WorldWideScience

Sample records for care costs phase

  1. The role of technology in reducing health care costs. Phase II and phase III.

    Energy Technology Data Exchange (ETDEWEB)

    Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray; Tebo, Michael A.; Murphy, Martin D.; Hightower, Marion Michael; Gallagher, Linda K.; Craft, Richard Layne, II; Garcia, Rudy John

    2004-04-01

    In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care delivery costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.

  2. Costs of Emergency Care

    Science.gov (United States)

    ... to care for patients, not fewer, and medical liability reform would help reduce overall costs by reducing ... NewsMediaResources/StatisticsData/Just%202%20booklet.pdf [ii] Report: Accounting for the cost of US health care: A ...

  3. At what cost care?

    Science.gov (United States)

    Pitman, J; Warelow, P J

    2000-03-01

    This paper looks at the concept of care in nursing and considers the ever-changing focus relative to the meaning of the term care and how this care is delivered by nursing staff. In the process of looking at these issues it examines the theoretical and practical issues and how these factors have changed considerably over the last twenty-five years. This examination touches upon some of the intermingled and not mutually exclusive issues which surround care and caring such as technology, stress and burnout, bureaucracy, fiscal policy, the humanness of the nurse and the ever changing nature of care delivery. Many readers will be able to relate to the issues discussed and understand how some of these factors tend to get in the way of one another and affect good patient care and outcomes. PMID:11141767

  4. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  5. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  6. The health care costs of smoking

    NARCIS (Netherlands)

    J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc); P.J. van der Maas (Paul)

    1997-01-01

    textabstractBACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs

  7. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

  8. Understanding your health care costs

    Science.gov (United States)

    ... as X-rays or MRIs Rehab, physical or occupational therapy, or chiropractic care Mental health, behavioral health, or substance abuse care Hospice, home health, skilled nursing, or durable medical equipment Prescription drugs Dental and ...

  9. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A

    2003-02-01

    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  10. The containment of cost of health care.

    Science.gov (United States)

    Gordts, B

    1996-04-01

    The cost of health care services has become increasingly important to society. Although hospital physicians are traditionally not involved in cost calculation and cost containment, they bear the consequences of budget restrictions. Since 1987, the reimbursement for clinical laboratories in Belgian hospitals has changed towards an envelope based system. Clinical biologists became aware that new resources can only be obtained mainly through cost reductions. But to contain cost, one must understand how it is generated. Activity based costing (ABC) is a new technique developed for strategic management in the industry. By analyzing the cost of all activities involved in the production process, this technique is very well suited to calculate cost in service organizations like medical departments. Using the principles of ABC, we performed a detailed analysis of the cost of a microbiology laboratory, determining the full cost as well as the proportion of each cost sorts (materials, labor, ...) for each laboratory test. This analysis illustrates that cost can effectively be calculated in a hospital department and guide doctors in the evaluation of alternative medical techniques, investments in automation, and the decision on medical priorities. In our opinion, cost containment of hospital care must start from within each medical department. Responsibility and participation of physicians in the discussion on budget allocation are essential in the process of cost containment of the hospital health care. PMID:8686402

  11. Variable cost of ICU care, a micro-costing analysis.

    Science.gov (United States)

    Karabatsou, Dimitra; Tsironi, Maria; Tsigou, Evdoxia; Boutzouka, Eleni; Katsoulas, Theodoros; Baltopoulos, George

    2016-08-01

    Intensive care unit (ICU) costs account for a great part of a hospital's expenses. The objective of the present study was to measure the patient-specific cost of ICU treatment, to identify the most important cost drivers in ICU and to examine the role of various contributing factors in cost configuration. A retrospective cost analysis of all ICU patients who were admitted during 2011 in a Greek General, seven-bed ICU and stayed for at least 24hours was performed, by applying bottom-up analysis. Data collected included demographics and the exact cost of every single material used for patients' care. Prices were yielded from the hospital's purchasing costs and from the national price list of the imaging and laboratory tests, which was provided by the Ministry of Health. A total of 138 patients were included. Variable cost per ICU day was €573.18. A substantial cost variation was found in the total costs obtained for individual patients (median: €3443, range: €243.70-€116,355). Medicines were responsible for more than half of the cost and antibiotics accounted for the largest part of it, followed by blood products and cardiovascular drugs. Medical cause of admission, severe illness and increased length of stay, mechanical ventilation and dialysis were the factors associated with cost escalation. ICU variable cost is patient-specific, varies according to each patient's needs and is influenced by several factors. The exact estimation of variable cost is a pre-requisite in order to control ICU expenses.

