Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions.
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SUBMITTER: Cerezo-Espinosa de Los Monteros J
PROVIDER: S-EPMC8069692 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceRural hospitals are increasingly merging with other hospitals. The associations of hospital mergers with quality of care need further investigation.ObjectivesTo examine changes in quality of care for patients at rural hospitals that merged compared with those that remained independent.Design, setting, and participantsIn this case-control study, mergers at community nonrehabilitation hospitals in Federal Office of Rural Health Policy-eligible zip codes during 2009 to 2016 in 32 states were identified from Irving Levin Associates and the American Hospital Association Annual Survey. Outcomes for inpatient stays for select conditions and elective procedures were derived from the Healthcare Cost and Utilization Project State Inpatient Databases. Difference-in-differences linear probability models were used to assess premerger to postmerger changes in outcomes for patients discharged from merged vs comparison hospitals that remained independent. Data were analyzed from February to December 2020.ExposuresHospital mergers.Main outcomes and measuresThe main outcome was in-hospital mortality among patients admitted for acute myocardial infarction (AMI), heart failure, stroke, gastrointestinal hemorrhage, hip fracture, or pneumonia, as well as complications during stays for elective surgeries.ResultsA total of 172 merged hospitals and 266 comparison hospitals were analyzed. After matching, baseline patient characteristics were similar for 303 747 medical stays and 175 970 surgical stays at merged hospitals and 461 092 medical stays and 278 070 surgical stays at comparison hospitals. In-hospital mortality among AMI stays decreased from premerger to postmerger at merged hospitals (9.4% to 5.0%) and comparison hospitals (7.9% to 6.3%). Adjusting for patient, hospital, and community characteristics, the decrease in in-hospital mortality among AMI stays 1 year postmerger was 1.755 (95% CI, -2.825 to -0.685) percentage points greater at merged hospitals than at comparison hospitals (P < .001). This finding held up to 4 years postmerger (DID, -2.039 [95% CI, -3.388 to -0.691] percentage points; P = .003). Greater premerger to postmerger decreases in mortality at merged vs comparison hospitals were also observed at 5 years postmerger among stays for heart failure (DID, -0.756 [95% CI, -1.448 to -0.064] percentage points; P = .03), stroke (DID, -1.667 [95% CI, -3.050 to -0.283] percentage points; P = .02), and pneumonia (DID, -0.862 [95% CI, -1.681 to -0.042] percentage points; P = .04).Conclusions and relevanceThese findings suggest that rural hospital mergers were associated with better mortality outcomes for AMI and several other conditions. This finding is important to enhancing rural health care and reducing urban-rural disparities in quality of care.
| S-EPMC8453322 | biostudies-literature
Project description:The purpose of this research is to test the ex-post cost structure effects in horizontal mergers and acquisitions (M&A). Our proposed methodology quantifies cost structure effects empirically to inform competition policy around M&As in the airline industry. The results show that horizontal M&As involving unprofitable firms significantly reduce variable costs and increase fixed costs ex-post. M&As involving only profitable firms show no significant impact on the cost structure. We offer support that the ex-post cost structure effects of airline M&As depend on the incentives to improve efficiency, reflected in the ex-ante performance of the merging firms. We further argue that market behavior may not just depend on market structure but cost structures too, all of which should be accounted for in antitrust decision making and regulation around airline M&As.
| S-EPMC7449883 | biostudies-literature
Project description:BACKGROUND:The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited. METHODS:Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership. RESULTS:The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, -0.17 SD; 95% confidence interval [CI], -0.26 to -0.07; P = 0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (-0.10 percentage points; 95% CI, -0.53 to 0.34; P = 0.72) or in 30-day mortality (-0.03 percentage points; 95% CI, -0.20 to 0.14; P = 0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P = 0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition. CONCLUSIONS:Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.).
