Smoothing It Out: Military Health Care Supply Chain in Transition.

Health care provision in the US can be characterized by its ongoing consolidation of systems and facilities in its efforts to achieve clinical and business integration. An important goal in health care systems is integration to reduce fragmentation and gain value. Functional integration has a long history of association with clinical performance.

A Commons for a Supply Chain in the Post-COVID-19 Era: The Case for a Reformed Strategic National Stockpile.

Unlabelled: Policy Points Reflecting on current response deficiencies, we offer a model for a national contingency supply chain cell (NCSCC) construct to manage the medical materials supply chain in support of emergencies, such as COVID-19. We develop the following: a framework for governance and response to enable a globally independent supply chain; a flexible structure to accommodate the requirements of state and county health systems for receiving and distributing materials; and a national material "control tower" to improve transparency and real-time access to material status and location.

Context: Much of the discussion about the failure of the COVID-19 supply chain has centered on personal protective equipment (PPE) and the degree of vulnerability of care.

Of barriers and bridges: Buyer-supplier relationships in health care.

Background: As the second largest expense category after labor, supply expense has received more strategic attention in recent years. Collaborative buyer-supplier relationships play a significant role in strategic supply chain management. In the health sector, however, buyer-supplier relationships are generally perceived as adversarial and distrusting.

Women, family medicine, and career choice: An opportunity cost analysis.

Objective: This study compared the cost of physician versus physician assistant (PA) education for women practicing in family medicine.

Methods: Using 2013 salary survey data from both the Medical Group Management Association and the American Academy of PAs as well as other publicly available data sources, the authors compared the current net present value (NPV) of physician and PA training for women practicing in family medicine.

Results: Considering a base case scenario involving a 24-year-old woman, the NPV to become a family medicine physician was $2,015,000 compared with an NPV of $1,751,000 to become a family medicine PA.

Corporate governance and the adoption of health information technology within integrated delivery systems.

Background: Although several previous studies have found "system affiliation" to be a significant and positive predictor of health information technology (IT) adoption, little is known about the association between corporate governance practices and adoption of IT within U.S. integrated delivery systems (IDSs).

Professionalism in 21st century professional practice: autonomy and accountability in orthopaedic surgery.

Orthopaedic surgical practice is becoming increasingly complex. The rapid change in pace associated with new information and technologies, the physician-supplier relationship, the growing costs and growing gap between costs and reimbursements for orthopaedic surgical procedures, and the influences of advertising on the patient, challenge all involved in the delivery of orthopaedic care. This paper assesses the concepts of professionalism, autonomy, and accountability in the 21st century practice of orthopaedic surgery.

Hip and knee implants: current trends and policy considerations.

This paper constitutes an analysis of the issues, relationships, emerging hospital strategies, and policy needs surrounding hip and knee implants. Demand for hip and knee replacements is rising annually, and growth is expected to be substantial. Costs are high, reaching $11 billion for hospitals in 2004 and $5 billion for Medicare in 2006.

Hospitals' strategies for orchestrating selection of physician preference items.

This article analyzes hospitals' strategies to shape physicians' behavior and counter suppliers' power in purchasing physician preference items. Two models of standardization are limitations on the range of manufacturers or products (the "formulary" model) and price ceilings for particular item categories (the "payment-cap" model), both requiring processes to define product equivalencies often with inadequate product comparison data. The formulary model is more difficult to implement because of physicians' resistance to top-down dictates.

The hospitalist movement in the United States: agency and common agency issues.

Agency relationships and their effect on patient representation in the hospitalist role are examined in this article. Emphasis is on relationship(s) with patients, primary care physicians, health plans, and hospitals.

A diagnostic approach to understanding entrepreneurship in health care.

Health care is quite different from other industries because of its organizational structure, service delivery, and financing of health services. Balancing costs, quality, and access presents unique challenges for each stakeholder group committed to promoting the health and healing of its citizens. Using the diagnostic approach to health care entrepreneurship, we created a framework from research in the field to understand the predisposing, enabling, and reinforcing factors most relevant to successful entrepreneurship.

AHSCs: the movement from brokers of scarce resources to victims of the changing environment of healthcare delivery.

Academic health sciences centres in both the United States and Canada, once major "brokers" of medical and biomedical knowledge and other scare resources, are frequently depicted as "victims" of the environments in which they exist. While the national and local environments in which these organizations exist differ substantially, the integrity of AHSCs in both nations is threatened by a variety of emergent and continuing externalities. It is important that AHSCs develop a sufficient vision and market to be self-determining and successful in countering pressures that challenge their teaching, research and service activities.