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Rehabilitative care is often overlooked and underfunded despite being a key component of universal health coverage, and now faces further neglect due to indirect impacts of the coronavirus disease 2019 pandemic. Policy-makers can leverage strategic purchasing approaches to make the most of available funds and maximize health gains. To implement more strategic purchasing of rehabilitation, health planners must: (i) develop and prioritize evidence-based rehabilitation service packages; (ii) use fit-for-purpose contracting and provider payment mechanisms to incentivize quality and efficient service delivery; and (iii) strengthen stewardship. This paper examines these three policy priorities by analysing their associated processes, actors and resources based on country experiences. Policy-makers will likely face several obstacles in operationalizing these policy priorities, including: inadequate accountability and coordination among sectors; limited data and research; undefined and non-standardized rehabilitation services, costs and outcomes; and inadequate availability of rehabilitative care. To overcome challenges and institute optimal strategic purchasing practices for rehabilitation, we recommend that policy-makers strengthen health sector stewardship and establish a framework for multisectoral collaboration, invest in data and research and make use of available experience from high-income settings, while creating a body of evidence from low- and middle-income settings.Les soins de réadaptation sont souvent négligés et sous-financés malgré la place essentielle qu'ils occupent dans la couverture sanitaire universelle. Aujourd'hui, ils risquent même d'être relégués au second plan à la suite des conséquences indirectes de la pandémie de maladie à coronavirus 2019. Les responsables politiques peuvent néanmoins adopter des méthodes d'achat stratégiques afin de tirer le meilleur parti des fonds disponibles et de maximiser les bénéfices pour la santé. Pour ce faire, les planificateurs sanitaires doivent: (i) développer et privilégier les programmes de réadaptation étayés par des faits; (ii) utiliser des contrats adéquats et des mécanismes de paiement des fournisseurs qui mettent en valeur la qualité et l'efficacité des prestations de services; et enfin, (iii) renforcer les activités de gestion. Le présent document se penche sur ces trois priorités politiques en analysant les processus, acteurs et ressources qui y sont associés dans différents pays. Les décideurs seront probablement confrontés à de nombreux obstacles lors de la mise en œuvre de telles politiques: un manque de responsabilisation et de coordination entre secteurs; des recherches et données limitées; une absence de normalisation et de définition claire des services, coûts et résultats; et des soins de réadaptation en pénurie. Pour relever ces défis et instaurer des pratiques d'achat stratégiques optimales en matière de réadaptation, nous leur conseillons de renforcer la gestion du secteur de la santé et d'établir un cadre de collaboration multisectorielle, d'investir dans la recherche et la collecte de données, et de s'inspirer des expériences vécues dans les régions à revenu élevé tout en récoltant un ensemble de preuves dans les régions à revenu faible et intermédiaire.La atención de rehabilitación suele pasar desapercibida y carecer de fondos a pesar de ser un componente clave de la cobertura sanitaria universal, y ahora se enfrenta a una mayor desatención debido a las repercusiones indirectas de la pandemia de la enfermedad por coronavirus de 2019. Los responsables de formular las políticas pueden aprovechar los enfoques de adquisición estratégica para sacar el máximo provecho de los fondos disponibles y maximizar los beneficios para la salud. Para aplicar una adquisición más estratégica en materia de rehabilitación, los planificadores sanitarios deben (i) desarrollar y priorizar paquetes de servicios de rehabilitación a partir de la evidencia; (ii) utilizar mecanismos de contratación y pago a proveedores adecuados para incentivar la calidad y la prestación eficiente de los servicios; y (iii) fortalecer la administración. El presente documento estudia estas tres prioridades políticas mediante el análisis de sus procesos, actores y recursos asociados, basándose en las experiencias de los países. Es probable que los responsables de formular las políticas se enfrenten a varios obstáculos a la hora de poner en práctica estas prioridades políticas, entre los que se incluyen: una