James Moises

Hospital capacity, capability, and emergency preparedness

Disasters often result in shifts in hospital capacity utilization. Emergency preparedness plans must recognize capacity at the service-line level. This information can provide an additional level of detail to better design response activities and develop cost-effective disaster response plans. We model a possible preparedness plan for Florida hospitals in the case of a major disaster. We model a hurricane event because, in addition to its similarity to other disasters, it provides enough warning for substantive preparation activities. Following Johansen, we measure capacity in a frontier setting using data envelopment analysis. We also use a criterion of economic capability to ensure that a Pareto Optimal situation can be maintained. Information on hospital capacity, patient characteristics of inpatient discharges, and financial performance was merged to perform this study. Our findings suggest there is not enough excess capacity for some specialized services in Florida. However, possible evacuation policies can still be derived from our findings satisfying medical and economic capabilities.

Social Efficiency of Hospital Care Delivery: Frontier Analysis From the Consumer’s Perspective

The efficiency of hospital services and patients’ access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients’ travel distances, we found increases in social efficiency when patients’ travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corroborated past literature in the hospital and travel distance literature and set out a framework for future research. Perhaps most important, we demonstrate the techniques needed to incorporate broader measures of social costs into studies of hospital efficiency.

Opportunities for Prevention: Assessing Where Low-Income Patients Seek Care for Preventable Coronary Artery Disease

The Affordable Care Act has many aspects that are aimed at improving health care for all Americans, including mandated insurance coverage for individuals, as well as required community health needs assessments (CHNAs), and reporting of investments in community benefit by nonprofit hospitals in order to maintain tax exemptions. Although millions of Americans have gained access to health insurance, many--often the most vulnerable--remain uninsured, and will continue to depend on hospital community benefits for care. Understanding where patients go for care can assist hospitals and communities to develop their CHNA and implementation plans in order to focus resources where the need for prevention is greatest. This study evaluated patient care-seeking behavior among patients with coronary artery disease (CAD) in Florida in 2008--analyzed in 2013--to assess whether low-income patients accessed specific safety net hospitals for treatment or received care from hospitals that were geographically closer to their residence. This study found evidence that low-income patients went to hospitals that treated more low-income patients, regardless of where they lived. The findings demonstrate that hospitals-especially public safety net hospitals with a tradition of treating low-income patients suffering from CAD-should focus prevention activities where low-income patients reside.

Renovating Charity Hospital or Building a New Hospital in Post-Katrina New Orleans: Economic Rationale versus Political Will

Since September 2005, Charity Hospital of New Orleans has been closed due to Hurricane Katrina. A debate following the closing arose about whether this public hospital should be renovated or a new medical center affiliated with the Louisiana State University should be built. Using academic literature, government statistics, and popular press reports, we describe the economic implications that support the view that Charity Hospital should have been renovated. We also address why this policy was not pursued by demonstrating the influence politics and individual stakeholders (specifically, Louisiana State University) had on the eventual policy pursued. In this commentary we also note the political identity movement away from public-sector provision of services to private-sector interests.