The supply of volunteer labor: the case of hospitals

Little is known about the labor market for volunteers, but even less is known about the supply of volunteers to particular industries. This article examines the supply of volunteer labor to one industry, hospitals, and the choices that volunteers make among hospitals with different ownership attributes. Survey data of volunteers at four hospitals located in Madison, Wisconsin, are used to estimate the importance of a number of factors influencing people's willingness to volunteer at hospitals. We found that job opportunities in the labor market and tax rates affect the supply of volunteers. We also found that volunteers are not indifferent to the type of hospital at which they volunteer; a federal government hospital, a nonprofit state-owned teaching hospital, and other nonprofit hospitals were not perfect substitutes in the eyes of individual volunteers in our study.     

Under wraps: prevalence of staff-patient sexual interactions on inpatient units

1. Fifty-seven percent of the hospitals with inpatient psychiatric units responded to the survey. 2. Out of these hospitals, 23% reported suspicions, 43% allegations, and 23% occurrences of staff-patient sexual interactions within the previous 2 years. 3. Neither the existence of staff educational programs, hospital size, nor ownership status were significant predictors of the number of events. 4. Patient abuse predictors must be identified.     

Wages,productivity, and costs in union and nonunion hospitals

This paper considers the effects of labor unions on the economic performance of hospitals. Two data sets are considered. The first includes 275 hospitals from 13 urban areas; the second includes 114 hospitals from Ohio. The analysis is designed to determine whether or not union-induced productivity improvements occur within the rather noncompetitive hospital market and questions whether or not there are cost differences between union and nonunion hospitals. On the question of productivity, both data sets indicate that positive effects occur in the hospital sector. The answer to the second question is less clear. The primary data set indicates that unionized hospitals actually have lower costs than their nonunion counterparts, while the Ohio sample indicates that unionized hospital costs are lower, but not significantly so. The author wishes to thank Donald R. Williams and an anonymous referee for their valuable comments.     

Fund-raising by hospital foundations

1986–87 data for eighty hospitals in Ontario and their foundations are used to assess the influence of various socioeconomic characteristics of the constituent populations and selected characteristics of the beneficiary hospitals on foundation revenue. Six factors appear to increase hospital foundation revenue: a higher percentage of the population that is elderly, a lower percentage of the population born outside Canada, a higher percentage of the population that has not moved within the past year, a larger hospital market share, teaching-status for the beneficiary hospital, and a higher level of foundation expenses.     

Principles of steam sterilization

Moist heat in the form of saturated steam under pressure, is by far the most reliable medium, known for the destruction of all forms of microbial life. Steam sterilisation, therefore, is the most economical, effective and widely used method of seeking sterilisation in hospital practice. This article aims at describing the principle mechanism that makes steam an effective destruction of micro-organisms, the equipment that is most commonly used for the purpose and the practical methods of testing for sterility. The application of these principles, it is hoped, will ensure standardisation and quality control of routine sterilisation practice in hospitals thus, contributing towards the reduction in the incidence of hospital acquired infection.     

OUTSIDE OWNERSHIP AND WORKERS' EARNINGS AND TENURE

Increasing aggregate concentration in the economy has increased attention to the issues surrounding the outside ownership of enterprises. Outside ownership entails both industrial diversification and various forms of conglomerate ownership and represents an important new direction for studies of economic sociology and labor market segmentation. The article shows that the influence of four measures of outside ownership on worker's earnings and tenure is largely, though not universally, negative. Outside ownership tends to suppress earnings otherwise accruing to workers in companies with high levels of unionization, rapid growth, and high profits. Workers' tenure is influenced negatively by some types of outside ownership but positively by others. Tenure is reduced in subsidiary firms and in industries predominately owned by other industries due to reduced union influence on job tenure in these settings. Average tenure is increased in companies that are spread across several industries. These findings provide little support for dual labor market theories and other economic theories that argue that workers benefit from the market power of their employing organizations. Instead, the findings provide support for theories that stress the dangers to workers' fates arising from the increasing dominance of financial management in economic decision making.     