| S-EPMC7080214 | biostudies-literature
Project description:Understanding the fundamental mechanisms behind the complex landscape of corporate mergers and acquisitions is of crucial importance to economies across the world. Adapting ideas from the fields of complexity and evolutionary dynamics to analyse business ecosystems, we show here that ancestry, i.e. the cumulative sum of historical mergers across all ancestors, is the key characteristic to company mergers and acquisitions. We verify this by comparing an agent-based model to an extensive range of business data, covering the period from the 1830s to the present day and a range of industries and geographies. This seemingly universal mechanism leads to imbalanced business ecosystems, with the emergence of a few very large, but sluggish 'too big to fail' entities, and very small, niche entities, thereby creating a paradigm where a configuration akin to effective oligopoly or monopoly is a likely outcome for free market systems.
| S-EPMC4197467 | biostudies-literature
Project description:BackgroundDrug shortages and increasing generic drug prices are associated with low levels of competition. Mergers and acquisitions impact the level of competition. Record merger and acquisition activity was reported for the pharmaceutical sector in 2014/15, yet information on mergers and acquisitions in the generic drug sector are absent from the literature. This information is necessary to understand if and how such mergers and acquisitions can be a factor in drug shortages and increasing prices.MethodsData on completed merger and acquisition deals that had a generic drug company being taken over (i.e. 'target') were extracted from Bloomberg Finance L.P. The number and announced value of deals are presented globally, for the United States, and globally excluding the United States annually from 1995 to 2016 in United States dollars.ResultsGeneric drug companies comprised 9.3% of the value of all deals with pharmaceutical targets occurring from 1995 to 2016. Globally, in 1995 there were no deals, in 2014 there were 22 deals worth $1.86 billion, in 2015 there were 34 deals totalling $33.56 billion, and in 2016 there were 42 deals worth in excess of $44 billion. This substantial increase was partially attributed to Teva's 2016 acquisition of Allergan's generic drug business. The surge in mergers and acquisitions for 2015/16 was driven by deals in the United States, where they represented 89.7% of the dollar value of deals in those years.ConclusionsThe recent blitz in mergers and acquisitions signals that the generic drug industry is undergoing a transformation, especially in the United States. This restructuring can negatively affect the level of competition that might impact prices and shortages for some products, emphasizing the importance of updating regulations and procurement policies.
| S-EPMC5567637 | biostudies-literature
Project description:Based on the serial mergers and acquisitions(M&A) data of Chinese A-share listed companies from 2010 to 2019, this paper discusses whether there are geographical peer effects in serial M&A, and tests its mechanism and influence path. The empirical study shows that geographical peer decision-making has geographical peer effects in the decision-making of serial M&A, and the average number of serial M&A of geographical peers has a significant positive impact on the serial M&A decision-making of focal firms. Social learning and director networks are essential to produce geographical peer effects in serial M&A. The external learning mechanism shows that the geographical peer effect of serial M&A decision-making is partly caused by backward firms' social learning to the leading peer firms' decision-making, but vice versa. The director network relationship of focal firms can positively moderate the relationship between the geographical peer firms' average serial M&A decision-making and the focal firm's serial M&A decision-making. This paper reveals the mechanism of geographical peer effect in serial M&A decision-making and provides a new perspective to understand the motivation of serial M&A decision-making. These empirical findings not only provide important empirical evidence on serial M&A from developing countries such as China, but also provide a valuable reference for decision-makers and researchers of serial M&A in the future.