  12. Variable cost of ICU care, a micro-costing analysis.

    Science.gov (United States)

    Karabatsou, Dimitra; Tsironi, Maria; Tsigou, Evdoxia; Boutzouka, Eleni; Katsoulas, Theodoros; Baltopoulos, George

    2016-08-01

    Intensive care unit (ICU) costs account for a great part of a hospital's expenses. The objective of the present study was to measure the patient-specific cost of ICU treatment, to identify the most important cost drivers in ICU and to examine the role of various contributing factors in cost configuration. A retrospective cost analysis of all ICU patients who were admitted during 2011 in a Greek General, seven-bed ICU and stayed for at least 24hours was performed, by applying bottom-up analysis. Data collected included demographics and the exact cost of every single material used for patients' care. Prices were yielded from the hospital's purchasing costs and from the national price list of the imaging and laboratory tests, which was provided by the Ministry of Health. A total of 138 patients were included. Variable cost per ICU day was €573.18. A substantial cost variation was found in the total costs obtained for individual patients (median: €3443, range: €243.70-€116,355). Medicines were responsible for more than half of the cost and antibiotics accounted for the largest part of it, followed by blood products and cardiovascular drugs. Medical cause of admission, severe illness and increased length of stay, mechanical ventilation and dialysis were the factors associated with cost escalation. ICU variable cost is patient-specific, varies according to each patient's needs and is influenced by several factors. The exact estimation of variable cost is a pre-requisite in order to control ICU expenses. PMID:27080569

  13. How not to cut health care costs.

    Science.gov (United States)

    Kaplan, Robert S; Haas, Derek A

    2014-11-01

    Health care providers in much of the world are trying to respond to the tremendous pressure to reduce costs--but evidence suggests that many of their attempts are counterproductive, raising costs and sometimes decreasing the quality of care. Kaplan and Haas reached this conclusion after conducting field research with more than 50 health care provider organizations. Administrators looking for cuts typically work from the line-item expense categories on their P&Ls, they found. This may appear to generate immediate results, but it usually does not reflect the optimal mix of resources needed to efficiently deliver excellent care. The authors describe five common mistakes: (1) Reducing support staff. This often lowers the productivity of clinicians, whose time is far more expensive. (2) Underinvesting in space and equipment. The costs of these are consistently an order of magnitude smaller than personnel costs, so cuts here are short-sighted if they lower people's productivity. (3) Focusing narrowly on procurement prices and neglecting to examine how individual clinicians actually consume supplies. (4) Maximizing patient throughput. Physicians achieve greater overall productivity by spending more time with fewer patients. (5) Failing to benchmark and standardize. Administrators, in collaboration with clinicians, should examine all the costs of treating patients' conditions. This will uncover multiple opportunities to improve processes in ways that lower total costs and deliver better care. PMID:25509507

  14. Low Cost Phased Array Antenna System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — JEM Engineering proved the technical feasibility of the FlexScan array?a very low-cost, highly-efficient, wideband phased array antenna?in Phase I, and stands ready...

  15. Careful telemedicine planning limits costly liability exposure.

    Science.gov (United States)

    Edelstein, S A

    1999-12-01

    Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust.

  16. Applying activity-based costing in long-term care.

    Science.gov (United States)

    Wodchis, W P

    1998-01-01

    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care. PMID:10339203

  17. Applying activity-based costing in long-term care.

    Science.gov (United States)

    Wodchis, W P

    1998-01-01

    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care.

  18. Medical Care Cost Recovery National Database (MCCR NDB)

    Data.gov (United States)

    Department of Veterans Affairs — The Medical Care Cost Recovery National Database (MCCR NDB) provides a repository of summary Medical Care Collections Fund (MCCF) billing and collection information...

