Health network mergers and hospital re-planning

This paper presents an integer programming formulation for the hospital re-planning problem which arises after hospital network mergers. The model finds the best re-allocation of resources among hospitals, the assignment of patients to hospitals and the service portfolio to minimize the system costs subject to quality and capacity constraints. An application in the Turkish hospital networks case is illustrated to show the implications of consolidation of health insurance funds on resource allocations and flow of patients in the system. © 2010 Operational Research Society Ltd. All rights reserved

Health Center Financial Check-Up: Prescriptions for Strengthening New York's Diagnostic and Treatment Centers

Analyzes evidence of financial distress among nonprofit health centers and contributing factors for individual centers as well as the sector. Makes recommendations for the state, philanthropic organizations, public and private payers, and health centers

The Protection of Patients Under the Clayton Act

The vast consolidation among health-care providers in the aftermath of the Affordable Care Act’s enactment has led to much debate over the benefits of mergers in the health-care industry. In 2016, the Federal Trade Commission filed motions in federal court to enjoin three hospital mergers in various parts of the country. This amounted to more challenges to hospital mergers in a single year than any year in recent history. Though two of these motions succeeded at the district court level, both were overturned on appeal, which led many to wonder what the effect of these decisions would be on future health-care mergers. While many fear that hospital mergers lead to higher prices for consumers, there are also those who contend that mergers lead to efficiencies, which allow merging parties to utilize resources more effectively, increase the quality of patient care and coordination, and potentially save lives. This Note argues that the possibility of quality-enhancing or life-saving efficiencies is worth the risk that consumers see increased prices. To allow mergers that may realize these types of efficiencies, antitrust enforcement agencies and courts must begin placing greater weight on merging parties’ efficiency arguments by easing the current standard. Additionally, in light of new research suggesting that cross-market health-care mergers, or mergers between providers in different geographic markets, affect bargaining dynamics between providers and insurers, this Note argues that parties’ relative bargaining power must be considered in agencies’ and courts’ analyses of the competitive landscape relevant to a merger

Capacity for All

Although BSCF has not completed a full-scale evaluation of all of its capacity-building work, it does have preliminary data based on early efforts and grantee interviews. This feedback alone provides the Foundation with clear evidence and options for other funders to take on capacity building using similar tactics at the field level. Key takeaways include: organizational networks are forming Perhaps the greatest benefit to field-level capacity building is the networking that reinforces the connections created. Instead of competing for limited resources, grantees are now brought together by the same funder, and under the same roof, to share their experiences around a common cause. Key to creating this type of field-level impact is first creating the space for these foundational relationships to take place. leaders are stepping up Evaluation data from BSCF's leadership development programs show that participants feel better prepared to assume high-level roles after their training, and existing senior leaders recognize a growing cadre of qualified up-and-comers with the confidence and ability to enter field-level leadership roles, even at regional and statewide levels. operational savvy is growing Technical assistance outcomes, while perhaps relatively easy to measure at the organizational level, are harder to quantify at the field level. However, conversations within both fields have shifted to reflect greater capacity and understanding in finance, management, data, technology and collaboration. For example, mergers were once thought of only as negative last-ditch options for safety net providers and domestic violence organizations. Thanks to BSCF-funded technical assistance, this opinion has changed and we continue to see more and more successful mergers among BSCF grantees and across the entire field. field leaders are more connected Leaders throughout the domestic violence field (and to some extent the community health center field as well) say that they feel more connected to their peers and have more opportunities to discuss ideas and work in collaboration. In particular, participants in the Strong Field Project report more knowledge sharing and more common language and frameworks used when discussing issues important to the field and its future

Georgia: Individual State Report - State-level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.According to the report, much of the reduction in Georgia's uninsured population can be attributed to the extensive education and outreach efforts that were carried out by a variety of nonprofit and community-based organizations. Many media organizations also played a role through various public information activities and their extensive coverage of the eligibility requirements, the process for signing up for coverage through the federal health insurance marketplace, and opportunities for obtaining consumer assistance with the enrollment process.Unlike many other states that embraced a more positive response to health reform, Georgia's state government did not engage in any formal education, public information, or outreach activities to assist eligible low-income households in connecting to the most appropriate health insurance plan for their needs and circumstances through the marketplace. The report concludes that while notable gains were made in extending health care coverage to the uninsured during the first two enrollment periods, given the size of Georgia's "coverage gap," further reductions in the state's uninsured population will likely depend on state officials crafting an alternative to Medicaid expansion acceptable to the state's political leadership

Concentration in Health Care Markets: Chronic Problems and Better Solutions

Health care providers with market power enjoy substantially more pricing freedom than monopolists in other markets, for a reason not generally recognized: US-style health insurance. Consequently, monopolies in health care cause undesirable redistribution of wealth and inefficient allocation of resources, both of which burden consumers at levels beyond those of other monopolists. The unusual costliness of monopoly power in health care markets demands far more policy attention than it has received. For starters, the health sector needs a more aggressive antitrust policy that effectively prevents the creation of new provider market power through mergers, alliances, or government immunity. An immediate need is ensuring that the formation of accountable care organizations under the Patient Protection and Affordable Care Act (PPACA), which in theory might achieve efficiencies through vertical integrations, do not primarily lead to horizontal integrations that give providers additional market power. Because antitrust policy has been so inadequate for so long in the health sector, and because it remains unlikely that courts or enforcement agencies will undo past mergers that created these powerful provider monopolies, policymakers should pursue additional strategies for contesting existing monopolies. One approach is to apply antitrust rules against “tying” arrangements so that purchasers can combat providers’ profit-enhancing practice of overcharging for large bundles of services instead of trying to exploit separately any monopolies they possess in various submarkets. Another strategy is to use antitrust or regulatory rules to prohibit anticompetitive provisions, such as “antisteering” or “most-favored-nation” clauses, in provider-insurer contracts. Policymakers could also help restore price competition in monopolized markets by enabling private payers to negotiate prices for specific provider services and encouraging insurers to expand the scope of competition — via medical tourism, for example, or configuring innovative health care delivery that bypasses many of the embedded costs in the current system. Some commentators have suggested that the provider monopoly problem is severe enough to warrant consideration of a more radical alternative: regulating provider prices. By restricting how insurers can purchase health services, the PPACA might effectuate a regulatory regime that significantly limits price and nonprice competition. However, even under the PPACA room remains for creative regulatory policies that enhance competition in health care markets and encourage better uses of our increasingly scarce health care dollars

Big business with Chinese characteristics: two paths to growth of the firm in China under reform

This paper presents a case study of two large firms which emerged from among the ranks of traditional state-owned enterprises and new entrants: Shougang (steel) and Sanjiu (pharmaceuticals). Rather than being irreconcilable with the market economy, the experience of these two firms suggests that the Chinese Communist Party and the People's Liberation Army possessed a rich legacy of organisational and motivational skills. Moreover, Shougang and Sanjiu both grew rapidly through mergers and acquisitions in the absence of privatisation and a developed stock market. Furthermore, the main reason for Shougang and Sanjiu's success is not special help from the government or the army, but rather the fact that its leadership used their autonomy to construct a highly effective business organisation