Hospital Funding Research Articles

The legacy of voluntarism: Charitable funding in the early NHS

AbstractBefore 1948, approximately one‐third of the United Kingdom (UK)’s hospital beds were located in voluntary hospitals, many of which continued to benefit from the funds generated by their historic endowments. When the National Health Service (NHS) was created, the vast majority of these hospitals were taken over by the State. This paper examines the neglected question of what happened to these endowments and the role which charity continued to play in the funding of NHS hospitals more generally. It makes an explicit attempt to examine the development of hospital services in each of the UK's constituent nations and shows how the treatment of endowments and the role of charity differed between them. It also highlights the continuing importance of arguments over the ‘boundaries’ between ‘essential’ and ‘non‐essential’ forms of health service expenditure, and between the roles of the statutory and voluntary sectors more generally.

Post-COVID trends in hospital financial performance: updated data from California paint an improved but challenging picture for hospitals and commercially insured patients.

The COVID-19 pandemic caused major disruptions to the operation and financing of US acute care hospitals. Previous research has documented early effects of the COVID pandemic on hospital financial performance. This paper updates the literature with current data on utilization and financial performance for a large sample of California hospitals covering the period 2017 through the end of 2022 and the first quarter of 2023. The data show that, while hospital overall utilization has largely returned to pre-COVID levels, patient mix has changed and financial performance still lags. Hospital net income margins remain below pre-COVID levels which could trigger price increases to commercially insured patients to offset continuing post-COVID financial shortfalls.

Evaluation of Drug Management and Improvement Strategies Using the Hanlon Method in the Pharmacy Installation of Ki Ageng Selo Wirosari General Hospital, Grobogan Regency, Indonesia

Drug management in the hospital is one of the important hospital management. Its inefficiency can have a negative impact on the hospital, both medically and economically. The purpose of this study was to evaluate drug management at the pharmacy installation of Ki Ageng Selo General Hospital by using efficiency indicators and implementing improvement strategies using the Hanlon method. This study uses a descriptive design for data that is retrospective and concurrent. Data in the form of quantitative and qualitative accompanied by interviews with related parties. All stages of drug management at the Pharmacy Installation of Ki Ageng Selo General Hospital were measured for their level of efficiency using indicators from the Ministry of Health, Permenkes, and WHO, then compared with standards and described based on priority analysis of action plans using the Hanlon method. The results of the study according to the standards were: the suitability of the available drug items with the RS Formulary (92.21%), the frequency of delayed payments (5 times), the percentage of correctness between the drug and the stock card (100%), the level of drug availability (12 months), average time spent serving prescriptions to patients (non-concocted 7.7 minutes, concocted 17 minutes), percentage of prescriptions with generic drugs (84.9%). Stages of drug management that are not in accordance with standards, namely: the percentage of available capital/funds with all the funds needed (202.14%), the percentage of drug procurement funds allocation (20.17%), the percentage of expired drug value (8.1%), the number of drug items per prescription sheet (4.27). Priorities for handling problems are as follows: 1) Monitor drugs for a maximum of 6 months before the ED, 2) Increase the role of KFT in evaluating and coordinating with doctors regarding the use of drugs to avoid polypharmacy, 3) Evaluation is needed every 3 months or 6 months for budget revisions, 4) carry out an evaluation at the end of each year to determine the budget and better coordination between drug managers and hospital fund providers.

Robotic Surgery and Hospital Reimbursement.

The field of plastic surgery remains at the forefront of technological and surgical innovation. However, the promising applications of robotics in plastic surgery must be thoughtfully balanced with hospital finances and reimbursements. Robotic systems have been studied extensively across multiple surgical disciplines and across diverse health care systems. The results show that there may be equal or better patient outcomes than alternatives. In an era where fiscal responsibility in health care is a top priority, thoughtful budgeting and spending must be considered and revisited frequently to attain sustainable organizational models that ensure appropriate use of robotic technology.

Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic.

Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic.

