4期4卷 415-430页

作者： Hamilton, Vivian DepartmentofMedicine McGillUniversityMontrealQuebecCanada.

This article examines differential responses to the Medicare hospice benefit across ownership types. The analysis reveals little difference in costs or quality of service among government‐owned, for‐profit, and nonprofit hospices. However, there are significant differences in the numbers of patients served by ownership status. The results are consistent with the hypothesis that nonprofit hospices are patient maximizers, not profit maximizers in disguise who are aiming to circumvent the nondistribution constraint. A comparison of these results with those in the hospital and nursing home industries leads to the conclusion that Medicare regulations and the predominance of Medicare revenues in an industry induce similar outcomes in cost and quality across ownership types. Copyright © 1994 Wiley Periodicals, Inc., A Wiley Company

关键词：成本及成本分析/统计学和数值数据卫生设施私立卫生服务研究临终关怀医院/经济学临终关怀医院/组织和管理临终关怀医院/标准临终关怀医院/利用 Medicare/经济学多元分析组织非盈利所有权/经济学公营部门卫生保健质量/统计学和数值数据回归分析偿还途径/标准美国

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