Hospitals in the USA form company joint ventures by their own doctors (PHO – Physicians Hospital Organizations). They profit together from the execution of reforms and by the increase of productivity. It is projected that productivity today is 40 percent less from the public sector than from the private one. That is a dubious estimate: the patient populations are distinct (sicker people in the public sector). But even though the figure is incorrect – the character is: public associations are less Hospital Urgencias Medicas effective.
They are not as efficient due to primitive scheduling of patient-doctor appointments, lab tests and operations, because of obsolete or non-existent data systems, because of long turnaround times and because of redundant laboratory tests and medical procedures. The support – which is present in private hospitals – from additional (clinical and nonclinical) employees is absent due to impossibly complex labour rules and job descriptions imposed by the unions. Most of the doctors have split loyalties between the medical colleges where they teach and the various hospital affiliates. They would often neglect the voluntary affiliates and contribute more to the prestigious ones. Public hospitals might, consequently, be well advised to hire new staff, not from medical colleges, share risks with its physicians through joint ventures, sign contracts with pay according to productivity and place doctors in the boards. Generally, the hospitals need to shrink and re-engineer the workforce. About half the funding is generally spent on labour costs in private hospitals – and more than 70 percent in people ones. It’s no good to reduce the workforce through natural attrition, mass layoffs, or severance incentives. All 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 get completely out of hand.
The authorities must contribute its own part. Public hospitals cannot compete or comply with the demands of national, publicly traded HMOs with political clout and the capacity to raise capital to finance hyper-sophisticated advertising. Public policy must be written to encourage”safety net” institutions. They have to be permitted to arrange their own MCOs (Managed Care Organizations of individuals ), to insure patients and to advertise their services directly to classes of potential consumers. This way they’ll save the 20 percent commission that they are paying HMOs currently. Should they become more effective and reduce utilization, they will absorb the full advantages, rather than ceding them to contracting groups of patients and insurance companies or to the government’s medical insurance plans. The hospitals will thus have the ability to build their own networks of providers and discuss their risks with their physicians or with the insurance companies as best suits their objective.