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1	The impact of managed care on the hospital industry Bernard, Didem M. January 2001 (has links) Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Managed care health plans have become an important new force in the US health care system, changing the delivery of health care and the nature of competition in the health care industry. Lower health care costs of managed care emollees have led many to see 'managed care' as the solution to rising health care expenditures. Therefore, it is important to understand the impact of managed care on the health care industry. This dissertation focuses on the impact of 'managed care' on the acute care hospital industry and physicians who work in inpatient settings, using data on hospitals in Massachusetts between 1992 and 1998. In the first essay, I investigate the impact of managed care penetration on the prices and costs of hospitals. Managed care plans provide coverage for health care through a predetermined group of providers selected by the plan. Their ability to direct demand potentially gives them power to extract lower prices from providers. However, the impact of managed care penetration on prices for the overall patient population depends on whether hospitals raise prices to non-managed care insurers. Using instrumental variables estimation, I find evidence that managed care penetration leads to significant reductions in hospital prices and costs for the overall patient population. Managed care involves methods of financing and delivering health care services that manage, or intervene, in care decisions made by patients and physicians in order to reduce costs. The second essay empirically investigates whether managed care plans are able to reduce the resource use of physicians in inpatient settings. Using instrumental variables estimation, I find evidence that managed care involvement reduces physicians' resource use not only for managed care patients but for nonmanaged care patients as well. / 2031-01-01 Hospitals Hospital industry Managed care
2	Diversification of Hospital-A case study of Hospital J Liou, Wen-Chin 23 August 2005 (has links) The troublesome Taiwan medical care system is at the brim of bankruptcy. The system was forced to control the growth of its pay to hospital, thus jeopardize the industry. Hospitals have to formulate strategies to respond to the environment changes, and to reshape themselves to be a ¡§future hospital¡¨. This dissertation is about the way for hospital management through diversification. Hospitals which I interviewed have positive attitudes to diversification, they think that it provide synergic effect for their business. Among the cases that I studied, diversification are made based on the hospital¡¦s core competences and always related to health care or medicine. Companies are always changing their business model to survive, learning more to reinforce their core competence, extending their competitive advantages to emerging industries, and so must the hospitals do. A SWOT analysis based on hospital J has been made, followed by feasibility study on the following questions: What are our advantages compared to competitors? What resources do we need for diversification? What resources can hospital J provide? Dose diversification generate synergic effects or decrease the hospital¡¦s value? What can we learn through diversification? The candidate businesses that I proposed for diversification are highly related to hospital J¡¦s core business and can be conducted by its existing human resources.A future core business is likely to be created through the extension of existing competitive advantages. Diversification by extension of related core business can be done through joint-venture, strategic alliance or synergistically merging. Diversification to less core business related area are arranged by co-operation with non-hospital company or recruiting new employee who have experience in the new field. There must be evaluation prior to diversification, hospitals diversify their businesses with different competitive advantages have different scenario. I hope that this dissertation can be a valuable reference to hospitals those have already made their diversification and those are under their way for diversifying their businesses. Hospital industry SWOT analysis diversification
3	The topics in common ownership January 2020 (has links) archives@tulane.edu / 1 / Mengde Liu Common ownership Hospital industry Institutional investor
4	Organizational Ecology and the Proliferation of Specialty Hospitals Al-Amin, Mona January 2009 (has links) This dissertation examines the proliferation of specialty hospitals in the United States. Since the 1990s specialty hospitals increased in number and stirred much controversy, given that most are for-profit and physician-owned. They are examined here according to the Organizational Ecology Theory, a theoretical framework used in many industries to explain the founding of new organizational forms. Given that general hospitals have been the dominant organizational form in the hospital industry, the emergence of specialty hospitals is explained in this dissertation by applying organizational ecology theories: resource partitioning, density dependence and niche formation. Moreover, I examine the effect environmental and institutional variables have on the variations in specialty