  19. Cost analysis of prenatal care using the activity-based costing model: a pilot study.

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  20. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  1. Parents and the High Cost of Child Care: 2014 Report

    Science.gov (United States)

    Wood, Stephen; Fraga, Lynette; McCready, Michelle

    2014-01-01

    Eleven million children younger than age five are in some form of child care in the United States. The "Parents and the High Cost of Child Care: 2014 Report" summarizes the cost of child care across the country, examines the importance of child care as a workforce support and as an early learning program, and explores the effect of high…

  2. The Health Care Costs of Violence Against Women

    DEFF Research Database (Denmark)

    Kruse, Marie; Sørensen, Jan; Brønnum-Hansen, Henrik;

    2011-01-01

    The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified...... care sector and costs of prescription pharmaceuticals. We estimated the attributable health care costs of violence against women in Denmark, using a generalized linear model where health care costs were modeled as a function of age, childbirth, and exposure to violence. In addition we tested whether...... socioeconomic status, multiple episodes of violence, and psychiatric contacts had any impact on health care costs. We found that the health care costs were about €1,800 higher for victims of violence than for nonvictims per year, driven mostly by higher psychiatric costs and multiple episodes of violence....

  3. Cost of care of haemophilia with inhibitors.

    Science.gov (United States)

    Di Minno, M N D; Di Minno, G; Di Capua, M; Cerbone, A M; Coppola, A

    2010-01-01

    In Western countries, the treatment of patients with inhibitors is presently the most challenging and serious issue in haemophilia management, direct costs of clotting factor concentrates accounting for >98% of the highest economic burden absorbed for the healthcare of patients in this setting. Being designed to address questions of resource allocation and effectiveness, decision models are the golden standard to reliably assess the overall economic implications of haemophilia with inhibitors in terms of mortality, bleeding-related morbidity, and severity of arthropathy. However, presently, most data analyses stem from retrospective short-term evaluations, that only allow for the analysis of direct health costs. In the setting of chronic diseases, the cost-utility analysis, that takes into account the beneficial effects of a given treatment/healthcare intervention in terms of health-related quality of life, is likely to be the most appropriate approach. To calculate net benefits, the quality adjusted life year, that significantly reflects such health gain, has to be compared with specific economic impacts. Differences in data sources, in medical practice and/or in healthcare systems and costs, imply that most current pharmacoeconomic analyses are confined to a narrow healthcare payer perspective. Long-term/lifetime prospective or observational studies, devoted to a careful definition of when to start a treatment; of regimens (dose and type of product) to employ, and of inhibitor population (children/adults, low-responding/high responding inhibitors) to study, are thus urgently needed to allow for newer insights, based on reliable data sources into resource allocation, effectiveness and cost-utility analysis in the treatment of haemophiliacs with inhibitors.

  4. Cost of care of haemophilia with inhibitors.

    Science.gov (United States)

    Di Minno, M N D; Di Minno, G; Di Capua, M; Cerbone, A M; Coppola, A

    2010-01-01

    In Western countries, the treatment of patients with inhibitors is presently the most challenging and serious issue in haemophilia management, direct costs of clotting factor concentrates accounting for >98% of the highest economic burden absorbed for the healthcare of patients in this setting. Being designed to address questions of resource allocation and effectiveness, decision models are the golden standard to reliably assess the overall economic implications of haemophilia with inhibitors in terms of mortality, bleeding-related morbidity, and severity of arthropathy. However, presently, most data analyses stem from retrospective short-term evaluations, that only allow for the analysis of direct health costs. In the setting of chronic diseases, the cost-utility analysis, that takes into account the beneficial effects of a given treatment/healthcare intervention in terms of health-related quality of life, is likely to be the most appropriate approach. To calculate net benefits, the quality adjusted life year, that significantly reflects such health gain, has to be compared with specific economic impacts. Differences in data sources, in medical practice and/or in healthcare systems and costs, imply that most current pharmacoeconomic analyses are confined to a narrow healthcare payer perspective. Long-term/lifetime prospective or observational studies, devoted to a careful definition of when to start a treatment; of regimens (dose and type of product) to employ, and of inhibitor population (children/adults, low-responding/high responding inhibitors) to study, are thus urgently needed to allow for newer insights, based on reliable data sources into resource allocation, effectiveness and cost-utility analysis in the treatment of haemophiliacs with inhibitors. PMID:19845772

  5. The Health Care Costs of Violence against Women

    Science.gov (United States)

    Kruse, Marie; Sorensen, Jan; Bronnum-Hansen, Henrik; Helweg-Larsen, Karin

    2011-01-01

    The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified a reference population. We computed the attributable costs,…

  6. 8 ways to cut health care costs

    Science.gov (United States)

    ... health care provider if you can switch to generic medicines. They have the same active ingredient, but ... Trust for America's Health. A Healthy America 2013: Strategies to Move From Sick Care to Health Care ...