Hospital pricing: cost shifting and competition

The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its profits on them will be unable to do so, at least to the same extent as it did in the past. Increased competition in health care without consideration of the uninsured will decrease the uninsured's access to care.     

Worker Ownership and Participation Enhances Economic Development in Low-Opportunity Communities

This study empirically estimates that worker ownership and participation modestly but importantly enhances the ability of firms to create ''mainstream'' employment in low-opportunity communities, both urban and rural. It is also associated with community development benefits not commonly provided by conventionally organized firms. In such forms as employee-owned firms and marketing cooperatives, worker ownership and participation should be more widely utilized in community development.     

EXIT FROM THE HOSPITAL INDUSTRY

We study the exit of hospitals from the market for inpatient services. More generous hospital reimbursement significantly reduces the probability of exit throughout the 1990s. Conditional on reimbursement levels, hospital efficiency was not a significant determinant in the early 1990s but in the mid‐ to late 1990s, less efficient hospitals were significantly more likely to exit. Throughout the period, high‐tech services increased the probability of survival, and for‐profit hospitals were more likely to exit. The role of Medicare as a determinant of exit became less important in the latter half of the 1990s. (JEL I11, L11)     

Hospital cost shifting, a continuing debate

This Issue Brief examines the evidence on hospital cost shifting. It defines cost shifting, explores the incentives facing hospitals and payers, reviews and critiques the new evidence on cost shifting, and discusses the policy concerns that arise from the new learning. Cost shifting has a precise and easily understood meaning. It does not mean that some payers pay different prices than others. Different prices are commonplace throughout the economy. Rather, cost shifting exists when the prices faced by one group of payers are higher because another group pays less. To be able to cost shift, a hospital must have market power, and it must not yet have fully exercised that power. There has been a spate of recent cost-shifting studies. The better known studies focus on industrywide, revenue-to-cost margins by payer. They find that the extent of cost shifting declined in the mid-1990's. The methods underlying these studies have been criticized in the academic literature, with the strong suggestion that the studies overstate any true cost shifting. Cross-sectional studies compared measures of prices across individual hospitals. These studies have failed to find evidence of hospital cost shifting. However, they suffer from a potential inability to control for levels of service, quality, and amenities that may simultaneously have changed as well. Dynamic studies compare individual measures of hospital prices through time and allow each hospital to serve as its own control. These studies find no evidence of hospital cost shifting. As one analysis concluded: "We found no evidence to suggest that cost-shifting strategies that might protect hospital revenues in the face of financial pressure were undertaken successfully." Rather than cost shifting, the existing evidence points to hospital competition limiting the provider's ability to raise prices. Whatever market power hospitals once enjoyed is disappearing--and with it the ability to cost shift. This research suggests that Medicare reform or Medicaid restructuring will have little direct effect on the hospital prices that employers and their workers pay for health care. The author argues that cost shifting is dead. However, the increased hospital competition necessarily squeezes hospital profits. This reduces the amount of charity care they can provide. Expect to see more and more examples of hospitals unable to provide care to nonpaying patients. This also suggests that care for the indigent will become a more pronounced public issue. This is a form of "cost" shifting, one that the "system" will need to deal with.     

Games of capacity allocation in many-to-one matching with an aftermarket

In this paper, we study many-to-one matching (hospital–intern markets) with an aftermarket. We first show that every stable matching system is manipulable via aftermarket. We then analyze the Nash equilibria of capacity allocation games, in which preferences of hospitals and interns are common knowledge and every hospital determines a quota for the regular market given its total capacity for the two matching periods. Under the intern-optimal stable matching system, we show that a pure-strategy Nash equilibrium may not exist. Common preferences for hospitals ensure the existence of equilibrium in weakly dominant strategies whereas unlike in games of capacity manipulation strong monotonicity of population is not a sufficient restriction on preferences to avoid the non-existence problem. Besides, in games of capacity allocation, it is not true either that every hospital weakly prefers a mixed-strategy Nash equilibrium to any larger regular market quota profiles.     

