Academic journal article Research in Healthcare Financial Management

A Plenitude of Research in Healthcare Financial Management

Academic journal article Research in Healthcare Financial Management

A Plenitude of Research in Healthcare Financial Management

Article excerpt

FOREWORD

This issue of RESEARCH IN HEALTHCARE MANAGEMENT (RHFM), has the most articles we have ever put together in a single issue. We debated. Should we split them up? Should we put them in separate issues? As we read, analyzed and sorted the manuscripts, we came to the conclusion that these articles belonged together. They gave this issue breadth and depth. They spanned across countries and methods, offering many different models of research in one issue. To paraphrase Rolf (1977) this issue is a "whole that is greater than the sum of its parts." To separate them from one another would do disservice to them all. Therefore, we proudly present eight articles for your examination. The articles in this issue of RHFM begin with our Best Paper Awards from the 7th Annual Meeting of the International Society for Research in Healthcare Financial Management in Baltimore, Maryland.

The Best Clinical Paper Award was bestowed upon authors Angeline Carlson, Stanley Williams and Samuel Wagner for their elegant qualitative analysis of the perceived utility of Prior Authorization (PA) programs. The authors conducted in-depth interviews of key informants in organizations, which had implemented PA programs. The consensus of the interviewees was that PA programs had, indeed, reduced the use of specific drugs and decreased overall pharmacy costs. Carlson, Williams & Wagner concluded that there has been little evaluation of PA programs and that more efforts are needed in this important area.

Stephen Magnus and his mentors, Dean Smith and John Wheeler, received the Best Student Paper Award. In this reflective piece, the authors proposed that prevailing theories about the agency role of debt may not apply in a not-for-profit hospital. A conceptual framework surrounding this important issue is presented in the article. One of the key implications is that not-for-profit managers may have a much more difficult time establishing appropriate debt levels than managers in for-profit corporations. Magnus, Smith & Wheeler recommended empirical research to test the hypotheses of their conceptual framework.

Baqar Husaini, Darren Sherkat, Robert Levine, Charles Holzer, Van Cain, Clinton Craun and Pamela Hull contributed an erudite analysis of the influence of race, gender, and mental disorder on healthcare service utilization and costs among the Medicare elderly. A large sample of Medicare recipients in Tennessee was used to see if there were any differences in these groups. Husaini, Sherkat, Levine, Holzer, Cain, Craun & Hull found that mental health diagnoses significantly impacted utilization and costs of care for all groups. Differences were found in utilization and costs for African-American and Caucasian recipients, most notably among male African-Americans. The take-away lesson for health policy is that greater attention should be given to those Medicare recipients with chronic disease and/or mental illness, and that more research is needed.

Raef Lawson set forth a case study about an HMO that developed a cost management system. Lawson shared the excitement of a great idea, planning, and the drama of culture conflict with healthcare professionals. He also shared the triumph of the achievement of a previously unattainable goal--a tool that enabled HMO managers to focus on improving the organization's decision making and its cost effectiveness. We don't want to ruin the story for you, but we will warn you, there is a twist at the end of the tale. It is compelling reading that captures the drama and messiness associated with healthcare financial management in HMOs.

Sally Stanton and Samuel Shortt examined the impact of change from fee-for-service payment to annual block funding for surgical specialty practice in five Canadian academic health centers. Stanton & Shortt obtained five years of retrospective administrative data for four discretionary surgical procedures known to be costly and commonly done. …

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