Treating drug-dependent patients in hospitals

Are hospital staff legally permitted to test drug-dependent patients for drugs or infectious disease without the patient's consent in order to treat the patient or to protect themselves or other patients? What should staff do with "suspicious" items in the patient's possession (drugs, credit cards in different names, firearms)? Can drug-dependent patients lawfully use illicit drugs in hospital? Who should supply and administer them?     

Medicaid reimbursement of teaching hospitals

This paper examines current Medicaid policies on the reimbursement of hospitals' medical education expenses. These policies are of interest because of the pressure on Medicaid programs to reduce expenditures. Data for the paper come mainly from two sources: a survey of Medicaid programs and a survey of teaching hospitals. Teaching hospitals receive a disproportionate share, nearly 70 percent in 1978, of Medicaid short-term hospital payments. Nevertheless, most Medicaid programs either have no explicit policies in this area or have not acted aggressively to limit reimbursement of hospitals' teaching expenses. Revenues from Medicaid are most important to public teaching hospitals. Thus, across-the-board reductions in Medicaid's reimbursement of teaching expenses would most severely affect public institutions, many of which already face cuts in their local government appropriations. Savings to Medicaid would also be short-lived, since teaching hospitals would have the incentive to reduce teaching program size and substitute reimbursable personnel (nurses and staff physicians) for residents.     

The profits of not-for-profit hospitals

This paper explores the profits of not-for-profit (NFP) hospitals and identifies the factors that determine whether such profits are adequate. A model which relates hospital charges to surpluses is used to derive NFP surplus from gross patient charges and operating costs. This is done to identify the items contributing to surpluses and to explore the dispersion of NFP surpluses. We first discuss why the literature is relatively silent on NFP profitability. We then present the model and use Tennessee hospital data to identify how its components vary by hospital type and through time. The dispersion of surpluses among NFPs is then examined. We next propose three rate of return measures of profitability and use these to relate NFP profits to select characteristics of hospitals and their environments. Several alternative profit levels of NFP are discussed, and the factors that are relevant to the issue of determining the adequate level of profit are identified. The paper ends with a plea for better data on NFP profits.     

Bypassing rural hospitals for obstetrics care

We use data from 1983 and 1988 on hospital use in Alabama to examine the decisions of rural pregnant women to bypass the nearest rural hospital providing obstetric services and seek care elsewhere. The proportion of women who made the decision to bypass the nearest rural hospital increased from 40 percent to 45 percent between 1983 and 1988, while the proportion who traveled to metropolitan areas increased from 41 percent to 68 percent. Women with resources appear to choose longer travel distances in order to use hospitals with high birth volumes and high-risk infant services, but women from counties with large Medicaid populations also more frequently bypassed nearby hospitals.     

Public hospitals on the brink: their problems and their options

This article defines the differences among public community hospitals, and examines the problems faced by those that serve primarily the poor. The article analyzes the impacts of (1) the tradition of local fiscal responsibility, (2) third-party funding arrangements, (3) public hospitals' bases of political support, and (4) problems in governance and administration. Three broad policy options for public hospitals are considered in the light of these impacts.     

A study of stranger rapists from the English high security hospitals

Abstract

Heterogeneity hinders our understanding of sexual violence; but does this problem extend to stranger rape and, if so, would the construction of homogeneous subtypes advance our understanding of this crime and aid criminal investigations and clinical practice? To answer these questions, 41 stranger rapists from the English high security hospitals were examined using version 3 of the Massachusetts Treatment Centre rapist typology (MTC:R3) and multidimensional scaling (MDS). The MTC:R3 suggested that sexual desire and opportunism were the primary motivations for these men, but that proportionately more psychopaths were violent and sadistic. In accordance with previous research, the men experienced problematic childhoods and displayed high rates of criminality and psychiatric morbidity in adulthood. However, MDS found that rapist histories and offence behaviours generally divide into sexual and violent themes. These results have important implications for theory, criminal investigations and clinical practice.     

Structural determinants of union activity in hospitals

This study uses national data from the American Hospital Association and the National Labor Relations Board in a multivariate framework to assess the impact of various structural factors on union activity in hospitals. The theoretical framework includes both management and union perspectives in evaluating (1) whether the hospital had a signed collective-bargaining contract in 1980; (2) whether a union election had been held; and (3) whether the union won the election. The results indicate that certain structural characteristics (hospital size, ownership, teaching status, and location) have had a significant impact on union activity in hospitals, while other characteristics (third-party reimbursement and area factors) have not. The results also show that prospective reimbursement has a positive impact on union activity.