The impact of ownership form and regulatory measures on firm behavior: a study of hospices

This article examines differential responses to the Medicare hospice benefit across ownership types. The analysis reveals little difference in costs or quality of service among government-owned, for-profit, and nonprofit hospices. However, there are significant differences in the numbers of patients served by ownership status. The results are consistent with the hypothesis that nonprofit hospices are patient maximizers, not profit maximizers in disguise who are aiming to circumvent the nondistribution constraint. A comparison of these results with those in the hospital and nursing home industries leads to the conclusion that Medicare regulations and the predominance of Medicare revenues in an industry induce similar outcomes in cost and quality across ownership types.     

How are employees of the nonprofit sector motivated? A research need

This article reviews research on motivation of employees in the nonprofit sector, with a major emphasis on the motivation of teachers and hospital nursing staff. Although both areas are widely researched in the nonprofit sector, empirical motivation research conducted in schools and hospitals is certainly not extensive. Nevertheless, based on these limited research findings, we derive potential hypotheses for future research in schools and hospitals.     

Hospital Community Benefit in Rural Appalachia: One More Gap*

Non‐profit hospitals are important anchors in Appalachian communities, in part because of the concentration of health care dollars within these institutions. Community benefit efforts of these hospitals, therefore, have the potential to fill gaps in public health and social service provision in underserved areas with documented health disparities and access barriers. To date, however, we do not fully understand how community benefit practices vary by hospital setting. Employing hierarchical linear modeling using a multilevel mixed‐effects approach, this study analyzes data from the years 2010 to 2016 to assess community benefit practices and spending between hospitals in Appalachia and non‐Appalachian counties. Findings indicate that hospitals within Appalachian counties, and rural hospitals in this region, in particular, spent less on community benefit than hospitals, not in this region. Given the potential for community benefit to impact health outcomes and access to care, this disparity is important to state and local public health efforts and suggests the need for additional support for hospitals to engage their communities around critical health needs.     

The sequence analysis of hospitals that established social work department under fuzzy environment

This paper reviews the existing literature on hospital social work and discusses intervention strategies for improving social work practice in hospital. The objective of this study was to improve the quality of medical care. But few studies have compared social work services between different hospitals. This study describes qualitative analysis under fuzzy environment, extracts the main influencing factors and establishes a comprehensive evaluation index system. It provides comprehensive evaluation for alternative hospitals by the fuzzy clustering method. This paper proposes a new mixed fuzzy clustering algorithm on the basis of analysing the axiomatic fuzzy set (AFS) and K-means algorithm, which is not affected by some complicated parameter issues and has higher statistical validity. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is applied for selecting the best option for each cluster and a comparative analysis is done. Results from a case study in Shanghai, China, confirm that the proposed approach is effective by using information entropy to test. By comparing AFS, K-means and C-means algorithms, the hybrid algorithm can find the two closest attributes of evaluation index of hospital social work, and the proposed approach can be easily help raise the level of hospital social work service.     

Health care consolidation and the changing health care marketplace. A review of the literature and issues

This Issue Brief examines the academic literature and issues in consolidation of the hospital sector in the context of responses to changes in the competitive environment. It analyzes the motivations for consolidation as well as its effects. Hospital merger activity has increased dramatically in recent years. The current wave of mergers is primarily a reaction to a competitive environment that is placing a greater emphasis on controlling costs and forcing high-cost providers out of the market. The growth of managed care has placed considerable pressure on providers of health care and, in particular, on hospitals. The evolution of insurance companies' behavior helps explain the recent hospital consolidation movement. As managed care has become the dominant type of coverage in the last decade, insurance companies have become more active in trying to control costs--a reversion to their previous practices before the advent of managed care. Insurance companies have placed cost constraints on providers, both in the early years of health insurance and currently, when there are strong competitive forces. Hospitals claim that their primary merger motives are improving efficiency and the quality of care. The empirical evidence on this claim is mixed. Vertical integration (between suppliers and buyers of health care services, such as between hospitals and physicians) has appealed to hospitals because of their need to obtain more patients. More research is needed to explore the effects of vertical integration in the health care sector. In one of the more significant recent legal rulings, the U.S. Justice Department lost a 1997 case challenging the merger of two hospitals in the New York City metropolitan area. This, along with other recent losses by the antitrust authorities, does not bode well for the government's ability to prevent hospital mergers in metropolitan areas. It is difficult to generalize on an appropriate antitrust policy for hospital mergers. Hospital consolidation is likely to continue at a rapid pace. Since some developments may reduce the cost of employee benefits while others may increase the cost of these benefits, the final effect on the provision of health care benefits by employers is uncertain. Employers must pay close attention to the hospital consolidation movement because it will lead to important changes in the provision of health care benefits.     