responsabilidad y coordinación inadecuadas entre sectores; la limitación de los datos y la investigación; la falta de definición y estandarización de los servicios, los costes y los resultados de la rehabilitación; y la insuficiente disponibilidad de la atención de rehabilitación. Para superar los desafíos e instituir prácticas estratégicas óptimas de adquisición en materia de rehabilitación, se recomienda que los responsables de formular las políticas fortalezcan la administración del sector sanitario y establezcan un marco de colaboración multisectorial, inviertan en datos e investigación y aprovechen la experiencia disponible en entornos de ingresos altos, al tiempo que crean un conjunto de evidencias procedentes de entornos de ingresos bajos y medios.غالبًا ما يتم تجاهل الرعاية التأهيلية ولا يتم تمويلها بدرجة كافية على الرغم من أنها مكون رئيسي في التغطية الصحية العالمية، ونحن نواجه الآن إهمالاً إضافيًا بسبب التأثيرات غير المباشرة لجائحة مرض فيروس كورونا الذي ظهر عام 2019. يستطيع مقررو السياسات الاستعانة بنُهج الشراء الاستراتيجي لتحقيق أقصى استفادة من الأموال المتاحة وتعظيم المكاسب الصحية. لشراء خدمات إعادة التأهيل مع التركيز على الجانب الاستراتيجي بدرجة أكبر، يجب على مخططي الرعاية الصحية: (1) تصميم حزم لخدمات إعادة التأهيل القائمة على الأدلة ومنحها الأولوية؛ و(2) استخدام آليات تفي بالغرض فيما يتعلق بالتعاقدات وسداد مستحقات موفري الخدمات بهدف التشجيع على تقديم خدمات فعالة وذات جودة عالية؛ و(3) تعزيز الإدارة الجيدة. تتناول هذه الورقة الأولويات الثلاث للسياسة المذكورة عن طريق تحليل العمليات المرتبطة بها والجهات الفاعلة والموارد مع مراعاة تجارب كل بلد. من المحتمل أن يواجه مقررو السياسات عقبات عديدة في تفعيل أولويات السياسة المشار إليها، ويشمل ذلك: ضعف المساءلة وغياب التنسيق بين القطاعات المختلفة؛ ومحدودية البيانات والأبحاث؛ وخدمات إعادة التأهيل غير المحددة أو غير القياسية وتكاليفها ونتائجها؛ وعدم التوفر الكافي للرعاية التأهيلية. من أجل التغلب على الصعوبات وتأسيس ممارسات مُثلى لشراء خدمات إعادة التأهيل بمنظور استراتيجي، نوصي مقرري السياسات بتعزيز الإدارة الجيدة للقطاع الصحي، ووضع إطار عمل للتعاون بين القطاعات المختلفة، والاستثمار في البيانات والأبحاث والاستفادة من التجارب المتاحة للدول المرتفعة الدخل، مع إنشاء منظومة للأدلة المشتقة من الدول المنخفضة والمتوسطة الدخل.尽管康复护理已成为全民医疗保险中的重要组成部分,但仍经常被忽视并存在资金不足的问题。由于新型冠状病毒肺炎大流行的间接影响,现在康复护理面临着被进一步忽视的问题。决策制定者可以通过战略采购方法充分利用现有资金并最大限度地提高健康收益。为了实施更具战略性的康复服务采购计划,健康规划者必须:(I) 制定和优先考虑基于循证的综合康复服务;(ii) 使用量身定制的承包商和服务提供商付款机制,以激励高质量和高效的服务交付;以及 (iii) 加强管理工作。本论文基于各国的经验,通过分析各国的相关流程、参与者和资源,对三项政策的优先执行情况进行审查。政策制定者在优先执行这些政策时可能面临一些障碍,包括:部门之间的责任划分和协作不足;有限的数据和研究;未定义和非标准化的康复服务、费用和效果;以及所提供的康复护理服务不足。为了克服这些挑战和为康复服务制定最佳的战略采购实践,我们建议政策制定者加强卫生部门管理,建立多部门协作框架,投资数据开发和研究项目以及利用高收入地区的现有经验,同时在中低收入地区创建大量可用证据。.Несмотря на то что реабилитационная помощь является ключевым компонентом всеобщего охвата услугами здравоохранения, ее часто игнорируют и недостаточно финансируют. В настоящее время наблюдается дальнейшее игнорирование этой проблемы из-за косвенных последствий пандемии коронавирусной инфекции 2019 года. Лица, принимающие решения, могут задействовать стратегические подходы к закупкам, чтобы извлечь максимальную выгоду из имеющихся средств, а также получить максимальный эффект для здоровья человека. Чтобы более эффективно осуществлять стратегические закупки реабилитационных услуг, лица, занимающиеся планированием здравоохранения, должны: (i) разработать пакеты научно обоснованных реабилитационных услуг и определить их приоритетность; (ii) использовать целевые механизмы заключения договоров и оплаты поставщиков для стимулирования качества и эффективности предоставления услуг; (iii) усилить руководство. В данном документе рассматриваются данные политические приоритеты путем анализа связанных с ними процессов, действующих лиц и ресурсов на основе опыта стран. Лица, принимающие стратегические решения, скорее всего, столкнутся с рядом препятствий при реализации этих политических приоритетов, а именно: недостаточной подотчетностью и координацией между секторами, ограниченными данными и исследованиями, неопределенными и нестандартизированными реабилитационными услугами, затратами и результатами; недостаточной доступностью реабилитационной помощи. Чтобы преодолеть трудности и внедрить оптимальные методы стратегических закупок для реабилитации, авторы рекомендуют лицам, принимающим стратегические решения, усилить руководство сектором здравоохранения и создать основу для межсекторального сотрудничества, инвестировать в данные и исследования, а также использовать имеющийся опыт в странах с высоким уровнем дохода, создавая при этом совокупность фактических данных для стран с низким и средним уровнем дохода.

