There are many types of hospitals, but the most famous are the public hospitals. What distinguishes them is that they provide services to the poor (people without means) and the minorities.
Historically, public hospitals started as correction and CPAS. They were poor homes run by church and medical schools. A complete cycle of the following: communities established their own hospitals which were subsequently taken over by regional authorities and governments - onlyBack to the management community today. Between 1978 and 1995 followed a 25% decrease in the number of public hospitals and the remaining were converted into small rural facilities.
In the U.S., less than a third of hospitals in a city and only 15% had more than 200 beds. The 100 largest hospitals averaged 581 beds.
A debate is raging in the West: the complete privatization of health care - or should a segment of the center-left in public hands?
Public hospitalsare in serious financial difficulties. 65% of patients do not pay for medical services received by them. Public hospitals have a legal obligation to treat all. Some patients are insured by national health insurance plans (including Medicare / Medicaid in the U.S., the UK NHS). Other plans are insured by the community.
The other problem is that these patients consumed less or non-profitable services. The service mix is wrong, trauma, medications, HIV treatment and obstetricsprevail - long, obviously loss-making services.
The more profitable to be addressed by the private providers of health: hi-tech and specialized services (cardiac surgery, diagnostic imaging).
Public hospitals are forced to "culturally competent care": social services, child care. These are money losing operations to private hospitals can remember. Based on research, we can safely say that private, for profit hospitals, discriminate publicly insuredpatients. They prefer young, growing families and healthy patients. The latter assumption by the public system, leaving an enclave of poor, chronically ill.
This, in turn, makes it difficult for the public system of human and financial resources to attract. It is becoming increasingly poor.
The poor are poor voters, and they provide very little political power.
Public hospitals operate in a hostile environment: budget cuts, the rapidproliferation of competing alternative health care with a much better picture and the method of privatization (including a network of security institutions).
Public hospitals are heavily dependent on public funding. The governments foot most of bill for health care. Public and private providers to pursue this money. In the U.S., potential consumers are organized in Healthcare Maintenance Organizations (HMO). The HMO negotiates with providers (= hospitals, clinics, pharmacies) to obtaindiscounts and better prices through negotiation. Public hospitals - under-funded as they are - not in a position to offer what they want. Yes, lose patients to private hospitals.
But public hospitals are to blame for their situation.
They have not implemented the rules of liability. They do not do routine statistical measures of their effectiveness and productivity: the waiting times, financial reporting and the degree of network development. Because evengovernments have transformed from "dumb suppliers" to "smart purchasers", the new public hospitals, change of ownership (privatize, lease their facilities and long term), or perish. Currently, these institutions (often wrongly) charged with bad financial management (the fees for their services are unrealistically low), undersized, inefficient service, union labor, bloated bureaucracy and no incentive to improve performance and productivity. No wonder that there isthe abolition of the "bricks and mortar" infrastructure (= closure of public hospitals) and replace it with a virtual (= geographical portable medical insurance).
Actually, there are counterarguments:
The private sector is willing and able to charge patients in the public sector to absorb. There is no legal obligation to do so, and the marketing arms of the various HMOs are primarily interested in healthy patients.
These discriminatory practices imposedchaos and chaos (not to mention corruption and irregularities) on the communities that decided the public hospitals - and gradually in private.
True enough, the governments of poor performance such as price-conscious buyers of medical services. It 'also true that lack the resources for the uninsured to reach a significant proportion of (extensions through subsidized insurance).
40 million people in the U.S. do not have health insurance - and a million moreadded each year. However, there are no data for the claim that public hospitals care less at a higher price to offer support - and no doubt, have unique experience in caring for low-income populations (both medical and social).
Yes, in the absence of facts, the arguments really amounts to philosophy. Health care is a fundamental human right - or is it a good thing to be subjected to the market's invisible hand? Prices are expected to serve as the mechanism of the optimalallocation of healthcare resources - or are there other, less quantifiable parameters to consider?
Regardless of the philosophical preference, a reform is a must. It should include the following:
Public hospitals should be subject to health management experts stressed that the consideration and tax policy. This should be related to the vesting of authority in hospitals, with the return of local government. Hospitals can be arranged aspolitics and bureaucracy (public interest), companies with greater autonomy to the current dual effect of avoiding debilitating. Could be organized as a non-profit organizations with independent, self-perpetuating boards of directors.
