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Financial Viability (financial + viability)
Selected AbstractsTHE PRIVATE FINANCING OF NHS HOSPITALS: POLITICS, POLICY AND PRACTICEECONOMIC AFFAIRS, Issue 1 2009Mark Hellowell This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative and examines the impact of the policy on the long-term financial viability of NHS trusts. It concludes that the PFI funding of capital investment is highly problematic. Its high costs can have a negative impact on the finances of health systems. [source] Farrier services at veterinary teaching hospitals in the USAEQUINE VETERINARY EDUCATION, Issue 10 2010C. A. Kirker-Head Summary Horse health is best served when farriers and veterinarians collaborate in the care of their patients. Veterinary Teaching Hospitals (VTHs) provide an environment that can nurture that collaboration. While VTH veterinary services are well known, VTH farrier activities are undocumented. To characterise farrier services at VTHs in the USA, 27 VTH Diplomates of the American College of Veterinary Surgeons and/or VTH farriers completed a multiple choice questionnaire characterising VTH farrier details, training, certification, remuneration method, and clinical, teaching and research responsibilities; and farrier service prevalence, facilities and financial viability. Questionnaire response rate was 81%. Eighteen of 22 (82%) responding VTHs had in-house farrier services. Twenty-one of 22 (95%) VTH farriers were male. Farriers' ages ranged from <30 years (n = 1, 5%) to >50 years (n = 7, 32%). At 11 (61%) VTHs the farriers were paid by the client and at 7 (39%) by the VTH. Five farriers (23%) received a VTH salary. Eighteen of 22 (82%) farriers had a professional certification. At 5 (28%) VTHs the farrier service made a profit and operational costs were met at 13 (72%). Fifteen (83%) farrier services provided professional education in clinical settings and 13 (72%) in lecture settings. Nine (41%) VTH farriers participated in research activities. In the USA, VTH farrier services vary considerably in both nature and extent. The farriers' potential contributions to VTH operations are often recognised but not consistently exploited. VTH farriers are a valuable resource who can contribute effectively toward VTH patient care, veterinary education and research. [source] A sustainability assessment of a health equity fund initiative in CambodiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2007Bart Jacobs Abstract All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings. Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda-managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low. Copyright © 2007 John Wiley & Sons, Ltd. [source] Strategic decision-making in healthcare organizations: it is time to get serious,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2006David W. Young Abstract New and continuing environmental demands and competitive forces require healthcare organizations to be increasingly careful in thinking about their strategies. They must do so in a highly unusual (multi-actor) marketplace where a variety of system interdependencies complicate decision-making. A good strategy requires an attempt to understand the real, as distinct from the perceived, environment, and is characterized by explicit tradeoffs along three dimensions: service or program variety, patient needs, and patient access. The quality of these tradeoffs can be assessed in terms of whether the strategy is (a) attuned to critical success factors in the organization's environment, (b) highly focused, (c) linked to the organization's capabilities, and (d) accompanied by an activity set that is difficult for competitors to imitate. An organization also must be capable of adapting appropriately to changes in its environment. Thus, even the best strategy must be reviewed constantly if it is to remain viable. A strategy's sustainability can be adversely affected by increased buyer or supplier power, lowered barriers to entry, growing rivalry, the threat of substitutes, and increased slack in resource usage. By thinking more creatively in the future than they have in the past, healthcare organizations can make tradeoffs and choose a focused strategic position. They then can design an activity set that is appropriate for that position, and that will assist them to achieve both financial viability and superior programmatic performance. A well-designed activity set also will assist them to sustain their performance in the face of changing environmental demands and competitive forces. Copyright © 2006 John Wiley & Sons, Ltd. [source] The role of user charges and structural attributes of quality on the use of maternal health services in MoroccoINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005David R. Hotchkiss Abstract Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households. Copyright © 2005 John Wiley & Sons, Ltd. [source] The World Bank Approach to Pension ReformINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 1 2000Robert Holzmann This paper highlights the World Bank's thinking and worldwide involvement in pension reform. Both are driven by the Bank's mandate to help countries develop economically and to reduce poverty. The Bank has four key concerns in working with clients on pension policy: (1) short-term financing and long-term financial viability; (2) effects on economic growth; (3) adequacy and other distributive issues; and (4) political risk and sustainability. In response to these concerns and after review of the three main reform options for unfunded systems - mere PAYG reform, a rapid and complete shift to a mandatory funded system, and a gradual shift to a multipillar scheme - the Bank clearly favours the multipillar approach but in a pragmatic and country-specific manner. When helping to implement a pension reform the Bank fully takes account of country preferences and circumstances, bases its support on sound reform criteria, links the client assistance with knowledge management, provides training and other measures to enhance the reform capacity of a country, and seeks cooperation with other international institutions. In addition, the Bank has a comprehensive research agenda to improve the