Given the potential benefits of Group Purchasing Organizations in cost-containment efforts for hospitals on supplies and purchased services, an important question that remains unanswered is what conditions support or hinder the utilization of GPOs by hospitals. Therefore, this study explores the relationship between GPO use by hospitals and their market and organizational characteristics. Data on hospital GPO utilization and other organizational characteristics were combined with secondary hospital market characteristics. Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between hospitals' utilization of GPO services and hospitals' organizational and market characteristics. Overall, the majority of hospitals utilized the services of GPOs. Specifically, the number of hospitals utilizing the services of GPOs increased slightly from 3290 (72.2%) in 2004 to 3337 (74.4%) in 2013. In regression analyses, hospitals utilizing the services of GPOs operated in an external environment with mixed levels of munificence, more dynamism, and less competition. Specifically, hospitals operating in a less munificent environment are more likely to utilize the services of GPOs. The study findings provide organizational decision-makers and policymakers' insights into how certain market and organizational factors influence hospital strategy choice, in this case, the use of GPOs.

Canadian hospitals participate in provincial and national procurement processes to help reduce healthcare costs. This allows for redirection of funds to direct patient care, along with creating networks, integrating services, and improving innovative solutions. To be competitive, vendors offer creative solutions and provide free or low-cost supplies to hospitals with the hope that patients will continue to purchase those items when discharged. What is not always factored into the procurement decision-making processes is the potential financial impact of the supplies required for patients when discharged from hospital services and other ethical implications of accepting free/reduced-cost supplies. This column provides some guidance for health leaders in this respect.

Purpose The aim of this work was to prioritize in a quaternary academic environment necessary elements of a replacement PACS. Methods This quality improvement work was conducted at one academic medical center and was “not regulated” by the institutional review board. Three workgroups (10-15 members each) with unique resident, fellow, and attending radiologists; IT specialists; and departmental leaders convened in 2018 to prioritize elements for a PACS replacement project, including integrated IT tools. Each workgroup met two or three times and represented one of three missions (clinical, research, and education). Six elements assigned the highest priority were distilled from each workgroup. The resulting 18 elements were condensed into survey format and distributed to all department residents, fellows, and faculty members for 5-point Likert-type prioritization stratified by mission. Data were collected over 2 weeks. Results The survey response rate was 37% (71 of 192; 17 of 44 residents, 3 of 27 fellows, and 51 of 121 faculty members). Self-reported work effort was 63 ± 26% clinical, 14 ± 11% education, 15 ± 21% research, and 8 ± 14% administration. Aggregate priority ratings across all domains were highest for “stable system with predictable behavior” (mean, 4.51), “minimizes repetitive non-value-added work” (mean, 4.40), “interoperability” (mean, 4.12), and “near-instantaneous load times” (mean, 4.07). Clinical-specific ratings for these elements were even higher (means, 4.85-4.90). The lowest aggregate scores were mobile device compatibility (mean, 3.03), connectivity to nonaffiliated sites (mean, 3.01), and integrated instant messaging (mean, 2.87). Conclusions The department prioritized a stable and interoperable system that minimized non-value-added work. In other words, participants wanted a functioning PACS. PACS vendors should prioritize a reliable experience over niche add-ons.

