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Fifteen years of pioneering research in healthcare financial management.


IN 1994 a small group of intrepid pioneers arrived in Dallas, Texas. It was not dusty, there were no tumbleweeds, and thankfully we arrived by plane a whole lot faster than by wagon train. We were part of a special technical session organized in a small academic conference, dedicated to research in healthcare financial management. That group rapidly became an informal, interdisciplinary network of professionals that bridged leading organizations throughout the world. By the end of 1998 the network had grown to the point where it was formally organized under the laws of the State of Maryland as a non-stock, non-profit corporation, and was approved as a tax-exempt entity under Section 501(c)3 of the US Internal Revenue Code. It had a website and a long name for a small group: the International Society for Research in Healthcare Financial Management, Ltd. (RHFM). Its mission was simple: to advance international research, education and practice in healthcare financial management and related professions. The Society continued to grow and advance its mission, establishing the highest level of quality in every aspect of its programs, publications and services. We became known for our hallmark--a boutique of collegial, international research workshops, offering high-quality feedback with every presenter serving as a discussant on at least one other conference paper. That latter attribute always ensured the highest levels of participation and involvement by everyone attending, and is still unique to RHFM programs.

Our premier journal, Research in Healthcare Financial Management, filled a niche that, to this day, no other international, refereed, double-blind, peer-reviewed research journal has ever filled. Other societies and journals are either economic, public policy, practitioner, or country-specific in scope. None integrate those attributes in combination with financial management. We have provided a "home," and a publication outlet, for many researchers over the last 15 years. I am very proud to have played a part in the growth and development of RHFM. As I look back over the past 15 years and our cumulative publication index, it still amazes me that we have provided a publication outlet for 135 authors, representing 91 leading institutions, who wrote 77 papers, hailing from 10 different countries.

In this volume, we offer a selection of papers that address a number of technical, managerial, and consumer focused issues. We start with some good interchange of ideas by Faith M. Asper, who offered a Research Note on extracting Medicare Hospital Cost Report data that builds on a previous paper by Cutting, Goldberg and Jervis. She provides very helpful guidance for researchers that will surely advance future empirical work using this data. Kathryn J. Jervis, Alan C. Cutting and Gerson M. Goldberg then offer their reply to Asper's Research Note.

The next paper is by Catherine Plante, which addresses another perspective on differences between for-profit and nonprofit hospitals. This is a much debated comparison, and over time my view has come to settle on what I refer to as the "MMO"--the mission-margin ordering difference. Non-profit hospitals need a margin to survive and fulfill their service mission. For-profit hospitals need a consumer-serving mission to fulfill their margin producing objective. The difference is in the ordering of priorities--the "MMO."

Michael J. McCue then examines the effects of insurance on the yields of tax-exempt hospital bonds, and considers the relationships of underlying ratings with differences in the yields on insured bonds. Robert W. Broyles, Amir A. Khaliq and Steven E. Mattachione present a method for evaluating the short-term use of capacity to provide direct patient care. They partition provider capacity into components that enable an administrator to manage the effects of operating leverage and improve fiscal performance.

Karen M. Hogan, Gerard T. Olson and George P. Sillup present an analytic hierarchical process for helping the self-insured company screen and select a pharmacy benefits manager. Their approach incorporates both qualitative and quantitative information into a multi-criteria decision making process. It is potentially useful for both selecting a manager and assessing performance, especially by self-insured companies that spend millions annually on pharmacy benefits for their current and retired employees.

Next, Robert W. Broyles, Amir A. Khaliq and Steven E. Mattachione present another paper, on improving financial performance and reducing fiscal risk through variance analysis of contribution margins. They demonstrate that contribution margins are the sum of a standard contribution margin plus a set of variances on gross price, payer mix, collection rate and volume of care. They find a set of interactive or joint variances indicates that improving profitability and reducing fiscal risk will require a cooperative, interdisciplinary team comprised of the medical staff, fiscal services personnel, line managers and senior leaders of the organization.

Our final paper in this volume is by Michael V. Laric, Dennis A. Pitta and Lea Prevel Katsanis, who offer a cross-national perspective on healthcare information privacy. They find that the level of information privacy concerns varies with an individual's demographics, psychographics, country of origin, type of healthcare coverage, and the economic impact of the disclosure of sensitive information. They also find that information privacy concerns are a function of the individual's health condition treated and the individual's stage in the family life-cycle. They compare both US and Canadian citizens' concerns with privacy and the perceptions of issues surrounding various medical conditions. This is certainly a timely and important issue, and a provocative note on which to conclude this volume of RHFM.

Building on the words of my predecessor Senior Editor, Marsha Dowell, scholarly publications and research articles such as these continue to challenge all of us to be vocal about meaningful, rational, healthcare reform. These authors provide each of us with more knowledge, not only of the financial management issues that continue to challenge the US healthcare system, but they also provide valuable insights on how to address the financial aspect of proposed healthcare reforms. These efforts, coupled with others focused on the organization and delivery of care, continue to build a foundation of evidence that is useful for management and policy advances in the future.

Address for correspondence: Dana A. Forgione, College of Business, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249-6319 USA,

Dana A. Forgione

University of Texas at San Antonio and University of Texas
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Article Details
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Author:Forgione, Dana A.
Publication:Research in Healthcare Financial Management
Article Type:Editorial
Date:Jan 1, 2009
Previous Article:The measurement of fiscal risk in healthcare organizations: a statistical approach.
Next Article:Research note on 'An Easier Method to Extract Data From Large Databases: The Medicare Hospital Cost Report Database'.

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