Analysis of Hospital Emergency Department Performance Measurement with Balanced Scorecard

Emergency Department (IGD) is the face of a hospital (RS). Good hospital emergency room services will result in patient satisfaction and the community around the hospital, so that the hospital becomes an option as a health facility. The performance of a hospital emergency room needs to be assessed objectively so that continuous efforts can be made to improve services. Balanced Scorecard (BSC) assessment can be used in service assessment in organizations such as hospitals or parts of organizations such as emergency room hospitals. This study aims to determine the components in emergency room services that play the most role in achieving the performance of emergency room services that support hospital performance. This research method is a scoping review using literature studies using keywords from the Balanced Scorecard AND Hospital AND Emergency with literature search strategies from the databases Ebsco Host, Embase, Scopus, Pubmed, Proquest, and Google Scholar. The results of the study contained 6 (six) appropriate articles after screening using PRISMA 2020 Flow Diagram. BSC either independently or combined with other methods can be used as performance monitoring in the health sector both in hospitals and in one of the units such as the Emergency Installation. There are 4 perspectives, namely: finance, customers, internal business processes and growth learning, where it is found that the education factor of staff training is the most widely intervened approach that results in improving the performance of emergency rooms and hospital finances. Further research suggestion is that further research is needed to assess the other three factors in the Balanced Scorecard that will effectively improve performance in other units of RS.

Hospital COVID-19 preparedness: Are (were) we ready?

Terrorist attacks and natural disasters such as Hurricanes Katrina and Harvey have increased focus on disaster preparedness planning. Despite the attention on planning, many studies have found that hospitals in the United States are underprepared to manage extended disasters appropriately and the surge in patient volume it might bring. This study aims to profile and examine the availability of hospital capacity specifically related to COVID-19 patients, such as emergency department (ED) beds, intensive care unit (ICU) beds, temporary space setup, and ventilators. A cross-sectional retrospective study design was used to examine secondary data from the 2020 American Hospital Association (AHA) Annual Survey. A series of multivariate logistic analyses were conducted to investigate the strength of association between changes in ED beds, ICU beds, staffed beds, and temporary spaces setup, and the 3,655 hospitals' characteristics. Our results highlight that the odds of a change in ED beds are 44 percent lower for government hospitals and 54 percent for for-profit hospitals than not-for-profit hospitals. The odds of ED bed change for nonteaching hospitals were 34 percent lower compared to teaching hospitals. Small and medium hospitals have significantly lower odds (75 and 51 percent, respectively) than large hospitals. For ICU bed change, staffed bed change, and temporary spaces setup, the conclusions were consistently significant regarding the impact of hospital ownership, teaching status, and hospital size. However, temporary spaces setup differs by hospital location. The odds of change is significantly lower (OR = 0.71) in urban hospitals compared with rural hospitals, while for ED beds, the odds of change is considerably higher (OR = 1.57) in urban hospitals compared to rural hospitals. There is a need for policymakers to consider not only resource limitations that were created from supply line disruptions during the COVID-19 pandemic but also a more global assessment of the adequacy of funding and support for insurance coverage, hospital finance, and how hospitals meet the needs of the populations they serve.

Exploring healthcare authorities’ decisions to sustain or abandon a management control initiative

AbstractWe explore how a management control initiative travels across and is translated within organizations—from the decision motives for adoption or rejection to the subsequent decision motives for sustaining or abandoning the control—through the lens of diffusion theory. Our empirical case is the journey of activity‐based funding of hospitals across 21 Swedish healthcare authorities. We develop a framework in which the abandonment or sustainment of a management control is explained by the interplay between the decision motive underlying the adoption and the propensity to continuously adapt it in response to new organizational goals and circumstances. This propensity is determined by fits and misfits between organizational characteristics and properties of the control.

What factors are considered in hospital funding models? A review of the literature on health services funding in organisation for economic co-operation and development countries.