  7. A market approach to better care at lower cost.

    Science.gov (United States)

    Antos, Joseph

    2015-11-01

    The Affordable Care Act expanded health insurance coverage in the United States but did little to address the structural problems that plague the U.S. health care system. Controlling cost while maintaining or improving access to quality care requires a more fundamental reform based on market principles. Such an approach means aligning the financial incentives of patients and providers to promote smarter spending. It also requires better information and more flexible regulation to promote well-functioning competitive markets. Key elements of these reforms include setting reasonable limits on subsidies for Medicare, Medicaid, and private health insurance; modernizing the Medicare program and adopting reforms that promote competition between traditional Medicare and Medicare Advantage; allowing greater flexibility for states in running their Medicaid programs; enacting smarter regulations to protect consumers without imposing greater inefficiency on the health market; and promoting more direct consumer involvement in all phases of their health and health care. These changes will challenge academic medical centers as a new era of creativity and competition emerges in the health care market. PMID:26375266

  8. A market approach to better care at lower cost.

    Science.gov (United States)

    Antos, Joseph

    2015-11-01

    The Affordable Care Act expanded health insurance coverage in the United States but did little to address the structural problems that plague the U.S. health care system. Controlling cost while maintaining or improving access to quality care requires a more fundamental reform based on market principles. Such an approach means aligning the financial incentives of patients and providers to promote smarter spending. It also requires better information and more flexible regulation to promote well-functioning competitive markets. Key elements of these reforms include setting reasonable limits on subsidies for Medicare, Medicaid, and private health insurance; modernizing the Medicare program and adopting reforms that promote competition between traditional Medicare and Medicare Advantage; allowing greater flexibility for states in running their Medicaid programs; enacting smarter regulations to protect consumers without imposing greater inefficiency on the health market; and promoting more direct consumer involvement in all phases of their health and health care. These changes will challenge academic medical centers as a new era of creativity and competition emerges in the health care market.

  9. Potential Medicaid Cost Savings from Maternity Care Based..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

  10. The resistible growth of health care costs.

    Science.gov (United States)

    Grosjean, O V

    2008-01-01

    Rather than our routinely blamed ageing demography, pharmaceutical promotion and the medical business, not research, are responsible for our ever growing health bill. To keep essential health care affordable, only what has been proved necessary and cost effective should be financed by some kind of risk mutualisation system. Hedonistic care should be left to the free market. From conception to death, a devastating culture of medicalization and therapeutic agressivity has turned naturally inexpensive processes, such as conception, birth, ageing and death, into over-priced medical achievements. The increasing lack of personal and social responsibility triggered by the market, such as junk food, tobacco, drugs, sedentarity or trash media, multiply life-threatening illnesses such as diabetes 2, obesity, cardiovascular diseases and all kinds of cancers. Screenings require millions of participants and intense statistical analysis to prove any efficacy. Screenings, testings and proactive practices make people sick and produce more patients than they save lives , while generating exceptional returns on investments thanks to state and insurance financing; they should be put under public control. New drugs are unaffordable in spite of their dubious efficacy which often relies on biased and underpowered studies. Because they target desperate, debilitating, up to now incurable diseases like metastatic cancers, multiple sclerosis, Alzheimer, polyarthritis, Crohn disease, patients and their families want them by any means and at any price. The answer to the North-South health gap is in a global deal: a declining demographic trend, already well under way and free circulation not only of goods but also of people which would in the long run shape up the age pyramid of a progressively mixed population. That could also save lives at both ends of the human chain: those who die from starvation and those who die from overfeeding. PMID:18411565

  11. Adoption of new technologies and costs of health care

    OpenAIRE

    Kulvik, Martti; Linnosmaa, Ismo; Hermans, Raine

    2006-01-01

    New technological applications are usually expected to increase the health care costs. But they can also spawn cost savings in the long run, for example, when making time-consuming diagnostic methods more efficient and facilitating targeted therapy. This study analyses how the implementation of new technological applications in acute treatment affects the long-term cost structure of health care. The non-monetary utility is compared to cost-efficiency impacts of a new technology. A theoretical...

