Changes in Hospital Efficiency after Privatization

We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped DEA efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 3.2 and 5.4%. We defined four alternative post- privatization periods and found that the increase in efficiency after a conversion to private for- profit status appeared to be permanent. We also observed an increase in efficiency one year after hospitals were converted to private non-profit status, but our estimations suggest that this effect was transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the DRG era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.Privatization, Performance measurement, Data envelopment analysis, Propensity score matching, Germany

The use of cost accounting methodologies to determine prices in German health care

In many sectors of the health care system, prices at which providers are reimbursed by payers are not determined by the market mechanism, but rather by a defined administrative process. Depending on the sector, prices are set politically and are negotiated between different actors or are calculated according to a defined procedure, considering cost data from a sample of providers. The selected approach for price setting determines decisively, to which extent prices for certain services reflect the actual costs incurred for these services. A lack of reflection of actual costs can lead to unintended incentives for providers and therefore have implications on the allocative efficiency. Our analysis shows that in Germanys inpatient and outpatient sector, cost data is increasingly considered for price setting while in other sectors such as long-term care and rehabilitation, the use of cost data is still very limited. However, DRG-cost-weights in the inpatient sector insufficiently reflect actual costs incurred. Thus, decision makers in the German health care system rely more on cost data for price setting and improving the accuracy of cost calculations in order to increase allocative efficiency. -- Die Preisbildung für die Erstattung von Leistungserbringern erfolgt in vielen Sektoren des Gesundheitswesens nicht durch den Marktmechanismus, sondern durch einen administrativ definierten Prozess. Je nach Sektor werden politische Preise vorgegeben, unter den Akteuren verhandelt oder nach einem festgelegten Verfahren, unter Berücksichtigung von Kostendaten aus einer Stichprobe von Leistungserbringern, berechnet. Das gewählte Verfahren der Preisbildung determiniert in entscheidendem Maße, inwieweit die Preise für die erbrachten Leistungen die realen Kosten der Leistungserbringer für diese abbilden. Eine mangelnde Reflektion der Kosten in den Preisen kann zu Fehlanreizen für die Leistungserbringer und mithin zu einer Fehlallokation von Ressourcen führen. Im Rahmen dieser Untersuchung zeigt sich, dass in Deutschland im stationären und ambulanten Bereich zunehmend detaillierte Kostendaten für die Preisberechnung herangezogen werden, während dies in anderen Sektoren wie Pflege und Rehabilitation bislang nur sehr bedingt erfolgt. Es zeigt sich jedoch, dass auch im stationären Sektor die DRG-Relativgewichte bislang nur unzureichend die Kosten für die entsprechenden Leistungen abbilden. Insgesamt muss in Deutschland für die Preisbildung im Gesundheitswesen mehr auf Kosteninformationen für die Preisberechnung zurückgegriffen und die Verursachungsgerechtigkeit der Kostenkalkulationen verbessert werden, um die Allokationseffizienz zu erhöhen.

Epigenetics and developmental programming of welfare and production traits in farm animals

The concept that postnatal health and development can be influenced by events that occur in utero originated from epidemiological studies in humans supported by numerous mechanistic (including epigenetic) studies in a variety of model species. Referred to as the ‘developmental origins of health and disease’ or ‘DOHaD’ hypothesis, the primary focus of large-animal studies until quite recently had been biomedical. Attention has since turned towards traits of commercial importance in farm animals. Herein we review the evidence that prenatal risk factors, including suboptimal parental nutrition, gestational stress, exposure to environmental chemicals and advanced breeding technologies, can determine traits such as postnatal growth, feed efficiency, milk yield, carcass composition, animal welfare and reproductive potential. We consider the role of epigenetic and cytoplasmic mechanisms of inheritance, and discuss implications for livestock production and future research endeavours. We conclude that although the concept is proven for several traits, issues relating to effect size, and hence commercial importance, remain. Studies have also invariably been conducted under controlled experimental conditions, frequently assessing single risk factors, thereby limiting their translational value for livestock production. We propose concerted international research efforts that consider multiple, concurrent stressors to better represent effects of contemporary animal production systems

Тhe effect of Cr substitution for Fe on ferroelectric and magnetic properties of PbFe0.5Nb0.5O3, PbFe0.5Sb0.5O3 and BiFeO3 multiferroics

Проведены диэлектрические и мессбауэровские исследования сегнетоэлектрических и магнитных фазовых переходов в твердых растворах PbFe0.5-xCrxNb0.5O3, BiFe1-xCrxO3, PbFe0.5-xCrxSb0.5O3. Во всех этих системах замещение железа хромом разрушает как сегнетоэлектрический, так и магнитный дальний порядок.PbFe0.5-xCrxNb0.5O3, BiFe1-xCrxO3, PbFe0.5-xCrxSb0.5O3 solid solutions have been carried out. In all the systems studied Cr substitution for Fe destroys both ferroelectric and magnetic long-range order.Работа выполнена при поддержке Российского Фонда Фундаментальных Исследований (грант 16-52-0072 Бел_a) и Белорусского Республиканского Фонда Фундаментальных Исследований (грант T16R-079)

Effects of Ownership on Hospital Efficiency in Germany

The objective of our study was to evaluate the efficiency of public, private for-profit, and private non-profit hospitals in Germany. First, bootstrapped data envelopment analysis (DEA) was used to evaluate the efficiency of a panel (n = 1,046) of public, private for-profit, and private non-profit hospitals between 2002 and 2006. This was followed by a second-step truncated linear regression model with bootstrapped DEA efficiency scores as dependent variable. The results show that public hospitals performed significantly better than their private for-profit and non-profit counterparts. In addition, we found a significant positive association between hospital size and efficiency, and that competitive pressure had a significant negative impact on hospital efficiency

Management im Gesundheitswesen

In Zeiten sinkender Ressourcen werden im Gesundheitswesen zunehmend kompetente Fach- und Führungskräfte im Managementbereich benötigt, die über eine interdisziplinäre Ausrichtung verfügen und mit den speziellen institutionellen Gegebenheiten des Gesundheitswesens vertraut sind. Die 2., komplett aktualisierte und ergänzte Auflage des Lehrbuches stellt alle wichtigen Aspekte des Managements von Einrichtungen im Gesundheitswesen umfassend dar. Didaktisch aufbereitet folgen alle Themenblöcke einer einheitlichen Struktur mit einer Einführung zu den gesetzlichen, strukturellen und methodischen Grundlagen. Ausführlich wird auf die speziellen Anforderungen und ihre praktische Umsetzung in den Sektoren des Gesundheitswesens eingegangen: gesetzliche und private Krankenversicherungen, Krankenhäuser, Arztpraxen und Ärztenetze, Arzneimittelindustrie und Netzwerke zur integrierten Versorgung. Plus: Fallstudien vertiefen wichtige Aspekte der praktischen Anwendung und eignen sich gut als Material für Unterricht bzw. Selbststudium.Gesundheitsleistungen - Gesundheitsmanagement - Gesundheitswesen - Leistungsmanagement