One of the most difficult challenges in healthcare involves equitable allocation of resources. Our review aimed to identify international funding models in Organisation for Economic Co-operation and Development (OECD) countries for government-funded public hospitals and evidence underpinning their efficacy, via review of the peer-reviewed and grey literature. Ovid-Medline, Ovid Embase, Scopus, and PubMed were searched for peer-reviewed literature. Advanced Google searches and targeted hand searches of relevant organisational websites identified grey literature. Inclusion criteria were: English language, published between 2011 and 2022, and that the article: (1) focused on healthcare funding; (2) reported on or identified specific factors, indexes, algorithms or formulae associated with healthcare funding; and (3) referred to countries that are members of the OECD, excluding the United States (US). For peer-reviewed literature 1189 abstracts and 35 full-texts were reviewed; six articles met the inclusion criteria. For grey literature, 2996 titles or abstracts and 37 full-texts were reviewed; five articles met the inclusion criteria. Healthcare funding arrangements employed in 15 OECD countries (Australia, Belgium, Canada, Finland, France, Germany, Israel, Italy, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and the United Kingdom [UK; specifically, England, Scotland, Wales and Northern Ireland]) were identified, but papers reported population-based funding arrangements for specific regions rather than hospital-specific models. While some models adjusted for deprivation and ethnicity factors, none of the identified documents reported on health systems that adjusted funding allocation for social determinants such as health literacy levels.

Changes in US Hospital Financial Performance During the COVID-19 Public Health Emergency

The COVID-19 public health emergency (PHE) caused substantial changes in hospital operations. The net effect of these changes on hospital financial performance is unclear. To evaluate changes in hospital financial performance before and during the COVID-19 PHE. This longitudinal within-hospital cohort analysis from 2017 to 2021 used national RAND hospital data merged with American Community Survey data. A total of 4223 short-term acute care or critical access hospitals in the US with financial data spanning 2017 to 2021 were evaluated. Financial performance during the first 2 years of the PHE. The main outcome was PHE financial distress calculated based on net operating income (operating revenue minus operating expenses). Within-hospital changes in net operating income over time were evaluated with and without COVID-19 relief funding. From henceforth, 2020/2021 means the weighted average financial performance for both calendar year 2020 and 2021. Hospitals were characterized as having new financial distress if (1) their average 2020/2021 net operating income was negative and (2) the average 2020/2021 net operating income was less than that hospital's pre-2020 net operating income. Predictors of new financial distress were evaluated using logistic regression and predictors of COVID-19 relief using 2-part models. In this sample of 4423 hospitals, 3529 (80.0%) received PHE funds during 2020/2021. A total of 846 (19.1%) were located in a census tract with more than 20% Hispanic residents. Of the total number of hospitals, 720 (16.3%) of hospitals had PHE financial distress, whereas 2047 (46.3%) had PHE financial distress after excluding COVID-19 relief funding from net operating income. The majority of hospitals (n = 3337; 74.8%) had a positive net operating income across 2020/2021, with 785 (17.8%) hospitals moving from a negative pre-2020 to a positive 2020/2021 net operating income. In adjusted analyses, hospitals treating a higher proportion of Hispanic populations were more likely to have PHE distress (adjusted odds ratio, 1.3; 95% CI, 1.1-1.6; P = .02). Median (IQR) operating margins from 2020/2021 were at an all-time high of 6.5% (0.2%-13.3%) compared with pre-2020 operating margins of 2.8% (-2.8% to 9.3%). In this cohort study of US hospitals, the large majority had positive financial performance during 2020/2021, partly due to COVID-19 relief funds. However, hospitals serving Hispanic populations had substantially worsened financial performance during 2020/2021, even after accounting for COVID-19 relief. That COVID-19 relief funding aided in operating margins reaching all-time highs indicates funding amounts may have been larger than was necessary for many hospitals. With COVID-19 relief funding ending yet COVID-19 related continuing to affect hospital expenses, ongoing monitoring of hospital financial performance is vital to ensure patients retain access to care.