  12. Adaption of New Technologies and Costs of Health Care

    OpenAIRE

    Kulvik, Martti; Linnosmaa, Ismo; Hermans, Raine

    2006-01-01

    New technological applications are usually expected to increase the health care costs. But they can also spawn cost savings in the long run, for example, when making time-consuming diagnostic methods more efficient and facilitating targeted therapy. This study analyses how the implementation of new technological applications in acute treatment affects the long-term cost structure of health care. The non-monetary utility is compared to cost-efficiency impacts of a new technology. A theoretical...

  13. Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

    Directory of Open Access Journals (Sweden)

    Patricia Steinert

    2016-08-01

    Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

  14. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

    Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.

  15. Phase-in, abandonment, and cost disallowances

    International Nuclear Information System (INIS)

    The major regulatory challenge to the electric utility industry appears to be coming from the financial side with its bookkeeping and financial reporting requirements. The author describes the accounting procedures and problems associated with straightforward phase-in rate treatment, abandonment, excess capacity, cost allowances, etc. She concludes that the available options to the Financial Accounting Standards Board are to adopt either the proposed exposure draft or a modification of the draft, to drop the proposed draft of amendments to Statement No. 71, or issue a whole new exposure draft

  16. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    Science.gov (United States)

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  17. Finding Low-Cost Medical Care

    Science.gov (United States)

    ... care clinics in your area or walk-in clinics at your local pharmacy. They are designed to help people who need care right away or if their doctors aren't in the office. Some of these clinics can be expensive. They may not take certain ...

  18. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.

    Science.gov (United States)

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E

    1996-10-01

    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

  19. Activity cost analysis: a tool to cost medical services and improve quality of care.

    Science.gov (United States)

    Udpa, S

    2001-01-01

    This paper suggests an activity-based cost (ABC) system as the appropriate cost accounting system to measure and control costs under the microstatistical episode of care (EOC) paradigm suggested by D. W. Emery (1999). ABC systems work well in such an environment because they focus on activities performed to provide services in the delivery of care. Thus, under an ABC system it is not only possible to accurately cost episodes of care but also to more effectively monitor and improve the quality of care. Under the ABC system, costs are first traced to activities and then traced from the activities to units of episodic care using cost drivers based on the consumption of activity resources.

  20. Cost-analysis of neonatal intensive and special care.

    Science.gov (United States)

    Tudehope, D I; Lee, W; Harris, F; Addison, C

    1989-04-01

    In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 costs in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6,408,000. Daily costs per baby for each were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for greater than 2500 g, $4050 for 2000-2500 g, $9200 for 1500-1999 g, $23,900 for 1000-1499 g and $63,450 for less than 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128,400 for infants less than 800 g birthweight and $43,950 for those 800-999 g. This methodology might serve as a basis for further accounting and cost-evaluation exercises. PMID:2735885

  1. Health care cost in Switzerland: quantity- or price-driven?

    Science.gov (United States)

    Schleiniger, Reto

    2014-07-01

    In Switzerland, per capita health care costs vary substantially from canton to canton and rise considerably and steadily from year to year. Since costs are equal to the product of quantities and prices, the question arises whether regional cost variations and cost increase over time are quantity- or price-driven. Depending on the answer, the containment of health care costs must be approached differently. This article examines the cost of mandatory health insurance in Switzerland for the period from 2004 to 2010 and breaks it down into quantity and price effects. The main result of the cross-section analysis reveals that regional cost differences are mainly due to quantity differences. Similarly, the longitudinal analysis shows that the cost increase across all health care services is primarily caused by increasing per capita quantities. Any attempt to contain costs must therefore focus primarily on the extent of medical care utilization, and the key challenge to be met is how to identify medical care services which do not have a positive effect on patients' health status. PMID:24794986

  2. Tying supply chain costs to patient care.

    Science.gov (United States)

    Parkinson, Rosalind C

    2014-05-01

    In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality. PMID:24851451

  3. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  4. Obesity, weight management, and health care costs: a primer.

