All this can’t be achieved without the complete collaboration of the doctors used by the hospitals. Hospitals in the united states form company joint ventures with their own physicians (PHO – Physicians Hospital Organizations). They profit together from the execution of reforms and from the rise of productivity. It’s projected that productivity now is 40% less in the public sector than from the private one. This is a dubious quote: the individual populations are distinct (sicker people in the public sector). But even though the figure is wrong – the character is: public hospitals are less efficient.
They are less efficient because of archaic scheduling of patient-doctor appointments, laboratory tests and surgeries, because of obsolete or non invasive information systems, due to long turnaround times and due to redundant laboratory tests and medical procedures. The support – that exists in private hospitals – from additional (clinical and nonclinical) employees is absent because of complex labour rules and job descriptions imposed from the unions. The majority of the doctors have broken loyalties Hospital Urgencias Medicas between the medical schools where they teach and the a variety of hospital affiliates.
They would often overlook that the voluntary affiliates and contribute more to the esteemed ones. Public hospitals might, consequently, be well advised to hire new staff, not from medical schools, discuss risks with its physicians through joint ventures, sign contracts with pay according to productivity and put doctors in the governing boards. In general, the hospitals must shrink and re-engineer the work force. About half the funding is generally spent on labor costs in hospitals – and over 70 percent in people ones. It’s no good to reduce the work force through natural attrition, mass layoffs, or severance incentives. These are”blind”, nondiscriminating steps that influence the quality of the care offered by the hospital. When compounded by work rules, seniority systems, job name structures and skewed grievance processes – that the situation can become completely out of control.
The authorities must contribute its own part. Public hospitals cannot comply or compete with the demands of national, publicly traded HMOs with political clout and the capability to raise funds to finance hyper-sophisticated advertising. Public policy must be written to encourage”safety net” institutions. They have to be permitted to organize their own MCOs (Managed Care Organizations of individuals ), to insure patients and to advertise their services directly to groups of potential consumers. This way they’ll save the 20% commission that they are paying HMOs currently. Should they become more effective and reduce utilization, they will absorb the full benefits, rather than ceding them to contracting groups of individuals and insurance companies or to the government’s medical insurance programs. The hospitals will thus be able to construct their own networks of suppliers and discuss their risks with their physicians or with the insurance firms as best suits their aim.