hospital proliferation between different states in the United States. The data used in this dissertation are mainly derived from the American Hospital Association Annual Database and the Area Resource File. The Negative Binomial Generalized Estimating Equations method is used to test the models in Stata 9. The findings from this dissertation provide support to both the density dependence, niche formation, and resource partitioning theories. The volume of surgical procedures seems to have a positive effect on the number of new specialty hospitals in a state. Specialty hospitals founding rates also seems to be positively related to the closure rate of general hospitals. Moreover, specialty hospitals founding rate was significantly affected by the intra-population density of specialty hospitals in the area they were founded. As for environmental and institutional factors, the presence of a Certificate of Need program negatively affects the founding rate of specialty hospitals in a state when specialty hospital density is not accounted for in the model. Economical variables, on the other hand, were significant in all the models. Specialty hospitals were positively related to state per capita income and negatively related to unemployment rate. One of the interesting findings of this study is that specialty hospitals founding rate is negatively related to physician expenditures. Thus, less income might be inducing physicians to open their hospitals to recoup financial losses. This dissertation is not just important due to its contribution to organizational ecology, it is also important because it explains to policy makers the reasons that lead to the proliferation of specialty hospitals and the future of these new entrants into the health care arena. / Business Administration Business Administration, Management Health Services Organizations Hospital Industry Organizational Ecology Specialty Hospitals
5	創新性智慧資本之評估：以醫療產業為例林貞瑜 Unknown Date (has links) 全民健康保險實施，促使醫院走向非價格競爭的經營模式，「創新」將會是醫院維持競爭力的利器。本研究透過兩兩成對比較之問卷調查方式了解影響醫療產業創新之組成要素權重，並進一步經由訪談之方式針對醫療產業創新性智慧資本之價值加以衡量，為個案醫院建立一套創新性智慧資本的聯合價值層級衡量系統。考量院方之與創新相關之核心價值及願景的情況下，個案醫院最看重的是人力資本，其次依序是財務資本、結構資本及關係資本，代表在創新策略為導向的情況中，人力資本更是醫院最重要的無形資產。推導出個案醫院創新性智慧資本之價值為0.380，處於醫療產業的個案醫院的創新性智慧資本之價值較低。聯合價值層級衡量系統除了解關鍵成功因素外，針對該因素實際成果進行探討，其價值結果可以提供管理者於資源投入時重要的參考依據與策略執行力及權重認知的檢視。 / The hospitals tend to non-price competition because of the National Health Insurance. “Innovation” will be hospitals’ sharp weapons to maintain their competitive advantage. This thesis conducted the case study under the hospital industry to confer two themes. The first is the weights of determinants of innovation within hospital industry via pair-comparison in a questionnaire. The last is the value of innovative intellectual capital within hospital industry through interviews. This thesis developed a new measurement system of innovative intellectual capital within hospital industry-- conjoint value hierarchy. Considering the core value and vision, the most capital is human capital for object of the case study. the next are financial capital and structural capital. The last one is relational capital this order implicated that human capital is the most important intangible asset in the case the innovation strategy as a consideration. The value of innovative intellectual capital in object of the case study is low, only 0.380. The measurement system, conjoint value hierarchy, cannot only understand key success factors, but also consider the value of actual result of the key success factors. The value result can provide management a important reference basis for resource input and review of execution of strategy and of weight perception. 智慧資本醫療產業創新聯合價值層級 Intellectual capital innovation in hospital industry conjoint value hierarchy
6	Talent retention framework for the hospitality industry Kruger, Patsy Loura 12 1900 (has links) Abstracts in English, Afrikaans and Zulu / This research study aimed to propose a talent retention framework for the hospitality industry in the Indian Ocean region by examining the relationship between fit, flourishing and organisational commitment in relation to employee retention. In addition, the study aimed to determine whether demographic factors (age, gender, nationality, marital status and employment status [local or expatriate]), work role fit and flourishing significantly and positively predict organisational commitment, and whether demographic factors (age, gender, nationality, marital status and employment status (local or expatriate) differ with regard to these variables. The study was directed at a random sample of employees at international hotels represented in the Indian Ocean region. The data was collected using the Work Role Fit Scale, the Flourishing-at-Work Scale and the Organisational Commitment Scale. The study revealed significant positive relationships between fit, flourishing and organisational commitment in the hospitality industry. The results found that fit and flourishing positively and significantly predict organisational commitment. Lastly significant differences were found between the fit, flourishing and organisational commitment of employees in the hospitality industry in terms of demographic variables: age, gender, nationality, marital status and employment status (local or expatriate). / Hierdie navorsingstudie het ten doel gehad om 'n talentbehoudraamwerk vir die gasvryheidsbedryf in die