Hospital financial control strategy in the COVID-19 Pandemic era

Background and purpose: The pandemic of COVID-19 is an unprecedented medical and economic challenge for healthcare system. The number of patients during pandemic of COVID-19 had a rapid growth which led to changes in services aspects that threaten financial viability of hospitals, including private hospitals. This study aims to determine the efforts of private hospitals in maintaining financial stability during the pandemic of COVID-19. Methods: A qualitative study with a multi-case design carried out in 7 (seven) private hospitals in Denpasar. Informants were obtained based on a purposive sampling approach. This study recruited 19 informants from 7 private hospitals in Denpasar. Data was collected through in-depth interviews conducted face-to-face, using the Zoom and Whatsapp applications. The data were analysed using a content analysis approach. Results: Almost all hospitals stated that their finances disrupted. Financial mitigation efforts were difficult to do, hospital preparation and responses were dependent on the hospital's financial condition and regulations that changing, and recovery efforts were not easy either because in general the community's economy has not recovered. Conclusion: Private hospital finances were experiencing disruption. Mitigation efforts were difficult to do due to the unpredictable changing regulations and policies during the pandemic. Based on the study results, it can be recommended that the hospital management needs to develop a service strategy that is able to overcome the problem of the surge in the number of patients.

Database System for Medical Record Keeping and Retrieval

The field of healthcare is producing a lot of information in the form of data and knowledge. Medical knowledge is increasing day by day. The data needs to be accessed for providing health services and for administrative, economic, and legal purposes. Most of the health sectors use a paper-based system, which due to its certain limitations can affect the quality of care. Modern medical systems observed the need for the use of medical databases. Medical Database System (MDS) is an advancing concept and is defined as a systematic collection of online-based health records in any health facility that helps to overcome the limitations of conventional paper-based systems. The problem remains in the existing methods of medical record keeping and retrieval, which are less efficient as well as accurate. Recent systems have problems in their systems, such as inaccuracies in data, inefficiencies in their workflows, and other potential security weaknesses. Thus, there is a need for a database system specifically designed for medical record keeping that can overcome these problems and can offer a reliable, secure, and efficient solution for storing and retrieving medical records. In this research, an online-based health record system is designed that can keep, manage, and retrieve medical health records. The system’s frontend, as well as backend, are designed on Microsoft Access 365. Microsoft Access 365 offers suitability in keeping medical records, cost-effectiveness, integration capabilities, user-friendly interface, and scalability which also support the objectives and requirements of our project. The system includes patient registration for reception, a questioner and data retrieval for cancer diagnosis, and a complete pharmacy system including multiple forms and ledgers as well as the reports to get the summary of data where desired. Furthermore, the system contains a login system to make it secure. Our proposed database system shows a very significant improvement over existing systems in terms of efficiency, scalability, security, retrieval capabilities, and societal impact in medical record keeping and retrieval with significant societal impacts. This system can further be improved in the future, expanding its design by including other hospital services, like laboratories, finance departments, and consultation appointments. Nowadays artificial intelligence is performing an excellent role in each domain. Implementing artificial intelligence in this database system can lead this database system to the next level.

Problems of the modernisation of 20th-century healthcare facilities based on the example of hospitals within the Lubelskie Voivodeship

Most hospitals in Poland date back to the 20th century. Due to developments in technology and medicine, these buildings need to be adapted to meet modern needs. Due to these needs and the possibility of EU funding for hospitals, modernisation has become an extremely topical subject. The aim of the research was to identify what types of modernisation work had been carried out after 2004 and to identify the main problems associated with this work. The subjects of the study were 38 hospitals from the Lubelskie Voivodeship in which various types of modernisation work had been carried out. Based on the data collected on these hospitals, interviews with selected managers and the authors' own experience of working on the modernisation of hospitals from the 20th century, seven main problems associated with the ten different modernisation works identified were distinguished. The authors formulated ten questions which can be helpful to hospital managers before embarking on building upgrades and that will help them define the main problems, objectives and a more holistic rather than fragmented approach to adapting hospitals to modern requirements.