    Science.gov (United States)

    Bachman, Keith H

    2007-06-01

    Rational decision-making regarding health care spending for weight management requires an understanding of the cost of care provided to obese patients and the potential cost-effectiveness or cost savings of interventions. The purpose of this review is to assist health plans and disease management leaders in making informed decisions for weight management services. Among the review's findings, obesity and severe obesity are strongly and consistently associated with increased health care costs. The cost-effectiveness of obesity-related interventions is highly dependent on the risk status of the treated population, as well as the length, cost, and effectiveness of the intervention. Bariatric surgery offers high initial costs and uncertain long-term cost savings. From the perspective of a payor, obesity management services are as cost-effective as other commonly offered health services, though not likely to offer cost savings. Behavioral health promotion interventions in the worksite setting provide cost savings from the employer's perspective, if decreased rates of absenteeism are included in the analysis.

  5. Linking quality of care and training costs

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Tabor, Ann; Madsen, Mette E;

    2015-01-01

    OBJECTIVE: To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as com......OBJECTIVE: To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM......) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation...

  6. Quality Adjusted Cost Functions for Child Care Centers

    OpenAIRE

    H. Naci Mocan

    1995-01-01

    Using a newly compiled data set, this paper estimates multi- product translog cost functions for 399 child care centers from California, Colorado, Connecticut, and North Carolina. Quality of child care is controlled by a quality index, which has been shown to be positively related to child outcomes by previous research. Nonprofit centers that receive public money, either from the state or federal government, (which is tied to higher standards), have total variable costs that are 18 percent hi...

  7. Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

    Science.gov (United States)

    Martini, Gilbert R., Jr.

    1991-01-01

    A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

  8. COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

    Directory of Open Access Journals (Sweden)

    A. V. Kontsevaya

    2016-01-01

    Full Text Available Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.

  9. Cost of care of atopic dermatitis in India

    Directory of Open Access Journals (Sweden)

    Sanjeev Handa

    2015-01-01

    Full Text Available Background: Atopic dermatitis (AD is a common dermatologic condition with a prevalence varying from 5% to 15%, and it has been rising over time. Several studies from developed countries have revealed the substantial economic burden of AD on health care budgets. There has been no research however on the cost of care of AD from India a country where health care is self-funded with no health insurance or social security provided by the government. Aim: The aim of our study was to assess prospectively the cost of care of AD in children in an outpatient hospital setting in India. Methods: A total of 40 children with AD, <10 years of age, registered in the pediatric dermatology clinic at our institute were enrolled for the study. All patients were followed-up for 6 months. Demographic information, clinical profile, severity, and the extent of AD were recorded in predesigned performa. Caregivers were asked to fill up a cost assessment questionnaire specially designed for the study. It had a provision for measuring direct, indirect, and provider costs. Results: Of the 40 patients, 37 completed the study. Mean total cost for AD was Rs. 6235.00 ± 3514.00. Direct caregiver cost was Rs. 3022.00 ± 1620.00 of which treatment cost constituted 77.2 ± 11.1%. The total provider cost (cost of consultation, nursing/paramedical staff and infrastructure was Rs. 948.00, which was 15.2% of the total cost of care and the mean indirect cost calculated by adding loss of earnings of parents due to hospital visits was Rs. 2264.00 ± 2392.00 (range: 0-13,332. The mean total cost depending on the severity of AD was Rs. 3579.00 ± 948.00, Rs. 6806.00 ± 3676.00 and Rs. 8991.00 ± 3129.00 for mild, moderate and severe disease, respectively. Conclusions: AD causes a considerable drain on the financial resources of families in India since the treatment is mostly self-funded. Cost of care of AD is high and comparable to those of chronic physical illness, such as diabetes

  10. Tweedie distributions for fitting semicontinuous health care utilization cost data

    OpenAIRE

    Kurz, Christoph

    2016-01-01

    We explore a statistical distribution that can simultaneously model the probability of zero outcome for non-users of health care utilization and continuous costs for users. We compare this distribution to other com- monly used models on example data and show that it fits cost data well and has some appealing properties that provide flexible use.

