Abstract
Hospitals, like healthcare systems generally, show unwarranted variation. They turn vast amounts of resource into medical output, with the intersection being the business model; this is an ethical as well as a logical statement. The Christensen approach links a value proposition through a profit formula, and processes (the model of care) to the resources required. Business models relate to the product, processes, ownership, payment systems and strategy, but are not defined by these. Christensen suggests three archetypal models—“solution shops” (medicine as craft, in hospitals or primary care), “value-added processes” (medicine as factory production) and “facilitated networks” (users as producers). “Disruptive innovation” may not be as powerful in healthcare as other industries, nor drive care settings to networks. Metrics are lacking, but it is likely that separability of processes will be important even if hybrid models remain.
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Notes
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A revealing example: two decades (and a world economic crisis) after their start, the evaluation of European experiences in hospital reform is far from complete.
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This is essentially the idea of “consumer surplus” in economics, rather than “producer surplus”, which is closely related to profit.
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The study indicates that, in France, the introduction of DRG payment (“T2A”) meant price reductions for public hospitals and steady prices for private ones, since tariffs are based on average costs in areas where the private sector had a competitive advantage (ambulatory surgery) and already had a profit margin.
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The term intermediate care (Steiner A (2002) Intermediate care—a good thing? Age Ageing 2002, 30–S3: 33–39) describes those services related with these patients in their transition from hospital to home, as well as from medical and social dependence to functional independence, in an attempt to prevent the risk of new hospital admissions. These services play the bridging role between social and primary as well as specialized care.
References
Accenture. (2019). The Product as a Service Business Model. Outlook, Accenture’s Journal of High Performance Business. Retrieved from https://www.accenture.com/us-en/insight-outlook-buy-own-thats-yesterdays-model.
Arrow, K. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53, 941–973.
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of Multimorbidity and Implications for Health Care, Research, and Medical Education: A Cross-Sectional Study. Lancet, 380, 37–43.
Bartley, K. B., & Haney, R. (2010). Improving Access to Care, Health Outcomes, and Patient Satisfaction Are Primary Objectives for Healthcare Practices. The Journal of Cardiovascular Nursing, 25(1), 13–19.
Baumol, W., & Bowen, W. (1966). Performing Arts, the Economic Dilemma: A Study of Problems Common to Theater, Opera, Music, and Dance. New York: Twentieth Century Fund.
Bojke, C., Grašič, K., & Street, A. (2018). How Should Hospital Reimbursement Be Refined to Support Concentration of Complex Care Services? Health Economics, 27(1), e26–e38.
Busse, R., van Ginneken, E., & Normand, C. (2011). Re-examining the Cost Pressures on Health Systems. In M. McKee & J. Figueras (Eds.), Health Systems: Health, Wealth, Society and Well-being (pp. 37–61). Maidenhead: Open University Press. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0007/164383/e96159.pdf?ua=1.
Casadeus-Masanell, R., & Ricart, J. E. (2009). From Strategy to Business Models and to Tactics. Harvard Business School. Working Paper 10-036, 2009. Retrieved July 18, 2018, from https://www.hbs.edu/faculty/Publication%20Files/10-036.pdf.
Cash, E., Cash, R., & Dupilet, C. (2011). Étude sur la réactivité des établissements de santé aux incitations tarifaires, vol. 106. Drees, Série Études et Recherche.
Castano, R. (2014). Towards a Framework for Business Model Innovation in Health Care Delivery in Developing Countries. BMC Medicine, 12, 233. Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0233-z.
Castoro, C., Bertinato, L., Baccaglini, U., Drace, C. A., & McKee, M. (2007). Day Surgery: Making It Happen. Copenhagen: European Observatory on Health Systems and Policies. Policy Brief.
Christensen, C. M., & Raynor, M. E. (2003). The Innovator’s Solution. Boston: Harvard Business Review Press.
Christensen, C. M., Grossman, J. H., & Hwang, J. (2017). The Innovator’s Prescription. New York: McGraw Hill.
Cochrane, A. (1971). Effectiveness and Efficiency. Random Reflections on Health Services. London: The Nuffield Provincial Hospital Trust. Retrieved from http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/Effectiveness_and_Efficiency.pdf.
Coxa Hospital. (2019). Hospital Website. History. Retrieved March 12, 2019, from https://www.coxa.fi/en/about-coxa/history/.
Department of Health. (2016). Operational Productivity & Performance in English NHS Acute Hospitals: Unwarranted Variations. Lord Carter of Coles Independent Report for the Department of Health. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf.
Dixon, A., Robertson, R., Appleby, J., Burge, P., Devlin, N., & Magee, H. (2010). Patient Choice; How Patients Choose and How Providers Respond. London: The King’s Fund.