We present the different steps for procurement of a dose management system for a university hospital, starting from the Europe-wide request for proposals, the product presentations by the suppliers and the final decision. For a project of this size, it is advisable to involve external consultants, especially for preparation of the system specifications and the calculation of the total cost of ownership (TCO). Use cases were of special interest in assessing the functionality of the different systems. Following the product presentations some changes were made concerning the system specifications and minimum requirements. Qualified users like medical physics experts, radiologists and technicians as well as users from generic quality management should form the team for evaluation and final product decision.Von der europaweiten Ausschreibung, über die Anbieterpräsentation bis zur endgültigen Produktwahl werden die verschiedenen Schritte für die Einführung eines Dosismanagementsystems an einer Universitätsklinik beschrieben. Für ein Projekt dieser Größenordnung ist das Hinzuziehen von externen Beratern insbesondere für die Erstellung des Pflichtenheftes und der Bewertung der Gesamtkosten angeraten. Besonderer Wert wurde dabei auf die Use-Cases und die Bewertungsschemata gelegt. Die im Nachgang der Produktpräsentationen durchgeführten Ergänzungen bei Pflichtenheft und Mindestanforderungen werden ebenfalls aufgeführt. Das Team für die Festlegung der Mindestanforderungen, die Bewertung der Funktionalität und die abschließende Bewertung sollte sich zusammensetzen aus den zuständigen Medizinphysik-Experten, den Hauptanwendern (Radiologen, MTA-R) und falls möglich aus den übergeordneten organisatorischen Einheiten (Stabsstellen, Qualitätsmanagement).

Through the functional combination of relevant departments involved in hospital procurement, to simplify and unify the work process, we establish a standardized procurement system, to realize the pre-procurement budget and approval, power balance, strengthen the fairness and openness of procurement process. By introducing the closed-loop process of in-process supervision to ensure the impartiality of review and post-evaluation control, it comprehensively strengthens the internal control of procurement management, and finally realizes the purpose of strengthening procurement risk prevention and procurement quality management.

Background Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. Method Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. Results The ‘Procurement process’ emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. Conclusions Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.

Medicare's Value-Based Purchasing Program (VBPP) compensates hospitals based on value of care provided. VBPP's total performance score (TPS) components data were evaluated by hospital groups: physician-owned surgical hospitals (POSH), Kaiser Hospitals, University HealthSystem Consortium Hospitals, Pioneer Accountable Care Organization Hospitals, US News and World Report Honor Roll Hospitals, and other hospitals. Multilevel random coefficient models estimated mean and significance of TPS differences from fiscal year (FY) 2015 and FY 2016, by hospital type. Overall mean TPS for 2985 hospitals decreased from 41.65 to 40.25. POSH and Kaiser Hospitals had significantly higher TPS in FY 2015 and FY 2016. POSH Patient Experience Domain scores exceeded all other Patient Experience Domain scores. The Efficiency Domain scores of Kaiser greatly exceeded the scores of all groups. Results suggest that POSH and Kaiser Hospitals provide significantly greater value of care with consistency from year to year when compared with other groups studied.

The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician–hospital arrangements, and value-based purchasing.

We present findings of a UK study into how those involved in purchasing interactive medical devices go about evaluating usability, the challenges that arise, and opportunities for improvement. The study focused on procurement of infusion devices because these are used by various professionals across healthcare. A semi-structured interview study was carried out involving a range of stakeholders (20 in total) involved in or impacted by medical device procurement. Data was analysed using thematic analysis, a qualitative method designed to support the identification, analysis and reporting of patterns. In principle, health service purchasing was found to accommodate consideration of equipment usability. In practice, the evaluation process was driven primarily by engineering standards; assessment of local needs did not accommodate substantive assessment of usability; and choice was limited by the availability of equipment on the marketplace. We discuss ways in which purchasing could be improved through techniques that account for social circumstances.

