Question 1
How has the healthcare industry changed (pre-1983 to post 1983)? What are the implications for BD? How has BD managed to build up an 80% market share in this market? Which many competitors bigger than BD have tried to enter without success?
In 1983 the entire health care industry was affected by the changes that the U.S government made in how to reimburse hospitals for Medicare patients (40% of all hospital patient days). So, let's see how the situation was before and after these changes.
Before 1983
Hospitals had been reimbursed for all costs incurred in serving those patients.
Hospitals were rewarded for efficiency.
The buyers at the hospitals were specialist, without purchasing skills or interests in negotiating for prices.
Distributors were making great profits and not paying enough attention to costs.
After 1983
Under the new system, the payment to a hospital was based on national and regional costs for each DRG, not on the hospital's costs. Moreover, the national and regional averages were to be updated, so that if hospitals improved their cost performance, they would be subject to stricter DRG-related payment limits.
Hospital admissions fell 4%-the largest drop on record; the average length of a patient's hospital stay fell 5% to 6.7 days, also the largest drop ever.
Multihospital chains and buying groups were formed, with the aim of increasing the hospital's bargaining and purchasing power for equipment and supplies. In 1985, about 45% of all U.S hospitals were affiliated with multihospital chains, and it was predicted that 65% would be so affiliated by 1990
Individual hospitals belong to a number of different buying groups and often switch from one group to the next.
Distributors are pressed to reduce their costs to balance the lower margins from lower prices.
A primary objective for BD in both tubes and needles was to maintain a leading market share. BD planned to combat Terumo through accelerated new product developments and annual improvements in product quality, while using its strong market share to become the lowest-cost procedure in all product segments.
The strategy of BD is to force other competitors to follow to this quality aggression, anticipating the increase of costs of all the competitors in the market, which would be easier for BD to handle due to the high market share that allowed BD to amortize the capital investment.
BD instituted a Z contract, in which prices and orders quantities were negotiated directly with hospitals but still delivered through distributors. Often Z contracts prices with large buying groups were 30% to 40% lower than list price.
...t them attain the services easily and at lower costs. In addition, these hospitals have the potential of managing effectively their cash flow. A fixed and proper payment system to the workers of the small health centers can m motivates them to avail quality services to the medical beneficiaries. Small hospitals can be able to have bonus payment in case they provide care in areas short of professional health. Hence, small hospital can implicate appropriately their method of payment. Conversely, there might be a risk possibility when it comes to accessing low amount due to the nature of the illness of the patients, the involvement of high cost of treatment amongst many other factors. In the vent that the overall health care costs are more than earlier anticipated, the hospital and the doctor shall receive less profits. This can have a negative impact on the hospital.
Supposedly, the national average occupancy rate of hospitals is lower than it should be because of rising costs of hospital care. Factors causing variations in occupancy rates are hospital size, product diversification, and urgent versus non-urgent
Many pivotal events over the last century have brought our healthcare system to where it is today. Some were indirect, such as World War II (and how it led to direct events such as medical advances that shifted focus from critical care and managing contagion to preventive medicine and health insurance as an employee benefit) and the internet (which has provided a wealth of tools and resources that were once only available to healthcare providers and has served to foster technological advancements such as Electronic Health Records and telemedicine). Others were targeted interventions, such as the Hill-Burton Act, which was enacted in 1946 and provided infrastructure dollars to healthcare facilities that agreed to provide a significant volume of free or reduced cost services to those with limited ability to pay (HRSA, 2014). Perhaps the most influential targeted event was the passage of Medicare and Medicaid programs, which was the point at which the government became the administrator for insurance programs for the poor, creating a system that would continuously grow and impact service delivery through regulatory control.
Over the last 5 years the healthcare system has begun to transform. This transformation includes a focus change to preventative care to the new health conscious consumers and the reduction of healthcare costs (PR Newswire, 2013). This change comes from the consumers of healthcare as well as new laws such as the Patient Protection and Affordable Care Act (PPACA). This has created a need for hospitals to enter in partnerships to create hospital systems such as Centura Health. These hospital systems are expanding the continuum of care to include everything from preventative care, emergency care, and finally end-of-life care. This creates a need to monitor competition and create ideation plans to increase likelihood the consumer will use Centura Health over the competitors.
Traurig, G., (2008/2009). Turmoil in the healthcare industry: what about the patients? The Americas Restructuring and Involvency Guide. Retrieved from http://www. americasrestructuring.com/08_SF/p100-106
Hospital Corporation of America (HCA). Staff Analysis Statement of Problem HCA, after following a conservative financial policy since its establishment, has entered the new decade preparing to make some changes in order to realign their financial strategy and capital structure. Since its establishment, HCA has often been used as a measure for the entire proprietary hospital industry. Is it now time for the market to realign their expectations for the industry as a whole? HCA has target goals that need to be met in order to accomplish milestones in the future.
With consolidation among hospital systems over the last few years there has been a trend toward ways to streamline processes. By having “shared services” such as laundry services, human resources and radiology and diagnostic services it’s possible to lower costs and have common processes. The advent of health care reform and the Affordable Care Act (ACA) with its Information Technology (IT) incentives has led to greater interest in risk management and IT solutions. While there was a decrease in 2012 on outsourcing IT services the finalization by the Supreme Court of the ACA and President Obama’s re-election cemented the need for an IT solution (Kutscher, 2012)
In 1997 the Clinton Administration signed into law the Balanced Budget Act. One of the key provisions of this act was reduction in Medicare payments to health care providers. The reductions threw a health care system that was essentially in equilibrium into turmoil.
Hospitals were reimbursed using a fee-for-service standard, sanctioning all insurance companies to pay the same prices for hospital services offered by different providers. Due to removing restrictions on hospital prices, hospitals now negotiate reimbursement rates for each payer, thus, causing a substantially difference in prices among payers.
As I began watching Reinventing Healthcare-A Fred Friendly Seminar (2008), I thought to myself, “man, things have changed since 2008.” And as the discussion progressed, I started to become irritated by how little had changed. The issues discussed were far-reaching, and the necessity for urgent change was a repeated theme. And yet, eight years later, health care has made changes, but many of its crucial problems still exist.
Regional Market: During the 1960’s, the hospital industry boomed with billions of dollars for hospital construction with additional funds for expansion and construction of medical schools. Government sought to reduce health care costs through cutbacks in subsidy programs and cost-control regulations. Innovations in health care delivery severely reduced the number of patients serviced by hospitals.
To comprehend our current health care system, it is important to understand the history and how health care has evolved in the United States. The healthcare system we have now didn't always exist. Believe it or not, before 1920, most people would not of known what health care coverage meant! So how did the United States turn into one of the few developed countries lacking nationwide healthcare? Understanding U.S. healthcare history will help you understand the dynamics that built the system that, we struggle with today. Furthermore, I will make conclusions on the current problems we are facing.
The diagnoses associated with the hospital stay are placed into groups requiring a similar intensity of services. The DRG reimbursement, similar to the system used by the federal Medicare program, is based on the average cost of providing services for the specific diagnosis group, regardless of how long a specific client may have actually been in the hospital. The department does adjust payments for exceptionally long stays or exceptionally high costs. It also pays hospitals for the capital costs associated with the Medicaid inpatient
...dred years ago is now equivalent to a small outpatient hospital visit. These huge advancements in medicine which save millions of lives every year are attributed to the medical industry.
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.