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Objective. To quantify the association between obesity and somatic hospital costs and number of overall somatic hospital contacts – number of inpatient admissions, number of outpatient visits, and number of emergency department visits – based on anthropometric measurements of waist circumference (WC) and information from The National Patient Registry and The Danish Case-Mix System (DRG).

Participants. The study population consisted of two sub-samples from the Inter99 study at Research Centre for Prevention and Health in 1999–2001. One sub-sample used WC as an indicator for obesity (n=5,151), whereas the other used BMI as an indicator for obesity (n=4,048). Using WC, obesity was defined as WC > 102cm for men and > 88cm for women. Normal weight was defined as circumference < 94cm for men and < 80cm for women. Using BMI, obesity was defined as BMI > 30kg/m2, whereas individuals with BMI=18.5–24.9kg/m2 were defined as normal weight. Individuals with BMI < 18.5kg/m2 were excluded from both sub-samples.

Design. We undertook a 3-year retrospective study of the relationship between obesity and use of hospital resources. Data on hospital contacts and costs were obtained from The National Patient Registry and DRG. Analyses were performed using two-part models and Poisson regression. Outcome variables were costs and hospital contacts.

Results. This study has demonstrated that obese individuals have a greater use of hospital services and greater hospital costs compared with normal weight individuals. When using WC as an indicator for obesity, mean hospital costs were 33.8% greater among obese women and 45.3% greater among obese men in a 3-year period but the differences were not significant. When using BMI to measure obesity, obese men had significantly greater costs (57.5%) than normal weight men.

Furthermore, obese men and women (indicated byWC) had an increased number of hospital contacts compared with normal weight individuals (rate ratio 1.32, 95% CI 1.21–1.43 for men and 1.20, 95% CI 1.11–1.28 for women) including inpatient admissions, outpatient visits, and emergency department visits. The same trends were seen when obesity was indicated by BMI.

Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.

Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days, and perhaps outpatient visits or numbers of surgeries performed. This simplicity represents an extreme of aggregation, focuses the attention of the analysis entirely on the structure of the organization at the highest levels, and provides no insight into the specific services that might be provided to each patient as well as the characteristics of those patients, which might lead to specialization of their care. This process is fundamentally complex, which makes it especially difficult to model. This table-setting chapter will characterize some of the key contextual choices that must be made by researchers in this field which are then applied in subsequent chapters. The key point of this chapter will be to argue that there are very few “one size fits all” decisions in this process and thus the context of particular research objectives and questions will determine how modeling choices are made in practice. Some intuition about how these decisions have substantial implications for outcomes of measurement for hospital productivity will be provided; however, no attempt will be made to conduct a literature review of all the choices that have been made. Instead, we will suggest that new careful attention to the choices made can make future studies more effective in communicating to the communities implementing the research.

It is well recognized that hospitals do not operate in a competitive market typically observed in the economics literature, but rather alternative measures of performance must be developed. In other words, health policy analysts, managers, and decision-makers cannot rely on determining efficiency via the typical profit maximizing/cost minimizing firm but develop techniques that address the issues germane to hospital productivity. What has been presented in this book demonstrates the research in both productivity and policy that must attend to this anomaly. In this introductory section, we briefly summarize the theoretical underpinnings of this book.

Hospitals worldwide command the majority of any countries’ health care budget. Reasons for these higher costs include the aging of the population requiring more intensive health care treatments provided in hospitals, the relatively high costs of labor in this labor intensive industry and payment systems that may encourage inefficient behavior on the part of hospital managers and physicians, that have not been fully mitigated via reforms and regulations.

This study aims to analyze the influence of the dimensions of Sharia hospital service standards, religiosity commitment and trust of Muslim patients on attitudes and satisfaction, as well as the implications of loyalty.

This study was carried out by analyzing data obtained from a survey with purposive sampling techniques with 425 patients in an Indonesian-certified Sharia hospital and analyzing it using partial least squares structural equation modeling software to test the path modeling and the relationship between the instruments.

This study shows that hospital amenities, doctor’s services, nurses’ services, health-care technicalities and hospital environmental and administrative behavior affect patient satisfaction. In addition, religiosity and trust in encouraging patient attitudes determine patient satisfaction. High satisfaction points will increase loyalty to Sharia hospitals.

This study encourages managers to maximize the quality of humanist Islamic medical services and the infrastructure of comfortable facilities. In addition, hospitals need to improve their holistic atmosphere, technical services and administrative behavior so that they can become essential value for hospital marketing – the development of competence and ethical behavior of health workers through various training programs internally and externally.

This study presents the determination of Sharia hospital service standards accompanied by a commitment to religiosity and trust as a psychological perspective of Muslim patients on attitudes and satisfaction and its implications on the brand loyalty of Indonesian Sharia hospitals that have been officially certified.

This study aims to address challenges in the distribution of social donations during epidemic emergencies, focusing on issues such as uneven distribution and material stacking. The goal is to propose optimized strategies that enhance equity and efficiency in the allocation of donated resources.