  11. Calculating the costs of training in primary care.

    Science.gov (United States)

    Gavett, J W; Mushlin, A I

    1986-04-01

    The costs of postgraduate medical education remain a relevant topic for educators and managers as well as for the payors of medical care. Historically, the pervasive problem has been that of identifying education costs in a program that jointly produces patient services and research as well as training. This problem is often approached by an accounting "allocation" of program costs to education. The previous literature on calculating the costs of medical education is reviewed in this paper and the theory related to joint product costing presented as an alternative to the accounting approach. A discussion of the issue centered around an example selected from a teaching hospital outpatient practice is presented. PMID:3959619

  12. Reducing the cost of health care capital.

    Science.gov (United States)

    Silberman, R

    1984-08-01

    Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

  13. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels; Laudicella, Mauro; Ejersted, Charlotte;

    2010-01-01

    care for all English hospitals for the financial year 2005/06. Our sample includes 31,371 patients admitted to 148 hospitals. We apply a multilevel approach. We analyse the relationship between patient costs and patient characteristics. We estimate the average cost of being treated in each hospital......Aims: We analyse the in-hospital costs of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained by patient and hospital characteristics. Methods: We use Hospital Episode Statistics and reference costs for all patients admitted to diabetes...... after controlling for patient characteristics. Second, we explore why these average costs vary across hospitals. Results: Much of the variation in the costs of controlling diabetes is driven by the Healthcare Resource Group to which the patient is allocated, but costs are also higher for patients who...

  14. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit.

    Science.gov (United States)

    Chang, Beverly; Lorenzo, Javier; Macario, Alex

    2015-12-01

    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  15. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels

    2009-01-01

    Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...... by patient and hospital characteristics. Methods: We apply a multilevel approach recognising that patients are clustered in hospitals. We first analyse the relationship between patient costs and their characteristics, such as HRG, age, gender, diagnostic markers and socio-economic status. We derive...... the hospital fixed effect and adjust for hospital characteristics such as number of patients treated, factor prices and number of specialties involved in diabetes care. We rank hospitals by their adjusted fixed effect, which measures the extent to which their costs vary from the average after controlling...

  16. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  17. Costing of consumables: use in an intensive care unit.

    Science.gov (United States)

    Mann, S A

    1999-08-01

    In 1991, the Intensive Care Unit (ICU) at Middlemore Hospital manually costed the treatment and care of asthmatic patients. This was long-winded and labour-intensive, but provided hard data to support anecdotal beliefs that intensive care patients are more expensive than was currently believed or accepted. It is a known problem that funder and provider organizations see a huge disparity on the funding issue. With additional accurate information on the actual cost of individual patients, which can be grouped into disease categories, funding applications can be backed with accurate, up-to-date quantitative data. After a long preparation time, we are now costing individual patient stays in the ICU. Each individual resource was established, costed and entered into an MS ACCESS computerized database. Schedules have been prepared for updating prices, as these change. The final report available gives a detailed list of resource use within certain categories. Some items proved to be impractical to cost on an individual patient basis, and these have been grouped together, costed, and divided by the number of patient days for the last year, and assigned to each individual patient as an hourly unit cost. Believed to be a world-first, this information now forms the basis for variance reporting and pricing. PMID:10786509

  18. Incentive-Based Primary Care: Cost and Utilization Analysis

    OpenAIRE

    Hollander, Marcus J.; Kadlec, Helena

    2015-01-01

    This study used Canadian Ministry of Health administrative data for Fiscal Year 2010–2011. After controlling for patients’ age, sex, service-needs level, and continuity of care (ie, attachment to a general practice), the incentives reduced the net annual health care costs for patients with hypertension, chronic obstructive pulmonary disease, and congestive heart failure, but not for diabetes. The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and ...

  19. Primary care utilisation and workers’ opportunity costs. Evidence from Italy

    OpenAIRE

    De Luca, Giuliana; Ponzo, Michela

    2010-01-01

    This paper analyses the effects of employment condition and work hours on the utilisation of primary care services in Italy. Although the Italian NHS provides free and equitable access to primary care, type of occupation and labour contracts may still deter workers to attend medical appointments. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian Nation...

