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Tort costs in the United States totaled $132 billion in 1991, or 2.3% of the nation's total economic output; and medical malpractice accounted for $9.1 billion of that total, according to new data from Tillinghast, a division of Towers Perrin, New York City.

The outcome of the reform debate will have an enormous impact on the health care vendor community as well as on providers. With arguments swirling about regarding such issues as technology costs, vendors offer their views of reform.

The 1992 purchasing outlook from the Joint Purchasing Corp. (JPC), New York City, forecasts a difficult winter followed by a mild economic recovery beginning in the spring or early summer. Pharmaceuticals, however, are forecast to undergo significant price increases, due in part to hospital pharmaceutical price hikes associated with the ramifications of the 1990 Medicaid drug rebate legislation passed by Congress.

The deepening recession hasn't slowed hospital construction activity--at least not yet. While experts say health care executives should expect fewer large projects within the next two years, as the result of unpredictable sources of capital and increasing censure of hospital capital spending, for the moment hospital projects are helping to shelter some design and construction firms from the recession's fallout.

For the second year, 12 hospitals with truly exceptional information systems are highlighted in Hospitals. The Shared Data Research Second Annual Award of Excellence is presented to those institutions showing leadership in information systems management. Recognition is based on cost and performance factors. As investment in these systems grows, so does executives' interest in measuring their cost and performance. Indeed, U.S. hospitals spent more than $6.5 billion on materials services in this area in 1989. "Hospitals with the Best Information Systems" leads off our 14-page Factbook--a guide to the 1991 HIMSS Annual Conference, to be held Feb. 11-14 in San Francisco.

Intensive care units (ICUs) are challenging emergency departments as the most overcrowded hospital department. ICU medical directors may provide a solution to overcrowding through more effective ICU management. However, 30 percent of hospitals don't have around-the-clock ICU directors, burnout is common, and the position is increasingly hard to fill. Adding to the problem is a shortage of skilled ICU personnel.

It is time for hospital executives to face up to the practical implications of increased union organizing, says attorney K. Bruce Stickler. Get ready for special-interest negotiations, increased job protection demands, escalating wage and benefits costs, and more.

When planning capital improvements, it is imperative that all involved recognize the importance of flexibility of design. Long-term cost savings can be realized if hospital buildings are designed with change in mind.