Healthcare of the Urals in the second half of the 40s – early 50s of the XX century: problems of material and personnel support

This article is discussed the reorganization of the healthcare system after the Great Patriotic war in Urals. The main task of the system was to solve the problem of providing the population with affordable quality medical care. The changing of medical and preventive institutions network, development human resources, the specific formation of hospital bed`s network and the special formation of the hospital fund are reviewed on the base of archival documents and legal sources. It is noted that, unfortunately, a number of problems in the health care system in the postwar years could not be solved: the planned indicators of the bed network were not systematically fulfilled, which had a negative impact on hospitalization of patients and increased the mortality rate; with a general increase in the number of doctors there was a lack of narrow specialists; there was a lack of medical equipment in medical institutions and not in all institutions it was possible to use it in practice. It is noted that the medical service in cities was better than in villages and the large work was done by the government reducing asymmetry in a healthcare system. In spite of technic-material and staff shortage problems there was an intensive development of the region healthcare.

Impact of surgical complications on hospital costs and revenues: retrospective database study of Medicare claims.

Aim: To compare the length of stay, hospital costsand hospital revenues for Medicare patients with and without a subset of potentially preventable postoperative complications after major noncardiac surgery. Materials& methods: Retrospective data analysis using the Medicare Standard Analytical Files, Limited Data Set, 5% inpatient claims files for years 2016-2020. Results: In 74,103 claims selected for analysis, 71,467 claims had no complications and 2636 had one or more complications of interest. Claims with complications had significantly longer length of hospital stay (12.41 vs 3.95days, p<0.01), increased payments to the provider ($34,664 vs $16,641, p<0.01)and substantially higher estimates of provider cost ($39,357 vs $16,158, p<0.01) compared with claims without complications. This results on average in a negative difference between payments and costs for patients with complications compared with a positive difference for claims without complications (-$4693 vs $483, p<0.01). Results were consistent across three different cost estimation methods used in the study. Conclusion: Compared with patients without postoperative complications, patients developing complications stay longer in the hospital and incur increased costs that outpace the increase in received payments. Complications are therefore costly to providers and payers, may negatively impact hospital profitability, and decrease the quality of life of patients. Quality initiatives aimed at reducing complications can be immensely valuable for both improving patient outcomes and hospital finances.

Clinical prediction score for prolonged length of hospital stay in aneurysmal subarachnoid hemorrhage

BackgroundLength of stay (LOS) is an important indicator of the optimization of health services and hospital financing efficiency in aneurysmal subarachnoid hemorrhage (aSAH) patients. The purpose of this study was to develop a scoring model to predict the LOS of patients with aSAH.MethodA clinical scoring was developed based on retrospectively collected data from the cerebral aneurysm registry of the National Brain Center Hospital, Jakarta, from January 2019 to June 2022. Multivariate logistic regression was used to determine the odds ratio for risk-adjusted prolonged LOS. LOS predictors were obtained based on the regression coefficients and converted into a point score model.ResultsOf the 209 aSAH patients observed, 117 patients had prolonged LOS (> 14 days of hospital stay). A clinical score was developed with a range of 0–7 points. Four variables were chosen as predictors of prolonged LOS: the presence of high-grade aSAH (1 point), aneurysm treatment (endovascular coiling: 1 point; surgical clipping: 2 points), cardiovascular comorbidities (1 point), and hospital-acquired pneumonia (3 points). The score showed good discrimination with an area under the receiving operating characteristics curve (AUC) of 0.8183 (SE 0.0278) and a p-value for the Hosmer–Lemeshow (HL) goodness-of-fit of 0.9322.ConclusionThis simple clinical score reliably predicted prolonged LOS in aneurysmal subarachnoid hemorrhage cases and may aid clinicians in improving patient outcomes and decreasing healthcare costs.