This study demonstrated the use of purchase data to determine the incidence of sharps injuries in a major tertiary referral hospital in Australia. The incidence rates of injuries per 100,000 items purchased were 2.65 and 12.60 for syringe needles and scalpel blades, respectively. These figures were lower than those reported previously using this method. The incidence rate for injuries with suture needles, which had not been reported previously, was 31.89/100,000 items purchased. Incidence data calculated in this manner may be used in conjunction with purchase cost estimates to inform policy and practices on institutional staff safety measures.

Six Sigma is used heavily in various industrial sectors, yet no noticeable applications are seen in healthcare logistics. This paper reveals the special case of healthcare logistics where cost reduction is not the only factor considered in project selection; performance and criticality of each item in the logistics system are of high importance as well. This paper provides a proposed framework to apply Six Sigma in the area of healthcare logistics. It also presents a case study implementing the proposed framework at a Jordanian hospital. In the case study, the paper reveals how the modifications of the define phase to take into consideration the criticality, cost, and performance of items make typical Six Sigma methodology very beneficial for healthcare logistics. In addition, it shows how the Six Sigma project selection can be done to deal effectively with healthcare logistics issues. This paper paves the road for research to elaborate on ways to use Six Sigma in the area of improving healthcare logistics.

This study examines the medical device industry in the context of the Fourth Industrial Revolution and identifies the key strategies and general directions for promoting this industry through analytical hierarchy process (AHP). It is based on discussions of the key issues with specialists such as doctors, medical device companies, hospital staff, professors, and government agencies in the medical device industry. A total of 18 responses were obtained from the survey, and an analysis was conducted on the results. Among the medical device strategies identified by the surveyed specialists, clarifying the application of regulations (access strategy), increasing R&amp, D investment for the technological development of medical devices (expansion strategy), and increasing support for global market expansion (infrastructure expansion strategy) were found to have the highest priority. Based on the above, we suggest key strategies and directions for promoting the medical device industry.

The emphasis on "value" within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the "Value Analysis" process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making.

Background Most hospitals outsource supply procurement to purchasing alliances, or group purchasing organizations (GPOs). Despite their early 20th century origin, we lack both national and trend data on alliance utilization, services, and performance. The topic is important as alliances help hospitals control costs, enjoy tailwinds from affiliated regional/local alliances, and face headwinds from hospital self-contracting and criticism of certain business practices. Purpose We compare the utilization, services, and performance of alliances in 2004 and 2014. Approach We analyze alliances using two comparable surveys of hospitals. We use significance tests to assess changes in alliance utilization, services, and performance (e.g., cost savings). We also assess the use of regional/local alliances affiliated with national GPOs. Results Purchasing through national alliances has somewhat diminished. Over 10 years, hospitals have diversified GPO memberships to include regional/local alliances (many affiliated with their national GPO) and engaged in self-contracting. At the same time, hospitals have increased purchases of many categories of supplies/services through national GPOs and endorsed their value-added functions and increasingly important role. Hospitals report greater satisfaction with several GPO functions; performance on most dimensions has not changed. Conclusions National alliances still play important roles that hospitals find valuable. Practice implications Purchasing alliances continue to play an important role in helping hospitals with both cost savings and new services. Their growing complexity, along with growing use of self-contracting, poses managerial challenges for hospital purchasing staff that may require greater hospital investment.

Background Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. Methods It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president’s site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10. Results Findings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes. Conclusions It seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.

Usability should be considered already by the procuring organizations when selecting future systems. In this paper, we present a framework for usability evaluation during electronic health record (EHR) system procurement. We describe the objectives of the evaluation, the procedure, selected usability attributes and the evaluation methods to measure them. We also present the emphasis usability had in the selection process. We do not elaborate on the details of the results, the application of methods or gathering of data. Instead we focus on the components of the framework to inform and give an example to other similar procurement projects.

The existing ProCure21+ (P21+) framework deal for delivering healthcare construction projects for the NHS is due to end this September, and will be replaced by ProCure22, which could see a spend of £2 bn - £5 bn over four years. Against this backdrop, Ian Nunn ICIOB, a senior associate at multidisciplinary design, property, and construction consultancy solutions business, Pellings, reviews the different types of procurement options open to NHS Trusts, and considers their 'pros and cons'.