Eisenmann, T. R., Parker, G., & van Alstyne, M. (2006). Strategies for Two-Sided Markets. Harvard Business Review, 84(10), 92–101.
Engström, S., Foldevi, M., & Borgquist, L. (2001). Is General Practice Effective? A Systematic Literature Review. Scandinavian Journal of Primary Health Care, 19, 131–144.
Gemmel, P., Vandeale, D., & Tambeur, W. (2008). Hospital Process Orientation (HPO): The Development of a Measurement Tool. Total Quality Management and Business Excellence, 19(12), 1207–1217.
Guenther, R., & Vittori, G. (2007). The Coventry Hospital. In Sustainable Healthcare Architecture (pp. 208–216). Hoboken: John Wiley and Sons.
Ham, C., Dixon, A., & Brooke, B. (2012). Transforming the Delivery of Health and Social Care; The Case for Fundamental Change (p. ix). London: The King’s Fund.
Herzlinger, R. E. (2004). Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers. San Francisco: Jossey-Bass.
Imison, C., et al. (2008). Under One Roof: Will Polyclinics Deliver Integrated Care. London: King’s Fund.
Institute for Healthcare Improvement. (2005). Going Lean in Health Care. Cambridge: Institute for Healthcare Improvement.
Kaidar-Person, O., Swartz, E. W., Lefkowitz, M., Conigliaro, K., Fritz, N., Birne, J., et al. (2006). Shared Medical Appointments: New Concept for High-Volume Follow-Up for Bariatric Patients. Surgery for Obesity and Related Diseases, 2(5), 509–512.
Kaiser, L. S., & Lee, T. H. (2015, October 8). Turning Value-Based Health Care into a Real Business Model. Harvard Business Review.
Kirsh, S., Watts, S., Pascuzzi, K., O’Day, M. E., Davidson, D., Strauss, G., et al. (2007). Shared Medical Appointments Based on the Chronic Care Model: A Quality Improvement Project to Address the Challenges of Patients with Diabetes with High Cardiovascular Risk. Quality & Safety in Health Care, 16(5), 349–353.
Leatt, P., Baker, G. R., & Kimberley, J. R. (2006). Organization Design. In S. M. Shortell & A. D. Kaluzny (Eds.), Health Care Management. Organization Design and Behavior (p. 339). Stanford: Thomson Delmar Learning.
Lee, K. S., Chun, K. H., & Lee, J. S. (2008). Reforming the Hospital Service Structure to Improve Efficiency: Urban Hospital Specialization. Health Policy, 87(1), 41–49.
Maarse H. & Normand C. Market Competition in European Hospital Care in Rechel, B., Wright, S., Edwards, N., Dowdeswell, B., & Mckee, M. (2009). Investing in Hospitals of the Future. European Observatory on Health Systems and Policies. Observatory Studies Series No. 16
Magretta, J. (2002a). What Management Is: How It Works and Why It’s Everyone’s Business. New York: The Free Press.
Magretta, J. (2002b, May). Why Business Models Matter. Harvard Business Review.
Martin, S., Purkayastha, S., Massey, R., Paraskeva, P., Tekkis, P., Kneebone, R., et al. (2007). The Surgical Care Practitioner: A Feasible Alternative. Results of a Prospective 4-Year Audit at St Mary’s Hospital Trust, London. Annals of the Royal College of Surgeons of England, 89(1), 30–35.
Nolte, E., & McKee, M. (2008). Integration and Chronic Care: A Review. In E. Nolte & M. McKee (Eds.), Caring for People with Chronic Conditions: A Health System Perspective. Maidenhead: Open University Press.
Nolte, E., Pitchforth, E., Miani, C., & McHugh, S. (2014, December 30). The Changing Hospital Landscape. An Exploration of International Experiences. RAND Health Quarterly, 4(3), 1. eCollection.
O’Connell, T., et al. (2008). Health Services Under Siege: The Case for Clinical Process Redesign. Medical Journal of Australia, 17(Suppl. 6), 9–13.
OECD. (2017). Health at a Glance 2017: OECD Indicators – Chapter 7. Health Expenditure. Last updated 9-Oct-2017. StatLink. https://doi.org/10.1787/888933604438.
Olsson, L. E., Karlsson, J., & Ekman, I. (2006). The Integrated Care Pathway Reduced the Number of Hospital Days by Half: A Prospective Comparative Study of Patients with Acute Hip Fracture. Journal of Orthopaedic Surgery and Research, 1(3), 121.
Oosterholt, R. I., & Simonse, L. W. L. (2016). Service Pathway: A Case Study of Business Model Design in Healthcare. ServDes. Fifth Service Design and Innovation Conference. Retrieved from http://www.ep.liu.se/ecp/125/052/ecp16125052.pdf.
