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[DRGs--their effect on the nursing systems]: Pflege Aktuell, Vol. 54, No. 10. (October 2000), pp. 550-553.U Schrader

Source: Pflege Aktuell, Vol. 54, No. 10. (October 2000), pp. 550-553.
Investment, R& D, and Financial Constraints in Britain and Germany: (1997)This paper tests for the importance of cash flow on investment in fixed capital and R&D using firm-level panel data in two countries. For German firms, cash flow is not informative in simple econometric models of fixed investment or R&D. In identical specifications for British firms, cash flow is informative about investment, although not about the level of R&D spending conditional on the R&D participation decision. In the UK, we also find that investment is less sensitive to cash flow for...S Bond, D Harhoff, Van Reenen

Source: (1997)
A descriptive framework for country-level analysis of health care financing arrangements: Health Policy, Vol. 56, No. 3. (June 2001), pp. 171-204.Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the [`]insurance function' (access to needed care without financial impoverishment ) of health care systems. The framework is proposed as a tool for descriptive analysis of the key functions, policies, and interactions within an existing health care system, and equally as a tool to assist the identification and preliminary assessment of policy options. The aim is to help to clarify the policy levers that are available to enhance the insurance function for the population as efficiently as possible, given the [`]starting point' of a country's existing institutional and organizational arrangements. Analysis of health care financing systems using this framework highlights the interactions of various policies and the need for a coherent package of coordinated reforms, rather than a focus on particular organizational forms of [`]health insurance'. The content of each main health care system function (revenue collection, pooling of funds, purchasing of services, provision of services) and the market structure with which the implementation of each is organized are found to be particularly important, as are policies with respect to the benefit package and user fees.Joseph Kutzin

Source: Health Policy, Vol. 56, No. 3. (June 2001), pp. 171-204.
The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach.: Health care management science, Vol. 3, No. 4. (September 2000), pp. 309-321.The 1997 hospital financing reform has been supposed to reduce considerable inefficiencies in the provision of hospital care in Austria. This paper focuses on the changes in hospital productivity between 1994 and 1998, thus including three years before the reform and two years after the reform. Using Data Envelopment Analysis we calculated the input-based Malmquist index, which is then decomposed into indices of pure technical efficiency change, scale efficiency change and technology change. The results illustrated a considerably positive shift in technology between 1996 and 1998, whereas the intended enhancement in technical efficiency has not yet taken place.M Sommersguter-R eichmann

Source: Health care management science, Vol. 3, No. 4. (September 2000), pp. 309-321.
Hospital financing reform and case-mix measurement: an international review.: Health care financing review, Vol. 13, No. 4. (1992), pp. 119-133.A review of reforms in the financing of hospital services in eight European countries and Australia reveals a commitment to a common objective of relating resource use to hospital workload by means of a standardized case-mix framework in the pursuit of greater efficiency. While this objective is also shared with the U.S. prospective payment system (PPS), it is noteworthy that the majority of countries reviewed favor a global budgeting approach to financing hospital services. Ongoing evaluation of these reforms should facilitate an assessment of the merits of case-mix adjusted global budgeting relative to the patient-based alternative.MM Wiley

Source: Health care financing review, Vol. 13, No. 4. (1992), pp. 119-133.
An optimal contract approach to hospital financing.: J Health Econ, Vol. 23, No. 1. (January 2004), pp. 85-110.Existin g models of hospital financing advocate mixed schemes which include both lump-sum and cost-based payments. The doctor is generally the unique decision maker, which is unrealistic in a hospital setting where both managers and doctors are involved. This paper develops a model in which managers and doctors are responsible for different decisions within the hospital. In this model, public authorities who provide the financing, hospital managers who allocate resources within the hospital, and doctors who assign patients to either a low-tech or a high-tech therapy have information of increasing quality on the casemix of patients. The public authorities sign with hospital managers contracts specifying some lump-sum financing and some size of a high-tech equipment. In turn, managers, who know the broad mix of patients in the hospital, sign with hospital doctors contracts that specify the non-medical resources allocated to this facility as well as some remuneration. Doctors, who know each patient's illness severity, select the patients to be treated by the high-tech facility, and receive from public authorities some fee-for-servic e payment that is differentiated according to the low- or high-tech treatment used for curing their patients. What emerges is a two-stage agency problem in which contracts are designed to elicit information in the most efficient way.R Boadway, M Marchand, M Sato