But all this can happen only through greater public accountability and a clear measure with clear quantitative criteria for the use of funds for public hospitals. Hospitals can begin renewing theirreward structures for wages and financial incentives to increase staff.
Current-fits-all compensation systems to discourage talented people. Pay should be tied to measurable criteria. top management of the hospital should receive a bonus when the hospital is accredited by the state, where the waiting time increased, disrollment when rates go down, and when multiple services are provided.
The implementation of these (especially mental) revolution, the management of public hospitals shouldbe trained to strict financial control, in order to improve customer service, process re-engineering and to negotiate agreements and commercial transactions.
Staff should be distributed through written labor contracts with provisions that allow the clear purpose of taking commercial risks.
Clarity of objectives must be defined and respected. Public hospitals should improve continuity of care, expand primary care capacity to reduce lengths of stay (= turning point increase) and satisfybudgetary constraints imposed by both the state and associations of patients or their insurers.
This can not be achieved without the full cooperation of the medical staff of hospitals. Hospitals in the United States form joint ventures with their own physicians (PHO - Physicians Hospital organizations). They benefit together with the implementation of reforms and increasing productivity. It is estimated that the productivity of today is 40% less in publicthe private sector. This is an estimate doubtful: the populations are different (more sick people in the public sector). But even if this figure is not correct - is the essence: public hospitals are less efficient.
They are less efficient because of the archaic scheduling of doctor-patient appointments, laboratory tests and operations, due to outdated computer systems or non-existent due to long lead times and reasons of redundant laboratory tests and medical procedures.The aid - which consists of private hospitals - from other (non-clinical and clinical) staff absent due to possible complex work rules and job descriptions required by the unions. Most doctors have divided loyalties between the medical schools where they teach and the hospital branches. They tend to overlook the contributions of volunteers for the classes and most prestigious. Public hospitals would therefore be wise not to take on new staff,medical schools, the sharing of risks through joint ventures with physicians, sign contracts with pay based on productivity and put the medical boards. In general, hospitals are shrunk and re-engineering of the workforce. About half of the budget is usually spent on labor costs in private hospitals - and over 70% in public law. It is not good for the staff through natural wastage, mass layoffs, severance pay or reduce incentives. These are "blind", nondiscriminating measuresaffecting the quality of care provided by the hospital. Further exacerbated by work rules, seniority systems, job title and complaints inclined structures - the situation can get out of hand.
The government should contribute its share. Public hospitals can not accommodate or compete with the demands of national, publicly traded healthcare organizations with political influence and ability to raise capital to fund marketing hyper-advanced. Public policies must be written in support of "security net "institutions. They should be able to make their own MCO (Managed Care Patients' organizations) to organize in order to ensure patients and their services directly to groups of potential consumers. In this way there is 20% of commissions they pay for HMOs shop now. If they use more efficient and less able to absorb all the benefits, rather than giving them authority groups of patients and medical insurers or the governmentInsurance>. Hospitals will then vendors can build their networks and share the risks with their doctor or the insurance companies when it suits their purposes.
An example: a public hospital with a private health plan is probably to use all the specialists and facilities, the ability to increase usage and profits - while today only primary care, less profitable services are used by independent health organizations.
The governmentmay limit the total number of health plans available, so it propagates the public hospital stand out and not be overwhelmed by hundreds of other plans. How to plan a public hospital could also be explained by "standard plan of care" - someone who has not chosen a plan which will automatically be included in the plan's public hospital.
Not all hospitals can start an HMO plan. Only the great can support the necessary insurance payments, the reserverequirements and administrative and marketing costs. The paradox is that large hospitals have already committed to HMOs, insurance, other patient groups, or government-sponsored MCO. They oppose the inclusion of hospitals that have competing health plans - in their networks. This is: a hospital with a plan - is a direct competitor of a private provider of health care insurance and encourage. Another obstacle is that governments are very reluctant topublic sector because of the individual. This is certainly out of fashion nowadays.
So an alternative strategy is more feasible:
Public hospitals can act as a network of direct contracting. They work together, pooling their resources to exert political pressure, degrade the administrative and budgetary control (data processing, request processing, payment, accounting, legal services) a common center. This eliminates the need for intermediaries such as HMOs. These shared networkswill be able to negotiate contracts with other doctors, pharmacists, specialized laboratories and so on. This helps the public hospitals a fair and stable (low-dropout rate) for the protection of patients.