Oxman, A. D., & Glasziou, P. (2008). What Should Clinicians Do When Faced with Conflicting Recommendations? British Medical Journal, 337, a2530.
Pammolli, F., Riccaboni, M., Oglialoro, C., Magazzini, L., Baio, G., & Salerno, N. (2005) Medical Devices, Competitiveness and Impact on Public Health Expenditure. Florence: University of Florence. Study Prepared for the Directorate General Enterprise of the European Commission. Retrieved August 3, 2017, from http://www.cermlab.it/_documents/MD_Report.pdf.
Pan, Z. X., & Pokharel, S. (2007). Logistics in Hospitals: A Case Study of Some Singapore Hospitals. Leadership Health Services, 20(3), 195–207.
Porter, M. E., & Lee, T. H. (2018, September 5). What 21st Century Health Care Should Learn from 20th Century Business. NEJM Catalyst.
Porter, M. E., & Teisberg, E. O. (2006). Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business School Press.
Rechel, B., Wright, S., Edwards, N., Dowdeswell, B., & Mckee, M. (2009). Investing in Hospitals of the Future. European Observatory on Health Systems and Policies. Observatory Studies Series No. 16.
Rotter, T., Plishka, C. T., Adegboyega, L., Fiander, M., Harrison, E. L., Flynn, R. et al. (2017, November 3). Lean Management in Health Care: Effects on Patient Outcomes, Professional Practice, and Healthcare Systems. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD012831.
Schull, M. J., Szalai, J. P., Schwartz, B., & Redelmeier, D. A. (2001). Emergency Department Overcrowding Following Systematic Hospital Restructuring: Trends at Twenty Hospitals Over Ten Years. Academic Emergency Medicine, 8(11), 1037–1043.
Shepperd, S., Doll, H., Angus, R. M., Clarke, M. J., Iliffe, S., Kalra, L., et al. (2009). Avoiding Hospital Admission Through Provision of Hospital Care at Home: A Systematic Review and Meta-Analysis of Individual Patient Data. CMAJ, 180(2), 175–182.
Singh, D. (2008). How Can Chronic Disease Management Programmes Operate Across Care Settings and Providers? Copenhagen: WHO Regional Office for Europe. A Policy Brief.
Solumsmo, A. O., & Aslaksen, R. (2009). St. Olav’s Hospital Trondheim, Norway. In B. Rechel, J. Erskine, B. Dowdeswell, S. Wright, & M. Mckee (Eds.), Capital Investment for Health. Case Studies from Europe. European Observatory on Health Systems and Policies. Observatory Studies Series No. 18.
Starfield, B. (1994). Is Primary Care Essential? Lancet, 344, 1129–1133.
Vera, A., & Kuntz, L. (2007). Process-Based Organization Design and Hospital Efficiency. Health Care Management Review, 32(1), 55–65.
Vos, L., van Oostenbrugge, R. J., Limburg, M., van Merode, G. G., & Groothuis, S. (2009). How to Implement Process-Oriented Care. Accreditation and Quality Assurance, 14, 5–13.
Vos, L., Chalmers, S. E., Dückers, M. L. A., Groenewegen, P. P., Wagner, C., & van Merode, G. G. (2011). Towards an Organisation-Wide Process-Oriented Organisation of Care: A Literature Review. Implementation Science, 6, 8.
Waters, A. (Ed.). (2015, July 22). Best Places to Work. Health Service Journal. Retrieved July 12, 2018, from https://www.hsj.co.uk/leadership/best-places-to-work/hsj-reveals-the-best-places-to-work-in-2015/5087434.article#.VgJD8ejkJv4.
Watts, S. A., Gee, J., O’Day, M. E., Schaub, K., Lawrence, R., Aron, D., et al. (2009). Nurse Practitioner-Led Multidisciplinary Teams to Improve Chronic Illness Care: The Unique Strengths of Nurse Practitioners Applied to Shared Medical Appointments/Group Visits. The Journal of the American Association of Nurse Practitioners, 21(3), 167–172.
Winblad, U., & Ringard, Å. (2009). Meeting Rising Public Expectations: The Changing Roles of Patients and Citizens. In J. Magnussen, K. Vrangbaek, & R. B. Saltman (Eds.), Nordic Health Care Systems. Recent Reforms and Current Policy Challenges (pp. 126–150). New York: Open University Press, McGraw Hill.
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Wright, S., Durán, A. (2020). Business Models and Hospitals. In: Durán, A., Wright, S. (eds) Understanding Hospitals in Changing Health Systems. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-28172-4_4
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