Source: J Health Econ, Vol. 23, No. 1. (January 2004), pp. 85-110.
Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy.: Health services research, Vol. 34, No. 1 Pt 2. (April 1999), pp. 405-415.OBJECT IVE: To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. DATA SOURCES: Hospital discharge abstract data from 1993 through 1996 for all hospitals (N=32) in the Friuli-Venezia -Giulia region of Italy. Regional population data were used to calculate rates. STUDY DESIGN: Changes between 1993 and 1996 in hospital admissions, length of stay, mortality rates, severity of illness, and readmission rates were studied for nine common medical and surgical conditions: appendicitis, diabetes mellitus, colorectal cancer, cholecystitis, bronchitis/chr onic obstructive pulmonary disease (COPD), bacterial pneumonia, coronary artery disease, cerebrovascula r disease, and hip fracture. PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from 244,581 to 204,054 between 1993 and 1996, a population-bas ed decrease of 17.3 percent (p

Source: Health services research, Vol. 34, No. 1 Pt 2. (April 1999), pp. 405-415.
Financing reforms in the German hospital sector: from full cost cover principle to prospective case fees.: Medical care, Vol. 35, No. 10 Suppl. (October 1997)OBJECTIVE S: The authors provide an overview of the hospital sector in Germany with a focus on the impact of recent reform legislation on this sector. METHODS: Data from the Federal Statistics Office, the Ministry of Health, and the Federal Association of Physicians are synthesized with information obtained from a general review of the literature. RESULTS: Before the implementation of recent health-care reforms, the German health-care system has been sharply divided into inpatient and ambulatory care sectors, resulting in a fragmented system of care delivery. All hospital operating costs were fully covered through per diem charges. The 1992 Health Care Structure Act and subsequent pieces of legislation have introduced new mechanisms to improve cost efficiency in the hospital sector and increase coordination between the inpatient and outpatient care. These measures notably include implementing an inpatient prospective payment system and permitting ambulatory surgery and care services to be offered in inpatient settings. CONCLUSIONS: Whereas prospective payments have greatly reduced the length of stay, hospitals were reluctant to offer ambulatory surgery due to budgetary constraints and the high level of ambulatory surgery by office-based physicians. The reforms passed have not yielded substantial cost savings. These reforms offer a natural experiment that could benefit from national and international studies on the impact of hospital sector redesign on management, financing, and patient outcomes.R Busse, FW Schwartz

Source: Medical care, Vol. 35, No. 10 Suppl. (October 1997)
Multiple payers, commonality and free-riding in health care: Medicare and private payers: Journal of Health Economics, Vol. 21, No. 6. (November 2002), pp. 1049-1069.Mana ged health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the total payments. While payers have different objectives and use different contracting practices, the plans and providers set some elements of the quality in common for all payers. In this paper, we study the interactions between a public payer, modeled on Medicare, which sets a price and takes any willing provider, a private payer, which limits providers and pays a price on the basis of quality, and a provider/plan, in the presence of shared elements of quality. The provider compromises in response to divergent incentives from payers. The private sector dilutes Medicare payment initiatives, and may, under some circumstances, repair Medicare payment policy mistakes. If Medicare behaves strategically in the presence of private payers, it can free-ride on the private payer and set its prices too low. Our paper has many testable implications, including a new hypothesis for why Medicare has failed to gain acceptance of health plans in the US.Jacob Glazer, Thomas Mcguire

Source: Journal of Health Economics, Vol. 21, No. 6. (November 2002), pp. 1049-1069.
Forest Restoration in Landscapes : Beyond Planting Trees: (29 October 2005)The importance of restoration continues to grow, and this book integrates the restoration of forest functions into landscape conservation plans. The global conservation organization WWF has made forest landscape restoration a key topic and priority for its environmental work. Due to the WWF?s extensive global reach, and together with is many partners and counterparts, it has acquired a significant level of experience on the topic of forest restoration at large scales. This book represents the collective body of knowledge and experience of WWF and its many partners--whic h is collected here for the first time and which will be invaluable to all of those working in the field. This guide will serve as a first stop for practitioners and researchers in any organization or region and as a key reference on the subject. Along with concise, practical information for a variety of specific systems and issues, it gives many suggestions for further research. From the Foreword by Chief Anyaoku, President, WWF International: "Is it a sign of the times that the Nobel committee chose to award the Nobel Peace prize to Wangari Maathai for having planted 30 million trees? We believe so. . . .The 21st Century will be a time of forest restoration."

Source: (29 October 2005)

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