| S-EPMC10735032 | biostudies-literature
Project description:AbstractCommunity transmission of COVID-19 is happening in Bangladesh-the country which did not have a noteworthy health policy and legislative structures to combat a pandemic like COVID-19. Early strategic planning and groundwork for evolving and established challenges are crucial to assemble resources and react in an appropriate timely manner. This article, therefore, focuses on the public perception of comparative lockdown scenario analysis and how they may affect the sustainable development goals (SDGs) and the strategic management regime of COVID-19 pandemic in Bangladesh socio-economically as well as the implications of the withdrawal of partial lockdown plan. Scenario-based public perceptions were collected via a purposive sampling survey method through a questionnaire. Datasets were analysed through a set of statistical techniques including classical test theory, principal component analysis, hierarchical cluster analysis, Pearson's correlation matrix and linear regression analysis. There were good associations among the lockdown scenarios and response strategies to be formulated. Scenario 1 describes how the death and infection rate will increase if the Bangladesh Government withdraws the existing partial lockdown. Scenario 2 outlines that limited people's movement will enable low-level community transmission of COVID-19 with the infection and death rate will increase slowly (r = 0.540, p < 0.01). Moreover, there will be less supply of necessities of daily use with a price hike (r = 0.680, p < 0.01). In scenario 3, full lockdown will reduce community transmission and death from COVID-19 (r = 0.545, p < 0.01). However, along with the other problems gender discrimination and gender-based violence will increase rapidly (r = 0.661, p < 0.01). Due to full lockdown, the formal and informal business, economy, and education sector will be hampered severely (R = 0.695). Subsequently, there was a strong association between the loss of livelihood and the unemployment rate which will increase due to business shutdown (p < 0.01). This will lead to the severe sufferings of poor and vulnerable communities in both urban and rural areas (p < 0.01). All these will further aggravate the humanitarian needs of the most vulnerable groups in the country in the coming months to be followed which will undoubtedly affect the Bangladesh targets to achieve the SDGs of 2030 and other development plans that need to be adjusted. From our analysis, it was apparent that maintaining partial lockdown with business and economic activities with social distancing and public health guidelines is the best strategy to maintain. However, as the government withdrew the partial lockdown, inclusive and transparent risk communication towards the public should be followed. Recovery and strengthening of the health sector, economy, industry, agriculture, and food security should be focused on under the "new normal standard of life" following health guidelines and social distancing. Proper response plans and strategic management are necessary for the sustainability of the nation.Graphic abstract
| S-EPMC7368637 | biostudies-literature
Project description:The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU) and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreements at an average of 75% of their cost (financial contribution agreed upon in the agreements), while private European business interests paid the equivalent of 1.5% of the value of the fish that was eventually landed. This raises questions of fisheries benefit-sharing and resource-use equity that the EU has the potential to address during the nearly completed reform of its Common Fisheries Policy.
| S-EPMC3842348 | biostudies-literature
Project description:ObjectivesChinese public hospitals are managed like a bureaucracy, which is divided into two levels of hospital and departmental management. Improving strategic human resource management ability (SHRMA) within clinical departments can improve department performance and service quality, which is an important way for public hospitals to obtain an advantage in a diversified competitive medical market. However, there is a lack of specialised evaluation tools for SHRMA in clinical departments to support this effort. Therefore, this study aims to develop an index for evaluating the SHRMA of clinical departments in public hospitals.Study design and settingThe Delphi technique was carried out with 22 experts, and an evaluation index of the SHRMA in the clinical departments of public hospitals was constructed. The weight of each indicator was calculated by the intuitive fuzzy analytic hierarchy process.ResultsThe SHRMA index constructed in this study for the clinical departments in public hospitals includes 5 first-level indicators, 13 second-level indicators and 36 third-level indicators. The first-level indicators are distributed in weight among human resource maintenance (0.204), human resource planning (0.201), human resource development (0.200), human resource stimulation (0.198) and human resource absorption (0.198). The top three weighted indicators on the second level are job analysis and position evaluation (0.105), career management (0.103) and salary incentivisation (0.100).ConclusionsThe index constructed in this study is scientific and feasible and is expected to provide an effective tool for the quantitative evaluation of SHRMA in the clinical departments of public hospitals in China.
| S-EPMC10030578 | biostudies-literature
Project description:The ecosystem service concept is recognized as a useful tool to support sustainability in decision-making. In this study, we collaborated with actors in the Helge å catchment, southern Sweden, in an iterative participatory ecosystem service assessment. Through workshops and interviews, we jointly decided which ecosystem services to assess and indicators to use in order to achieve a sense of ownership and a higher legitimacy of the assessment. Subsequently, we explored the landscape-level interactions between the 15 assessed services, and found that the area can be described using three distinct ecosystem service bundles. The iterative, participatory process strengthened our analysis and created a shared understanding and overview of the multifunctional landscape around Helge å among participants. Importantly, this allowed for the generated knowledge to impact local strategic sustainability planning. With this study, we illustrate how similar processes can support local decision-making for a more sustainable future.
| S-EPMC7782664 | biostudies-literature