The Patient Protection and Affordable Care Act instituted pay-for-performance programs, including Hospital Value-Based Purchasing (HVBP), designed to encourage hospital quality and efficiency. While these programs have been evaluated with respect to their implications for care quality and financial viability, this is the first study to assess the relationship between hospitals’ cost inefficiency and their participation in the programs. We estimate a translog specification of a stochastic cost frontier with controls for participation in the HVBP program and clinical and outcome quality for California hospitals for 2012–2015. The program-participation indicators’ parameters imply that participants were more cost inefficient than their peers. Further, the estimated coefficients for summary process of care quality indexes for three health conditions (acute myocardial infarction, pneumonia, and heart failure) suggest that higher quality scores are associated with increased operating costs. The estimated coefficients for the outcome quality variables suggest that future determination of HVBP payment adjustments, which will depend solely on mortality rates as measures of clinical care quality, may not only be aligned with increasing healthcare quality but also reducing healthcare costs.

Three separate pay-for-performance programs affect the amount of Medicare payment for inpatient services to about 3,400 US hospitals. These payments are based on hospital performance on specified measures of quality of care. A growing share of Medicare hospital payments (6 percent by 2017) are dependent upon how hospitals perform under the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. In 2015 four of five hospitals subject to these programs will be penalized under one or more of them, and more than one in three major teaching hospitals will be penalized under all three. Interactions among these programs should be considered going forward, including overlap among measures and differences in scoring performance.

Hospital procurement is a crucial field for any health care system, not only for economic reasons but also for reasons related to the quality and safety of the services provided. That is why the process of procurement is, in most countries, governed by a strict legal framework and policy mechanisms. This study investigates the problems and inefficiencies associated with the procurement of medical devices in public hospitals in Cyprus and formulates empirically documented proposals for improvement. Using the Delphi method, a group of 38 experts approach the procurement system in Cyprus from different angles, achieving high rates of consensus on 35 different statements on the weaknesses and problems of the current medical device procurement system, as well as presenting proposals and recommendations for improvement. The findings are highly valuable for future policy initiatives in Cyprus in the light of the economic crisis and the expected implementation of the new General Health Insurance System (GeSY), which the Government of the Republic of Cyprus and the Troika has agreed.

Randy Uttley, MBAHA, is director of operations at Pediatrix Medical Group in Phoenix, AZ. E-mail: randall_uttley@ pediatrix.com Emerging medical equipment and technologies (“medical technology”) offer the promise of improved patient outcomes, decreased labor costs, and increased operational efficiency and capabilities. Unfortunately, the allure of such benefits often lead well-intentioned healthcare leaders to make purchasing decisions without conducting a proper assessment of the resource demands, up-front costs (including integration costs), workflow impact, reimbursement potential, and other factors needed to fully understand the value added by new medical technology. One of the prevailing tenets of healthcare economists is that the continued development and dissemination of new technologies is a primary driver of increased healthcare costs in the United States. A recent study from Rice University of Texas hospitals between 2000 and 2007 concluded that technology costs, rather than hospital market power or cost shifting to private payers to compensate for the uninsured, was the largest contributor to the growth in hospital pricing. If healthcare leaders fail to conduct thorough due diligence prior to the purchase of medical technology, organizations run the risk of adding unnecessary costs to an organization’s budget without adding significant clinical or operational value. Admittedly, it is a challenge to find the right formula to accurately calculate the projected return on investment (ROI) for medical technology, as well as to decide which technical features and capabilities are best suited to meet to an organization’s strategic needs. The goal is to find an accurate measure of the medical technology investment and return in terms of patient care and safety and organizational efficiency. This article outlines practices for making financial and strategic decisions related to general medical technology purchases, and identifies factors that impede effective technology planning and decision making. This article does not discuss decisions related to electronic health records (EHRs) ROI.

Gaining large scale success was quite common in the later period of industrialization for hospitals in China. Today, Chinese hospital management face such problems as service inefficiency, high human resources cost, and low rate of capital use. This study analyzes the refined management chain of the Wuxi No. 2 People's Hospital. This consists of six gears namely "organizational structure, clinical practice, outpatient service, medical technology, and nursing care and logistics" used to achieve maximum scale and benefits. The gears are based on "flat management system targets, chief of medical staff, centralized outpatient service, intensified medical examinations, vertical nursing management and socialized logistics". The hospital took innovative measures. The "one doctor-one patient-one clinic" was well accepted; "one dispensary" shorten the waiting time by 20 min. The 168 rear service hot line "made patients' lives easier; and a red wrist ribbon" for seriously ill patient was implemented to prioritize medical treatment. The core concepts of refined hospital management are optimizing flow process, reducing waste, improving efficiency, saving costs, and taking good care of patients as most important.

