From Charity to Economics in Health Care

Author: Richard L. Johnson and Everett A. Johnson, PhD

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From Charity to Economics in Health Care

Two long-time practitioners and observers of health care management provide a detailed and compelling account of how the health care field moved from what they call the Charitable Era, through the Technological Era, into the present Economical Era. In illuminating the very real dangers that this new era poses for providers, patients, and payers alike, the authors make a convincing argument for new paths of cooperation and collaboration for all involved parties.

186 Pages © 2000

Table of Contents

Part A
Prologue-Health Care: A Century of Change

Chapter 1
A Time for Reflection

• The Charitable Era
• Cost Reimbursement Arrives
• The Technological Era
• Rise of Deductibles
• Discounts Off Of Billed Charges
• The Gate Keeper Model
• Economic Era Begins
• The Revolution
• Physician Reactions
• Hospital's View
• Prepayment View
• The Result
  
  

Chapter 2
The Horse and Buggy Days

• Major Factors
• Surplus Beds
• Growth of Managed Care
• The Fork in the Road
• Coping with Decline
• Managed Care Strategies
• The Next Step
• The For-Profit Model?
• An Alternative
• Another Possibility
• Lessons To Be Leaned
• Making the Right Choice
  
  

Chapter 3
Getting to Tomorrow

• On the Horizon
• The Not-for-Profit Hospital's View
• Antitrust Considerations
• Regulation by a Utility Commission
• Main Street or Wall Street
• Additional Concerns
• Developing an Effective Response
  
  

Chapter 4
The Chess Game in Health Care

• The New Equation
• A Growing Fear
• The Next Stage
• Provider Responsibility
• Need for a New Structure
• Create a Not-for-Profit Foundation
• Develop a Quality Foundation
• Organizing a Quality Foundation
• Costs of Operation
• Looking Ahead
  
  

Chapter 5
Disappearing Bottom Line

• Trends At Work
• The Past
• Cost Reimbursement Disappears
• The Tax Difference
• Other Differences
• Looking Ahead
• The Key
• The Boundary Line
• The Problem
• The Real Difference
• Ethical Values
• The Overriding Problem
  
  

Chapter 6
Defining Charity Care

• Changing Economic Conditions
• Not-for-Profit Hospital Dilemma
• Defining a Benchmark
• Maintaining Not-for-Profit Hospital Control
• Local Community Control
• A Governmental Alternative
• The Risk
  
  

Chapter 7
The Health Care Dilemma-Public Opinion vs. Realistic Medical Care

• The Current Situation
• Patient Safety
• Standards of Practice
• One-Sided Decisions
• Hospital Responses to Reverse Restraints
• Economic Issues
• Improving the Quality of Medical Care
• What's Next?
  
  

Part B
Preparing for the Future

Chapter 8
Looking Ahead to 2020

• The Driving Force
• Taking on Risk
• Controlling the Distribution System
• Public Expectations
• First Stage of Consolidation
• Fully Integrated Health Care Systems
• Competing Interests
• The Unanswered Questions
  
  

Chapter 9
Swimming with Sharks

• Is Patient Care Secondary
• Provider Only Perils
• Planning for the Future
• Selecting A Managed Care Partner
• Disadvantages of Joint Ownership
• Multiple Provider Owners
• Type of Ownership
• Critical Conditions of Ownership
• The Real Issue
  
  

Chapter 10
Leadership in Unexplored Territory

• Refocusing Leadership
• The New Era
• Coping with Physicians
• Corporate Ethical Behavior
• Management Leaders
  
  

Chapter 11
Rearranging the Deck Chairs

• The New Challenge
• Basic Building Blocks
• Product Line Organization
• Rearranging the Deck Chairs
• Committee, Council, and Position Descriptions
• Internal Organizational Structures
  
  

Chapter 12
Managing and Balancing Performance

• Performance: The Problem
• Organizational Concerns
• Characteristics of Incentives
• Structure of Incentives
• Patient Concerns
• New Dimensions
• Incentive Pay-Offs
• Data Collection
• Pricing Services
• Implementing Incentives
• Physician Incentives
• Patient Reactions
• An Organizational Approach
  
  

Chapter 13
Motivating Productivity

• Current Practice
• Providing Productivity Motivation
• Productivity Characteristics
• Elements of Productivity
• Measure of Department Productivity
• Funding of Productivity Incentives
• Eligible Positions
• Reasonable Goals
• Concluding Thoughts
  
  

Chapter 14
Educational Imperatives for Health Administration

• The Setting
• Administrative Behavior
• Administrative Judgment
• Administrative Knowledge
  
  

Chapter 15
Entrepreneurial Physicians in a Corporate Setting

• The Roots
• Those Approaching Retirement
• Funding the Solution
• Why Are Hospitals Paying Salaries?
• For-Profit Corporations in the Market
• What Mistakes Were Made?
• Physician Services and the Price Earning Ratio
• Dividing the Pie
• The Short- and Long-Term Outlook
• Lessons Learned
• Key to the Future
• Reaching the Common Goal
  
  

Chapter 16
Getting Up to Speed

• The New Era
• Improving Scheduling
• Authorizations
• Office Courtesy
• Elements of Quality of Care
• Handling of Prescriptions
• The Goal
  
  

Epilogue

• The Uncertain Future
• Unchanging Relationships
• Anticipated Trends
• Government Solutions
• Health Care Industry Solutions