Health care provider and hospital decision-maker perceptions and beliefs on global environmental sustainability in the operating room.

e18832 Background: Human health is intrinsically linked to the environment’s health; therefore, it is essential for the surgical oncology community, healthcare providers (HCPs) and hospital leadership alike, to incorporate environmentally sustainable practices, while continuing to provide high quality care. Hospital operating rooms (ORs) have a serious environmental impact due to a high rate of greenhouse gas (GHG) emissions, medical waste generation, and energy consumption. An evidence-based understanding of the environmental impact of ORs, as well as sustainability initiatives undertaken to decrease this impact, are crucial for generating and implementing appropriate policies and guidelines. This systematic literature review (SLR) aimed to determine the perceptions and beliefs of HCPs and decision-makers related to environmental sustainability in OR settings globally. Methods: An SLR was conducted following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Embase and PubMed searches were conducted to identify relevant studies published between January 2011 and November 2022. Results: The analysis incorporated thirty-four studies focused on the perceptions and beliefs of OR HCPs and decision-makers on sustainability initiatives. The majority of HCPs across all studies indicated a willingness to engage in these sustainability initiatives such as recycling, while noting frequent barriers that prevent participation, such as lack of awareness and education, hospital funding, facilities to carry out recycling processes, and guidance at the hospital level. One study noted that robotic and laparoscopic procedures, when compared to open procedures, generate greater quantities of waste and GHG emissions. In a survey of 400 anesthesiologists, the lack of support from the hospital and inadequate education were identified as the main barriers to OR recycling by more than 60% of respondents. Common sustainability initiatives suggested by HCPs included creating a sustainability steering committee, reducing overall OR waste via recycling and waste segregation, education and training dedicated to environmental sustainability and enforcement of rules and mandates for sustainability initiatives. Conclusions: HCPs are aware of potential opportunities to make ORs more environmentally sustainable and HCPs are willing, but not necessarily able, to participate in these efforts. Existing literature shows that HCPs have suggestions for how to minimize the environmental impact of the OR. Oncologists interested in adopting more sustainable practices can use this research as a guide for key themes and barriers to acknowledge when designing and implementing their own initiatives. More research is needed on the implementation and impact of sustainability initiatives on the environment.

Cross-tissue omics analysis discovers ten adipose genes encoding secreted proteins in obesity-related non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is a fast-growing, underdiagnosed, epidemic. We hypothesise that obesity-related inflammation compromises adipose tissue functions, preventing efficient fat storage, and thus driving ectopic fat accumulation into the liver. To identify adipose-based mechanisms and potential serum biomarker candidates (SBCs) for NAFLD, we utilise dual-tissue RNA-sequencing (RNA-seq) data in adipose tissue and liver, paired with histology-based NAFLD diagnosis, from the same individuals in a cohort of obese individuals. We first scan for genes that are differentially expressed (DE) for NAFLD in obese individuals' subcutaneous adipose tissue but not in their liver; encode proteins secreted to serum; and show preferential adipose expression. Then the identified genes are filtered to key adipose-origin NAFLD genes by best subset analysis, knockdown experiments during human preadipocyte differentiation, recombinant protein treatment experiments in human liver HepG2 cells, and genetic analysis. We discover a set of genes, including 10 SBCs, that may modulate NAFLD pathogenesis by impacting adipose tissue function. Based on best subset analysis, we further follow-up on two SBCs CCDC80 and SOD3 by knockdown in human preadipocytes and subsequent differentiation experiments, which show that they modulate crucial adipogenesis genes, LPL, SREBPF1, and LEP. We also show that treatment of the liver HepG2 cells with the CCDC80 and SOD3 recombinant proteins impacts genes related to steatosis and lipid processing, including PPARA, NFE2L2, and RNF128. Finally, utilizing the adipose NAFLD DE gene cis-regulatory variants associated with serum triglycerides (TGs) in extensive genome-wide association studies (GWASs), we demonstrate a unidirectional effect of serum TGs on NAFLD with Mendelian Randomization (MR) analysis. We also demonstrate that a single SNP regulating one of the SBC genes, rs2845885, produces a significant MR result by itself. This supports the conclusion that genetically regulated adipose expression of the NAFLD DE genes may contribute to NAFLD through changes in serum TG levels. Our results from the dual-tissue transcriptomics screening improve the understanding of obesity-related NAFLD by providing a targeted set of 10 adipose tissue-active genes as new serum biomarker candidates for the currently grossly underdiagnosed fatty liver disease. The work was supported by NIH grants R01HG010505 and R01DK132775. The Genotype-Tissue Expression (GTEx) Project was supported by the Common Fund of the Office of the Director of the National Institutes of Health, and by NCI, NHGRI, NHLBI, NIDA, NIMH, and NINDS. The KOBS study (J. P.) was supported by the Finnish Diabetes Research Foundation, Kuopio University Hospital Project grant (EVO/VTR grants 2005-2019), and the Academy of Finland grant (Contract no. 138006). This study was funded by the European Research Council under the European Union's Horizon 2020 research and innovation program (Grant No. 802825 to M. U. K.). K. H. P. was funded by the Academy of Finland (grant numbers 272376, 266286, 314383, and 335443), the Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation (grant numbers NNF10OC1013354, NNF17OC0027232, and NNF20OC0060547), Finnish Diabetes Research Foundation, Finnish Foundation for Cardiovascular Research, University of Helsinki, and Helsinki University Hospital and Government Research Funds. I. S. was funded by the Instrumentarium Science Foundation. Personal grants to U. T. A. were received from the Matti and Vappu Maukonen Foundation, Ella och Georg Ehrnrooths Stiftelse and the Finnish Foundation for Cardiovascular Research.

