Piloting Specialized Hospital Care

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Seeking to improve the quality of health care the Finnish government is engaged in a pilot activity to establish a specialized hospital which provides only endoprothesis surgery. Run by the public and private sector the hospital was opened in September 2002 and closely works with local district hospitals.

Purpose of health policy or idea

• In one hospital district (Pirkanmaa), a hospital (Coxa - Hospital for Joint Replacement) specialised to provide only endoprosthesis surgery (operations for hip, knee, shoulder, elbow and ankle joints, and revision operations) was opened in Sep 2002. The hospital operates as a limited company owned mainly by the local hospital district municipal federation, the capital of the region and a foreign (German) private hospital company. Other owners are four other hospital district federations, a non-profit foundation running an orthopaedic hospital, and three smaller towns of the region.         
• The new hospital is closely collaborating with the local hospital district. It mainly sells its procedures to the hospital district but also provides them to other districts and municipalities, other third-party payers and private patients. The local hospital district has also stopped to provide the procedures offered by the new hospital in its own hospitals. On the other hand the new hospital buys certain services, such as specialists' consultations, and emergency and ICU care from the neighbouring central hospital. 
• The objective of the arrangement is to improve quality and cost-effectiveness by specialisation and concentration of expertise and medical excellence. In addition, the hospital aims at providing better working conditions for its surgeons and other staff. The management has claimed that the owners has set no profit expectations for the hospital.  
• Besides providing surgical care, the hospital planned to do research in the field of its specialisation and to act as a training centre in endoprosthesis surgery for the local medical school and polytechnic.

Main points

Main objectives

1. to improve quality and cost-effectiveness of endoprosthesis surgery by specialisation and concentration of expertise,
2. a new form of hospital ownership:  a publicly and privately owned limited company;
3. a new way to organise service production in public hospitals: to move a part of services to be produced in a separate  specialised corporate hospital.

Groups affected

competing private hospitals, other local hospitals, staff in the new and neighbouring local hospitals

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

 The Ministry of Social Affairs and Health advocates a concentration of surgical procedures requiring specialised expertise in a larger hospital units but this is a local initiative not directly related to the Ministry's policy or any general policy statements or programmes.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The management of the hospital district federation is actively experimenting new forms to organise service provision. For instance, the district has earlier concentrated their clinical laboratory services in a central laboratory run by a public utility company. In some municipalities, the hospital district is also experimenting a merger of specialised services of its local hospital with the municipal health centre usually run by the municipality.

The kick-off of the new hospital includes several innovations in relation to regular hospital organisation in Finland. The most hospitals are public and they are owned and run by federations of municipalities. Private hospitals are owned by non-profit organisations or by private companies / persons. The new hospital operates as a publicly and privately owned limited company. The specialisation for only one type of procedures and the close collaboration of the new hospital and the local hospital district are also novelties. In fact, it can be claimed that the local hospital district has in a way streamlined its organisation and moved a part of its activities to a separate corporate hospital. 

Stakeholder positions

This new hospital is a local initiative which is accepted and supported amazingly widely by local politicians and decision makers. The initiative has also gain support at the national level: it has been appreciated, for partly different reasons, as a new model to provide services by the Ministry of Trade and Industry (a strongest advocate of market based health care in Finland) and the Ministry of Social Affairs and Health.

Influences in policy making and legislation

No change in legislation was needed.

Adoption and implementation

• The initiator of the new hospital was the management of the hospital district. They have got support from local political decision makers and the management of the central hospital. The formal decision about founding of the hospital and its corporate form was made by the hospital district council appointed by the member municipalities.
• The management of the new hospital claims that the hospital operates well and it has reached its goals of patient volume. It is, however, too early to judge the long-term success: the hospital has treated patients only for six months.
• The hospital is getting its main stock of patients from its host hospital districts which stopped most endoprosthesis surgery in its other hospitals. In addition,  since there is an obvious inadequate supply of endoprosthesis surgery in Finland, other hospital districts and municipalities are probably rather willing to shorten their patient queues by referring their patients to the new hospital.  The inadequate supply of services also facilitates the kick-off of the hospital for private sector services: market competition by other hospitals providing services for self-paying patients is weak.

Results of evaluation

• There are good chances that according to its objectives the new hospital can improve quality and cost-effectiveness of endoprosthesis surgery by having an focused opportunity to rationalise its processes due to narrow specialisation.
• The new hospital concept has criticised in public for potentially creating difficulties for other hospitals to get specialised medical (orthopaedic) staff and endangering their economic situation by creaming off 'lucrative' patients. The concentration of orthopaedic surgeons in one hospital has been claimed to result potentially in operational problems in other hospitals: difficulties to get consultations, increased work load (in emergency services and non-endoprosthesis orthopaedic surgery) due to decreased medical staff.
• The new arrangements may also produce inequalities within medical and nursing staff: the staff in the new hospital can be expected to have better contracts than the staff in the neighbouring public hospital, although the new hospital is factually a streamlined orthopaedic department of the public hospital.
• The operational concept of the new hospital may have difficulties with competition authorities due to its close collaboration with the hospital district which is also an owner of the new hospital. This collaboration could be interpreted as an unfair support to the hospital by other private hospitals competing with it for public customers (hospital districts, municipalities) and private patients.

Expected outcome

References

Empfohlene Zitierweise für diesen Online-Artikel:

. "Piloting Specialized Hospital Care". Health Policy Monitor, 020603. Available at http://www.hpm.org/survey/fi/a1/5