Finally, public hospitals are large employers with political power. All that's missing is the will to practice. They should governments do to some unpopular decisions: incentives for HMOs to refer patients to public hospitals, healthcare organizations mustuse the full range of services (both primary and specialty), direct compensation for nonpaying patients to public hospitals.
But public hospitals must begin to act as public bodies should open their decision-making and the creation of community-oriented. Must switch from relying on contract language to use an administrative law (regulations) - except when it comes to employment. In a nutshell: they need business-oriented, on one hand - and in publicresponsible to the other side.
There is the small problem of public relations and advocacy. Public hospitals have a terrible image, and they do very little to change it. They did not even cooperate with investigators trying to provide a factual basis for the health safety net and social assistance "to solve. In a world where images matter more than reality, this is perhaps the biggest mistake in public hospitals.
Eight ways to the functioning of public hospitals to improve
A publichospital can rent a physical space or time slots, computer equipment or other equipment in serviceable condition dies - to their physicians for private practice.
The tenant will have to pay doctors in the hospital - in the form of fixed rates or in the form of profit sharing (franchise).
They also undertake community-oriented, non-profit services in exchange for the right to use what is essentiallycommunity property.
Another method is to use the excess capacity to sell, rent or lease it to entrepreneurs who are not members of hospital staff. There are many possibilities such as: small laboratories, specialty medical services, primary care physicians and specialists. All these happy with the infrastructure of the hospital than to be used. The right to use this infrastructure can be provided in the form of a concession, a franchise, agreement or other arm oflongitudinal mode of cooperation. Professionals are likely to jump on the bandwagon when they realize that the hospital gives them a "captive market" of the patient. This is the relationship between an 'anchor' in a shopping mall and the little shops around it. The small stores can benefit from the business diverted in their direction of the large "anchor" retailers.
The next logical step would be to sell products and services to the community in a commercial,competitive basis. The hospital is not limited to the sale of goods and medical services. Medical services may also be entitled to sell, use your printer to print jobs to provide social services, to organize a profit center and selling the community or people, provide medical advice on a fee per service basis, even sell food from the hospital kitchen through a catering service, or data to researchers from its archives. A natural extension of this approach would"Internal privatization.
A hospital is a set of small (and medium) enterprises formed under one organizational roof. Laundry, cleaning, cooking, television and telephone that offers patients, a business center for business people hospitalized - these are all places of profit or loss.
Internal privatization leads to the transformation of the hospital in a holding company. The holding company will own and operate a large number of companies. Eachcompany, an entrepreneur in hospital with a separate service or product will deliver. And all the laundry done by a company that the hospital will provide its services. The same goes for food, printing, legal services and so on. These companies will be former employees of the hospital. In this way, knowledge and experience within the hospital is not lost. The company owned by a former employee will"Right of first refusal" in the first five years after the conversion. The employee-owned companies will be allowed to tender the best deals on annual subscription for the hospital will perform the services offered.
These companies will also be allowed to offer their services to other customers. So, they will reduce their dependence on the employer, the hospital. They are very entrepreneurial people, competing for profits in a marketenvironment.
Part of the reengineering process to determine which of the characteristics that the hospital perform its core functions, essential functions without which the hospital will cease to exist or change their identity so that it will no longer recognizable as a hospital. All other non-core functions should be offered (a concept called "outsourcing"). They must be granted a tender for the most competitive bidders, regardless of theirprevious identity and loyalty. The hospital is likely to benefit from the transfer of functions, which has no competitive advantage over foreign players whose experience of these functions. This is somewhat akin to international (free) trade, where each nation optimizes resources and gives the (positive) results of the optimization process for its business partners.
To control this type of processing, medical information management systems should be introduced. Manyavailable and improve the quality and quantity of data available for the management of the hospital and as a result of the decision. This will make it easier for management to identify which areas does what. For example: the management of the hospital will be able to determine what kind of incentives should be offered to those members of staff, where possible, cut costs and where and how productivity can be improved.
Finally, a novelconcept is emerging. Universities and hospitals are two important repositories of knowledge and human experience. Virtually every hospital somehow works with an academic institution, or a medical school.
There is a symbiosis between the hospital and medical and social research.
Hospitals should actively encourage this. It improves their image, which contributes to their ability to provide quality services. But do not do it for free. They have contractual partnerscommercial exploitation of research results in their classrooms or with their cooperation. There is a great field for the pharmaceutical, medical device, biotechnology and genetic research - and a lot of money making opportunities for the entire community. Not getting commercially involved - hospitals are actually spending the money that is not theirs to give.
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