Indiese Oseaan-streek voor te stel deur die verhouding tussen gepastheid, florering en organisatoriese toewyding met betrekking tot werknemerbehoud te ondersoek. Verder het die studie gepoog om te bepaal of demografiese faktore (ouderdom, geslag, nasionaliteit, huwelikstatus en werknemerstatus [plaaslik of uitgestuur]), werkrolgepastheid en florering die organisatoriese toewyding beduidendheid en positief voorspel, en of demografiese faktore (ouderdom, geslag, nasionaliteit, huwelikstatus en werknemerstatus [plaaslik of uitgestuur]) rakende hierdie veranderlikes verskil. Die studie is gerig op 'n ewekansige steekproefneming van werknemers by internasionale hotelle wat die Indiese Oseaan-streek verteenwoordig. Die data is deur die werkrolgepastheidskaal, die floreer-by-die-werk-skaal en die organisatoriese toewydingskaal versamel. Die studie het beduidende positiewe verhoudings tussen gepastheid, florering en organisatoriese toewyding in die gasvryheidsbedryf aan die lig gebring. Die resultate het bevind dat gepastheid en florering die organisatoriese toewyding positief en beduidend voorspel. Laastens is beduidende verskille gevind tussen die gepastheid, florering en organisatoriese toewyding van werknemers in die gasvryheidsbedryf met betrekking tot demografiese veranderlikes: ouderdom, geslag, nasionaliteit, huwelikstatus en werknemerstatus (plaaslik of uitgestuur). / Lolu cwaningo lwaluhlose ukuphakamisa uhlaka lokugcinwa kwamakhono embonini yezokungenisa izihambi esifundeni sase-Indian Ocean ngokuhlola ubudlelwano phakathi kokuzibophezela okufanelekile, okuchumayo nokuhlelekile maqondana nokugcinwa kwabasebenzi. Ngaphezu kwalokho, lolu cwaningo kuhloswe ngalo ukuthola ukuthi izici zabantu (ubudala, ubulili, ubuzwe, isimo somshado nesimo sokuqashwa ([okwendawo noma okudingisiwe]), indima yomsebenzi efanelekile nokuchuma kahle okuphawulekayo kubikezela ukuzibophezela kwenhlangano, nokuthi ngabe izici zabantu (ubudala, ubulili, ubuzwe, isimo somshado nesimo sokuqashwa (okwasekhaya noma okwamanye amazwe) ziyahluka maqondana nalezi ziguquko. Ucwaningo luqondiswe kusampula engahleliwe yabasebenzi emahhotela aphesheya amelwe esifundweni sase-Indian Ocean. Imiphumela ithole ukuthi okufanelekile nokuchuma kahle okuphawulekayo kubikezela ukuzibophezela kwenhlangano. Okokugcina umehluko obalulekile utholakale phakathi kokuzibophezela okufanelekile, okuchumayo nokuhlelekile kwabasebenzi embonini yezokungenisa izihambi ngokuya ngokuhlukahluka kwezici zabantu: ubudala, ubulili, ubuzwe, isimo somshado nesimo sokuqashwa (okwendawo noma okudingisiwe). / Human Resource Management / M. Com. in Business Management (Human Resource Management) Fit Flourishing Organisational commitment Retention Tourism 658.314 Hospitality industry -- Employees Organizational commitment Hospital industry -- Labor turnover
7	Essays in competition policy and public procurement / Essais sur la politique de la concurrence et les marchés publics Piechucka, Joanna 05 July 2018 (has links) Cette thèse de doctorat étudie trois questions de recherche en matière de marchés publics et de politique de la concurrence. Le premier chapitre se concentre sur une analyse microéconométrique des relations stratégiques entre d’une part l’entreprise choisie pour l’attribution d’un marché public et d’autre part l’autorité publique chargée de la régulation d’un service public. Il exploite des données sur le transport public urbain en France pour étudier les déterminants de choix réglementaires qui impactent à leur tour la rentabilité des opérateurs de transport. Le deuxième chapitre explore une évaluation ex-post d’une fusion qui a eu lieu entre deux grands groupes de transport en France (Veolia Transport et Transdev), en se concentrant sur l’existence éventuelle de gains d’efficacité dans les fusions. Enﬁn, le troisième chapitre donne un aperçu de l’impact d’une fusion lorsque les entreprises se font concurrence pour la qualité et repositionnent leurs services en analysant l’industrie hospitalière française. / This PhD dissertation studies three research questions in public procurement and competition policy presented in the respective chapters and preceded by a general introduction. The first chapter focuses on a microeconometric analysis of the strategic relationships between a firm awarded a public contract and the public authority responsible for regulating a public service. It exploits data on the French urban public transport industry to study the determinants of regulatory contract choices which in turn impact the cost efficiency of transport operators. The second chapter explores an ex-post assessment of a merger which took place between two major transport groups in France (Veolia Transport and Transdev), focusing on the possible existence of merger efficiency gains. Finally, the third chapter provides insight on the impact of merger when firms compete in quality and reposition their services by analyzing the French hospital industry. Concurrence Evaluation ex-post des fusions Repositionnement Estimation des coûts Contrats réglementaires Gains d'efficacité des fusions Industrie des transports Industrie hospitalière Competition Ex-post merger evaluation Product repositioning Cost estimation Regulatory contracts Merger efficiency gains Transport industry Hospital industry 338.5
8	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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