Following efforts made in recent years to have effective mental health treatments based on evidence-based guidelines, a working-definition of a minimum level of 'adequate mental health care (AMHC)' for serious mental illness (SMI) was developed in the literature. However, little is known about racial/ethnic disparities in receipt of adequate mental health care for SMI. The objective of this study was to examine disparities among Whites and non-Whites in receiving adequate mental health care for past-year major depressive episodes (MDE). The study sample was 1,688 US youth 12 to 17 years old affected by MDE in the 2005 National Survey on Drug Use and Health. We estimated the percentages of Whites and non-Whites that received adequate mental health care for MDE and estimated the correlates of receipt of adequate mental health care for the full sample and by racial/ethnic groups. About 34 percent of the sample received adequate mental health care; but separate analyses indicate that a significantly higher proportion of Whites (36 percent) received adequate mental health care relative to non-Whites (28 percent). The odds of receiving adequate mental health care for past-year MDE for Whites were 1.5 times that of non-Whites (p = 0.01). As more adolescents of diverse racial/ethnic backgrounds are identified to access mental health Treatment services, it might be important to examine the degree to which treatment should be tailored to engage and retain specific racial/ethnic groups to get the minimum of adequate mental health care.

Drawing on stakeholder theory and Weber's distinction between formal and substantive rationality, we posit that: (1) for-profit organizations manage stakeholders in ways that result in the organization being more efficient and less socially responsible than organizations that are not as profit oriented, and (2) organizations with major corporate relationships that are not local manage stakeholders in a manner that results in the organization being more efficient and less socially responsible than organizations without such arrangements. We test these hypotheses with 1994 data on 4,705 of the nation's short-term general hospitals using two measures of hospital efficiency and four measures of social responsibility. Results confirm that for-profit hospitals and hospitals lacking local ties are managing stakeholder relationships in ways that increases the efficiency of these hospitals but decreases their social responsiveness. We conclude by speculating that organizational efficiency and social responsibility may be inversely related and then summarize some of the academic, managerial, and policy implications, with emphasis on the implications for stakeholder theory.

Complementary and alternative medicine (CAM) has emerged as a significant sector within the health care industry as patient demand has increased, as the number and diversity of providers has grown, and as more providers deliver evidence-based CAM modalities to patients. The challenges confronting health care organizations that offer CAM are both similar and dissimilar to organizations that do not offer CAM. The unique challenges will be described in a way to provide academics and health care finance practitioners with a plan to address these challenges which range from lack of third-party coverage to lack of knowledge about financing CAM among patients and providers. Not only will the unique challenges be described but the distinctive opportunities to finance CAM will be highlighted. These opportunities will be discussed from both a financial perspective and innovation perspective with the aim of providing academics and health care financial practitioners with a rationale to offer CAM to patients and get compensated for providing these services.

The purpose of this study is to develop an estimation model for health care costs and cost recovery, and evaluate service sustainability under an uncertain environment. The Palestinian National Authority's recent focus on improving financial accountability supports the need to research health care costs in the Palestinian territories. We examine data from Rafidya Hospital from 2005-2009 and use step-down allocation to distribute overhead costs. We use an ingredient approach to estimate the costs and revenues of health services, and logarithmic estimation to prospectively estimate the demand for 2011. Our results indicate that while cost recovery is generally insufficient for long-term sustainability, some services can recover their costs in the short run. Our results provide information useful for health care policy makers in setting multiple-goal policies related to health care financing in Palestine, and provide an important initiative in the estimation of health service costs.

Ever since DRG-based payment systems were first introduced in the United States in 1983, the medical community has expressed concern about the potential impact of these price control systems on the quality of care. Several research studies have examined the impact of DRG-based payment systems on the quality of care within a single state in the United States, or within a specific country. We have not identified any attempts in the literature to examine the impact of DRG-based payment systems on the quality of health care across different countries. In this article we contribute to the debate by (1) providing a unique identification of DRG adoption status for each of 35 countries, (2) refining an international case mix index, and (3) applying it to examine whether DRG-based payments impact the quality of health care across national and cultural boundaries. We find some evidence for Organization for Economic Cooperation and Development countries that, compared with non-adopters, adoption of DRG-based payment systems is associated with faster hospital case mix increases and slower quality gains with respect to patient mortality from surgical and medical misadventures.