Identifying dimensions and components affecting the financial knowledge and skills required by hospital managers by using the phenomenological approach

Introduction: At the global level, the provision of health services even in the smallest units is complicated, and organizations providing health services are facing various challenges, including the increase in care costs and the reduction of health and treatment fund. The purpose of this research is to identify effective dimensions and components in the formation of financial knowledge and skills needed by hospital managers.&#x0D; Methods: Based on the exploratory approach, this research was conducted qualitatively through phenomenological method. In terms of the result, it is among developmental studies. Necessary analyses were done using the 7-step Colaizzi technique and with the help of Max Kyuda software. Purposive sampling method was used, and data was collected through interviews with 10 financial experts of Iranian hospitals in 1400. Then, data were analyzed, and finally, dimensions and components were extracted.&#x0D; Results: The main components in determining the financial knowledge of hospital managers included basic information related to financial flow, hospital financing system, financial management and funding, basic accounting and financial information, auditing, management accounting and evaluation, legal and regulatory frameworks in the Islamic Republic of Iran, the payment system, and financial incentives and contracts. In a nutshell, 145 key concepts were extracted.&#x0D; Conclusion: According to the results of the research, it is necessary to compile appropriate topics and develop educational resources to improve the financial knowledge and skills of hospital managers. It is necessary to prepare and formulate a suitable tool to measure knowledge and financial skills of hospital managers and determine their strengths and weaknesses for the purpose of targeted training and also as one of the requirements for the selection of hospital managers. It is recommended to periodically train the managers of the organization by holding in-service training courses.

Financial Reform and Public Good Provision: Municipal Bankruptcy Law and the Financing of Hospitals

Does financial reform improve public good provision? We examine state-level adoption of municipal bankruptcy law. After reform, municipalities’ borrowing costs decrease and bonds’ issuance increase, particularly for bonds financing hospitals; hospitals’ investments increase, particularly when using such bonds; local firms’ investment and performance increase, particularly in the construction sector. Ex ante, reform occurs earlier in states with weaker unions, stronger bondholders’ interests, and better courts. Similar factors explain congressional voting on municipal bankruptcy law. These results support the hypothesis that financial reform destroys labor union rents and expands investment, highlighting a novel spillover channel from public finance to the real economy. This paper was accepted by Victoria Ivashina, finance. Funding: This work was supported by the Baffi-CAREFIN Research Center at Bocconi. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4800 .