Hospital adaptation to risk-bearing: managerial implications of changes in purchaser-provider contracting.
Health Policy
; 39(3): 207-23, 1997 Mar.
Article
en En
| MEDLINE
| ID: mdl-10165462
A number of countries have adopted contracting reforms in which hospitals are placed at financial risk. This risk has stimulated a number of adaptive strategies to achieve organizational success. This paper presents a model of six forms of contracting relationships and reviews the adaptation strategies observed in three health systems: the USA, England and the Netherlands. These strategies include service diversification, improved management information systems, the employment of marketing and contract managers, the use of clinical pathways, case management and concurrent/retrospective review of hospital stays, quality management and quality assurance programs, pre-admission authorization, discharge planning, and physician profiling and participation in management. These adaptive strategies have three implications for managers: increased 'partnering', with purchasers, collaboration with medical staff, and assumption of managed care roles. Two groups of institutions are at risk from the changes in hospital contracting: university teaching hospitals and inner-city hospitals serving socially deprived populations. The paper ends with implications for the education of hospital managers and research on hospital management and adaptation to contracting.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Modelos Organizacionales
/
Servicios Contratados
/
Administración Hospitalaria
Tipo de estudio:
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
País/Región como asunto:
America do norte
/
Europa
Idioma:
En
Revista:
Health Policy
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
/
SAUDE PUBLICA
Año:
1997
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Irlanda