The purpose of this study is to examine the costs related to practice transformation from the perspective of primary care organizations transitioning to become participants in Accountable Care Organizations (ACOs). We pose two research questions: 1) Will a Rural Health Clinic that participates in an Accountable Care Organization see higher or lower cost per visit, and 2) If the cost per visit is higher or lower, how large will that difference be? We analyze administrative data from a panel of over 800 Rural Health Clinics for the period 2007 - 2013 using a treatment effects approach, where a clinic's participation in an ACO is viewed as a "treatment." Since the first year that an RHC could join an ACO was 2012 and our most recent year of complete data is 2013, we restricted our analysis of the impact of participation in an ACO to include only 2012 and 2013 data. The estimates of the average treatment effect on the treated (ATET) pertain to only those RHCs that joined ACOs. The results show that those 20 sample ACO RHCs experienced an average from $15.00 to $18.61 higher cost per visit than the matching non-ACO RHCs. At this very early stage of ACO development, our results must be considered very preliminary at best. Whatever conclusions we draw from these results are intended to merely suggest what might be found once many more RHCs join ACOs. The conclusions we draw from this early analysis can lay a foundation for more analysis after data are available when more RHCs join ACOs.

The central issue in the current health care reform is cost. No health care reform can be successful without putting a rein on cost while maintaining a high quality of health care service. We believe one approach to solving the cost and quality issue is to allow patients the option to choose resources that are currently underutilized. Traditional health insurance plans offer consumers limited choice in that coverage is often denied when patients choose complementary and alternative medicine (CAM) treatments, even though the economic and social cost of treating certain conditions with alternative medicine may be more favorable than with conventional medicine. This article proposes a Dual Choice health insurance plan that would cover the cost of alternative medicines for certain medical conditions in the first stage. Should the alternative treatment turn out to be less effective, patients have the option to switch to conventional treatment in the second stage. Not only does this policy provide patients with more choices than in traditional plans, it will also likely provide significant cost savings while taking into account uncertainty regarding the effectiveness of CAM. By virtue of the wider choice offered to patients and lower cost, which is illustrated by a 2x2 effectiveness matrix, the authors think that insurance companies will be successful offering such an innovative insurance plan and will even out-compete companies offering only traditional plans. Furthermore, there will be substantial benefits that go beyond the cost savings. With both cost savings and patient welfare being central in the health care reform being proposed by the Obama administration, the dual choice plan offers considerable benefits.

Management scholars have identified several cost accounting methods that provide organizations with accurate estimates of the costs they incur in producing output. However, little is known about which of these methods are most commonly used by hospitals. This article examines the literature on the relative costs and benefits of different accounting methods and the scant literature describing which of these methods are most commonly used by hospitals. It goes on to suggest that hospitals have not adopted sophisticated cost accounting systems because characteristics of the hospital industry make the costs of doing so high and the benefits of service-level cost information relatively low. However, changes in insurance benefit design are creating incentives for patients to compare hospital prices. If these changes continue, hospitals' patient volumes and revenues may increasingly be dictated by the decisions of individual patients shopping for low-cost services and as a result, providers could see increasing pressure to set prices at levels that reflect the costs of providing care. If these changes materialize, cost accounting information will become a much more important part of hospital management than it has been in the past.

Approved medical devices frequently undergo FDA mandated post-approval studies (PAS). However, there is uncertainty as to the value of PAS in assessing the safety of medical devices and the cost of these studies to the healthcare system is unknown. Since PAS costs are funded through device manufacturers who do not share the costs with regulators, we sought to estimate the total PAS costs through interviews with a panel of experts in medical device clinical trial design in order to design a general cost model for PAS which was then applied to the FDA PAS. A total of 277 PAS were initiated between 3/1/05 through 6/30/13 and demonstrated a median cost of $2.16 million per study and an overall cost of $1.22 billion over the 8.25 years of study. While these costs are funded through manufacturers, the ultimate cost is borne by the healthcare system through the medical device costs. Given concerns regarding the informational value of PAS, the resources used to support mandated PAS may be better allocated to other approaches to assure safety.

This study focuses on how financial analysts understand the strategy of a health care company and which elements, from such a strategy perspective, they perceive as constituting the cornerstone of a health care company's business model. The empirical part of this study is based on semi-structured interviews with analysts following a large health care company listed on the Copenhagen Stock Exchange. The authors analyse how the financial analysts view strategy and value creation within the framework of a business model. Further, the authors analyze whether the characteristics emerging from a comprehensive literature review are reflected in the financial analysts' perceptions of which information is decision-relevant and important to communicate to the financial markets. Among the conclusions of the study is the importance of distinguishing between the health care companies' business model and the model by which the payment of revenues are allocated between end users and reimbursing organizations.