The Political Economy of Employee Ownership in the United States: From Economic Democracy to Industrial Democracy?

This study examines the development of economic democracy in the United States since the 1700s with particular emphasis on the last 30 years. The particular focus is on employee ownership, although the phenomenon of profit sharing receives some attention. The nature of research and documentation on the subject is reviewed. The study concludes that research in the area has emphasized narrative studies of particular companies and sectors until the 1980s. At that time the support for the concept by the US Federal Government created reporting requirements for companies to the US Department of Labor and the US Internal Revenue Service (the taxation authority) and the US Securities and Exchange Commission. These data-sets have made systematic research on the phenomenon possible. Results of the first national random sample of employed individuals and work sites on the incidence of employee ownership and profit sharing are presented. Finally, we conduct a political economic analysis of the phenomenon. We demonstrate that, despite the growth of employee ownership in particular, a form of employee ownership has developed which encourages workers to use their savings to buy stock in their companies. This form dominates employee ownership in terms of the number of workers, firms, and dollar assets involved. Nevertheless, there is significant employee ownership in a group of closely held firms that use traditional ESOPs (Employee Stock Ownership Plans) and in a group of publicly traded high technology companies that use broad-based stock options. These two sectors offer fertile territory for the development of both economic democracy and nascent forms of industrial democracy.     

Control and participation for employees within geriatric care: does ownership make a difference?

The welfare sector in Sweden has undergone extensive changes during the last 15 years, and private and cooperative actors have entered the public market. In the light of high sick-leave rates, especially in female-dominated professions, it is important to identify factors that can help to improve the working conditions and promote health among employees. The purpose of this study was to compare how two of these factors, participation and control, are perceived by employees in three different forms of ownership: public, cooperative and private. In all, 186 employees working at seven geriatric care institutions with three ownership forms were invited to participate in the study. 82% responded to a questionnaire containing issues related to working conditions, e.g. control and participation. The one-way ANOVA and Kruskal-Wallis were used to analyse the findings among the three groups of employees working in public, cooperative or private setting. Results showed that employees in cooperatives experienced more participation than employees working in the public and private sectors in two out of four variables - employee's voice concerning work environment issues and sympathetic response from the manager and decision-making concerning work activities at large. As expected, there were no difference in perceived control between ownership forms, which might be explained by the fact that the work nature in geriatric care is rather regulated, restricted and formalized, regardless of ownership form, resulting in limited freedom over the work situation for the individual employee.     

Games of Capacity Manipulation in Hospital-intern Markets

In this paper, we analyze capacity manipulation games in hospital-intern markets inspired by the real-life entry-level labor markets for young physicians who seek residencies at hospitals. In a hospital-intern market, the matching is determined by a centralized clearinghouse using the preferences revealed by interns and hospitals and the number of vacant positions revealed by hospitals. We consider a model in which preferences of hospitals and interns are common knowledge. Hospitals play a capacity-reporting game. We analyze the equilibria of the game-form under the two most widely used matching rules: hospital-optimal and intern-optimal stable rules. We show that (i) there may not be a pure strategy equilibrium in general; and (ii) when a pure strategy equilibrium exists, every hospital weakly prefers this equilibrium outcome to the outcome of any larger capacity profile. Finally, we present conditions on preferences to guarantee the existence of pure strategy equilibria.     

The Hospital Foundation Strategy and Performance Relationship

Attracting philanthropic donations is a strategic imperative for many hospitals. A hospital can manage the giving process most effectively by developing a well‐managed hospital foundation. This study examines the hospital foundation strategy and performance relationship. Using a sample of 258 hospital foundations we identified different strategies and significant performance differences among them.