working of multipillar schemes, and the investigations include issues of coverage, administrative costs and annuities. [source] Tree plantations for restoration of degraded lands and greening of India: a case study of tree growers' cooperativesNATURAL RESOURCES FORUM, Issue 1 2001K. Balooni Abstract India has over 100 m ha (million hectares) of village common lands. De jure, these lands are owned by the state but, de facto, they are used in common by villagers. Most of the village commons are degraded and denuded and are almost nonproductive. Several attempts have been made in the recent past to restore them through planting of trees by governmental and non-governmental organizations. Tree Growers' Co-operative Societies (TGCS), as an organisational innovation of relatively recent origin, have proved to be more cost-effective than other forms of organisations engaged in greening the village commons in India. This paper attempts to assess the financial viability of tree plantations carried out by three selected TGCS and to distil lessons of their experience useful for policy purposes. The study revealed that plantations founded by the sample TGCS were financially viable, and that the plantations had transformed the desolate village commons into ,green wealth'. The authors conclude that the TGCS have a high potential as an instrument for promoting the afforestation of India's degraded village common lands and thereby improving village economy and the quality of the environment. [source] Commercial Insurance vs Community-based Health Plans: Time for a Policy Option With Clinical Emphasis to Address the Cost SpiralTHE JOURNAL OF RURAL HEALTH, Issue 2 2005Bruce Amundson MD ABSTRACT: The nation continues its ceaseless struggle with the spiraling cost of health care. Previous efforts (regulation, competition, voluntary action) have included almost every strategy except clinical. Insurers have largely failed in their cost-containment efforts. There is a strong emerging body of literature that demonstrates the relationship between various clinical strategies and reductions in utilization and costs. This article describes the organization of health services, including integration of delivery and financing systems, at the community level as a model that effectively addresses the critical structural flaws that have frustrated control of costs. Community-based health plans (CHPs) have been developed and have demonstrated viability. The key elements of CHPs are a legal organizational structure, a full provider network, advanced care-management systems, and the ability to assume financial risk. Common misconceptions regarding obstacles to CHP development are the complexity of the undertaking, difficulty assuming the insurance function, and insured pools that are too small to be viable. The characteristics of successful CHPs and 2 case studies are described, including the types of advanced care-management systems that have resulted in strong financial performance. The demonstrated ability of CHPs to establish financial viability with small numbers of enrollees challenges the common assumption that there is a fixed relationship between health plan enrollment size and financial performance. Organizing the health system at the community/regional level provides an attractive alternative model in the health-reformdebate. There is an opportunity for clinical systems and state and federal leaders to support the development of community-based integrated delivery and financing system models that, among other advantages, have significant potential to modulate the pernicious cost spiral. [source] Do PPPs in Social Infrastructure Enhance the Public Interest?AUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 2010Evidence from England's National Health Service This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative , by far the dominant form of public-private partnership in the United Kingdom (UK) , and examines the impact of the policy on the long term financial viability of the National Health Service. It shows that the interest rate on private finance contains a significant element of ,excess return' to investors, and there is no evidence that this ,excess cost' to the public sector is offset by greater efficiency through the contracting process. It concludes that the private financing of public capital investment is highly problematic , and can have a serious impact on the finances and capacity of public authorities. [source] Trends in Charges and Payments for Nonhospitalized Emergency Department Pediatric Visits, 1996,2003ACADEMIC EMERGENCY MEDICINE, Issue 4 2008Renee Y. Hsia MD Abstract Objectives:, To compare charges and payments for outpatient pediatric emergency visits across payer groups to provide information on reimbursement trends. Methods:, Total charges and payments for emergency department (ED) visits Medicaid/State Children's Health Insurance Program (SCHIP), privately insured, and uninsured pediatric patients from 1996 to 2003 using data from the Medical Expenditure Panel Survey. Average charges per visit and average payments per visit were also tracked, using regression analysis to adjust for changes in patient characteristics. Results:, While charges for pediatric ED visits rose over time, payments did not keep pace. This led to a decrease in reimbursement rates from 63% in 1996 to 48% in 2003. For all years, Medicaid/SCHIP visits had the lowest reimbursement rates, reaching 35% in 2003. The proportion of visits from children insured by Medicaid/SCHIP also increased over the period examined. In 2003, after adjustment, charges were $792 per visit from children covered by Medicaid/SCHIP, $913 for visits from uninsured children, and $952 for visits from privately insured children. Conclusions:, Reimbursements for outpatient ED visits in the pediatric population have decreased from the period of 1996 to 2003 in all payer groups: public (Medicaid/SCHIP), private, and the uninsured. Medicaid/SCHIP has consistently paid less per visit than the privately insured and the uninsured. Further research on the effects of these declining reimbursements on the financial viability of ED services for children is warranted. 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