Objectives The uninterrupted supply of essential items for patient care is crucial for organizations that deliver health care. Many products central to health care are derived from natural resources such as oil and cotton, supplies of which are vulnerable to climate change and increasing global demand. The purpose of this study was to identify which items would have the greatest effect on service delivery and patient outcomes should they no longer be available. Methods Using a consensus development approach, all items bought by one hospital, over one year, were subjected to a filtering process. Criteria were developed to identify at-risk products and assess them against specific risks and opportunities. Seventy-two items were identified for assessment against a range of potential impacts on service delivery and patient outcomes, from no impact to significant impact. Clinical and non-clinical participants rated the items. Results In the category of significant impact, consensus was achieved for 20 items out of 72. There were differences of opinion between clinical and non-clinical participants in terms of significant impact in relation to 18 items, suggesting that priority over purchasing decisions may create areas of conflict. Reducing reliance on critically scarce resources and reducing demand were seen as the most important criteria in developing sustainable procurement. Conclusion The method was successful in identifying items vulnerable to supply chain interruption and should be repeated in other areas to test its ability to adapt to local priorities, and to assess how it functions in a variety of public and private settings.

Background Health information technology (HIT) certification and meaningful use are interventions encouraging the adoption of electronic health records (EHRs) in the USA. However, these initiatives also constitute a significant intervention which will change the structure of the EHR market. Objective To describe quantitatively recent changes to both the demand and supply sides of the EHR market. Materials and methods A cohort of 3447 of hospitals from the HIMSS Analytics Database (2006–10) was created. Using hospital referral regions to define the local market, we determined the percentage of hospitals using paper records, the number of vendors, and local EHR vendor competition using the Herfindahl–Hirschman Index. Changes over time were assessed using a series of regression equations and geographic information systems analyses. Results Overall, there was movement away from paper records, upward trends in the number of EHR vendors, and greater competition. However, changes differed according to hospital size and region of the country. Changes were greatest for small hospitals, whereas competition and the number of vendors did not change dramatically for large hospitals. Discussion The EHR market is changing most dramatically for those least equipped to handle broad technological transformation, which underscores the need for continued targeted support. Furthermore, wide variations across the nation indicate a continued role for states in the support of EHR utilization. Conclusion The structure of the EHR market is undergoing substantial changes as desired by the proponents and architects of HIT certification and meaningful use. However, these transformations are not uniform for all hospitals or all the country.

Background In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called “hospital autonomy” policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals’ performance, hoping to reduce government’s costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. Methods We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. Results We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals’ organization, feasibility of policy implementation, actors and stakeholders’ support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Conclusions Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result.

To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals.This is a multicenter cross-sectional study of children aged19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability. Orders for blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient.A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25).The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood.

Osteoarthritis (OA) is a chronic, degenerative disease that is highly prevalent in the population, yet the factors that affect purchasing decisions related to this condition are poorly understood. A questionnaire was developed and administered to hospital executives across North America to determine the factors that affect purchasing decisions related to OA. Thirty-four individuals participated in the survey. Clinical evidence and cost effectiveness were deemed to be the most important factors in the process of making purchasing decisions. The most important considerations for adopting new technology were whether there was sufficient evidence in the literature, followed by thoughts of key opinion leaders, and cost of intervention/device. Ongoing research is still needed, but the current study allowed us to identify some trends in the data, providing new insight on how hospital purchasing decisions are made, which could have an immediate impact on those currently involved with making these decisions.

International audience; Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders’ perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as ‘new’, ‘safe’ and ‘effective’, whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital-based health technology assessment has been developed to support decisions. However, little is known about the different perceptions of innovative medical devices among practitioners and how different perceptions may affect decision making. What does this paper add? This paper compares and understands the perceptions of two groups of health professionals concerning innovative devices in the university hospital environment. What are the implications for practitioners? Such a comparison of viewpoints could facilitate improvements in current practices and decision-making processes in local health technology assessment for these medical products.