Firstly, the satisfaction function is constructed from two perspectives of the designated hospital and the Red Cross. On this basis, the fairness perception level of the two is portrayed. Then, we set the time weights, and construct a multi-objective programming model by combining the resource constraints in the social donation distribution process. The combined algorithm of NSGA-II and TOPSIS is also designed for model solving. Finally, an example of social donation distribution of the Red Cross Society of China Wuhan Branch is conducted for numerical analysis.

Numerical analysis reveals that timely transmission of demand information favors a demand-oriented distribution strategy for optimal efficiency. However, in scenarios with poor demand information transmission, an equal distribution of social donations proves to be a more effective strategy. Equal distribution ensures rapid allocation while minimizing perceived unfairness at designated hospitals, ultimately improving overall satisfaction levels and emergency response effectiveness.

The findings provide practical insights for emergency response planners. These include translating the developed methods into guiding principles, establishing real-time monitoring systems, enhancing training for relevant departments, and implementing evaluation mechanisms. Practitioners can utilize this knowledge to optimize the efficiency of social donation distribution during sudden outbreaks.

The equitable distribution of social donations ensures efficient resource allocation and minimizes perceived unfairness, contributing to improved social satisfaction levels. This has broader implications for community resilience and support during emergencies.

This research contributes to the field by proposing a comprehensive model for optimizing social donation distribution in emergencies. The integration of fairness perception, time weights, and a multi-objective planning approach, along with the application of the combined algorithm of NSGA-II and TOPSIS, adds novelty and practical value to the existing literature. The study serves as a decision-making reference for enhancing emergency response theories in sudden event.

The reduction of government expenditure in the healthcare system, the difficulty of finding new sources of funding and the reduction in disposable income per capita are the most important problems of the healthcare system in Greece over the last decade. Therefore, studying the profitability of health structures is a crucial factor in making decisions about their solvency and corporate sustainability. The aim of this study is to investigate the effect of economic liquidity, debt and business size on profitability for the Greek general hospitals (GHs) during the period 2016–2018.

Financial statements (balance sheets and income statements) of 84 general hospitals (GHs), 52 public and 32 private, over a three-year period (2016–2018), were analyzed. Spearman’s Rs correlation was carried out on two samples.

The results revealed that there is a positive relationship between the investigated determinants (liquidity, size) and profitability for both public and private GHs. It was also shown that debt has a negative effect on profitability only for private GHs.

Increasing the turnover of private hospitals through interventions such as expanding private health insurance and adopting modern financial management techniques in public hospitals would have a positive effect both on profitability and the efficient use of limited resources.

These results, in conjunction with the findings of the low profitability of private hospitals and the excess liquidity of public hospitals, can shape the appropriate framework to guide hospital administrators and government policymakers.

The purpose of this paper is twofold. First, it identifies whether sustainability reporting has become an institutionalized cultural norm in the daily routines and organizational practices of Spanish public hospitals. Second, it finds out why sustainability reporting has become (or not) an institutionalized norm in the Spanish public hospital field.

To accomplish the research aims, the authors have adopted a qualitative method approach by combining two main data sources: (1) a documentary analysis of reports published by 60 Spanish public hospitals that consistently maintained their commitment to this activity over the past 10 years; and (2) a semi-structured interview with seven hospital managers and with seven participants from professional organizations.

The authors have found that sustainability reporting has not become an institutionalized practice in the Spanish public hospital setting. Based on the notion of normativity, the findings indicate that the institutional conditions that support the emergence of a norm are not met (Bebbington et al., 2012). In particular, the lack of a coherent normative framework, the absence of congruence with previous similar practices and the lack of clarity in the norm explain why a reporting norm has not emerged. Currently, the societal context has not developed an appropriate discourse around the development of sustainability reporting in the Spanish public sector.

The contribution of this research is double: (1) From a practical level, this paper contributes to the accounting literature by analyzing the development of sustainability reporting practices in the public sector; (2) According to the notion of normativity, the novelty of this paper is to explore whether a sustainability reporting norm emerges in Spanish public hospitals.

Extant research documents the cost benefits of group purchasing organizations (GPOs) to member hospitals, but understudies concerns about the market dominance of a few large GPOs and the relatively weakened buyer power of hospitals in the US healthcare product supply chain. To fill the gap in the literature, this study investigates whether GPO size and a hospital’s relative power to its GPO affect the hospital’s supply expenses, and whether and how system membership moderates the power–performance link.

For this study, we collect the panel data from various secondary sources on GPO–hospital dyads, which include the seven largest GPOs and their 2,590 unique acute care hospital members in 51 states over the period of 2009–2017. To address the endogeneity issue associated with simultaneity, we establish a one-year time lag between dependent and independent variables and analyzed the 15,527 hospital-year observations using the time-series regression with fixed-effect.

We find that a hospital’s relative power to its GPO is the most critical factor to reduce its supply cost while GPO size has no effects. We also find that a nonsystem hospital achieves greater cost savings by leveraging its relative power to its GPO while a system hospital gains no benefits.

To the best of our knowledge, this study is the first to address the paradox of GPO size and a hospital’s relative power and the moderating role of system membership for the hospital’s purchasing efficiency using a large nation-wide dataset of US hospitals–GPO dyads.