  20. Costs of care in hemophilia and possible implications of health care reform.

    Science.gov (United States)

    Johnson, Kathleen A; Zhou, Zheng-Yi

    2011-01-01

    Economic evaluation in health care is increasingly used to assist policy makers in their difficult task of allocating limited resources. The high cost of care, including that for clotting factor concentrates, makes hemophilia a potential target for cost-cutting efforts by health care payers. Although the appropriate management of hemophilia is key to minimizing and preventing long-term morbidity, comparative effectiveness studies regarding the relative benefit of different treatment options are lacking. Cost-of-illness (COI) analysis, which includes direct and indirect costs from a societal perspective, can provide information to be used in cost-effectiveness and other economic analyses. Quality-of-life assessment provides another methodology with which to measure outcomes and benefits of appropriate disease management. Health care reform has implications for individuals with hemophilia and their families through changes in payment, insurance coverage expansion, and health care delivery system changes that reward quality and stimulate cooperative, team-based care. Providers will benefit from the expansion of insurance coverage and some financial benefits in rural areas, and from the expansion of coverage for preventive services. Accountable care organizations will potentially change the way providers are paid and financial incentives under reform will reward high quality of care.

  1. Comprehensive Child Care Program: Phase 1 - Evaluation Results.

    Science.gov (United States)

    Harachi, Tracy; Anthony, Emily; Bleisner, Siri

    Seattle's Comprehensive Child Care Program (CCCP) (Washington) is made up of a child care subsidy to offset child care costs for working and student families with low incomes, and quality assurance and technical assistance for 150 child care providers, including on-site evaluations, public health consulting, continuing education for providers, and…

  2. Cost differentials of dental outpatient care across clinical dentistry branches

    OpenAIRE

    Jovana Rančić; Nemanja Rančić; Nemanja Majstorović; Vladimir Biočanin; Marko Milosavljević; Mihajlo Jakovljević

    2015-01-01

    Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was...

  3. Investments and costs of oral health care for Family Health Care

    Directory of Open Access Journals (Sweden)

    Márcia Stefânia Ribeiro Macêdo

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

  4. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  5. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  6. Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs.

    Science.gov (United States)

    Jain, Kriti M; Maulsby, Catherine; Brantley, Meredith; Kim, Jeeyon Janet; Zulliger, Rose; Riordan, Maura; Charles, Vignetta; Holtgrave, David R

    2016-09-01

    Out of >1,000,000 people living with HIV in the USA, an estimated 60% were not adequately engaged in medical care in 2011. In response, AIDS United spearheaded 12 HIV linkage and retention in care programs. These programs were supported by the Social Innovation Fund, a White House initiative. Each program reflected the needs of its local population living with HIV. Economic analyses of such programs, such as cost and cost threshold analyses, provide important information for policy-makers and others allocating resources or planning programs. Implementation costs were examined from societal and payer perspectives. This paper presents the results of cost threshold analyses, which provide an estimated number of HIV transmissions that would have to be averted for each program to be considered cost-saving and cost-effective. The methods were adapted from the US Panel on Cost-effectiveness in Health and Medicine. Per client program costs ranged from $1109.45 to $7602.54 from a societal perspective. The cost-saving thresholds ranged from 0.32 to 1.19 infections averted, and the cost-effectiveness thresholds ranged from 0.11 to 0.43 infections averted by the programs. These results suggest that such programs are a sound and efficient investment towards supporting goals set by US HIV policy-makers. Cost-utility data are pending. PMID:27017972

  7. Low Cost Phased Array Antenna System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — A program is proposed to research the applicability of a unique phased array technology, dubbed FlexScan, to S-band and Ku-band communications links between...

  8. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

    Directory of Open Access Journals (Sweden)

    Jochen Profit

    Full Text Available BACKGROUND: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. METHODS AND FINDINGS: A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in

  9. The costs of long-term care: distribution and responsibility.

    Science.gov (United States)

    Wallack, S S; Cohen, M A

    1988-01-01

    Long-term care costs will result in financial hardship for millions of elderly Americans and their families. The growing number of elderly people has focused public attention on the catastrophic problem of coverage for long-term care. Social insurance is unlikely to emerge as a solution in the USA. One reason is that the expected total cost is viewed as an unmanageable burden by both Federal and State governments. To others, it is the uncertainty surrounding the projected costs. This paper reports on the results of a double-decrement life-table analysis, based on a national survey of the elderly taken in early 1977 and one year later, that estimated the distribution and total lifetime nursing-home costs of the elderly. Combining the probability of nursing-home entry and length of stay, a 65-year-old faces a 43% chance of entering a nursing home and spending about +11,000 (1980 dollars). The distribution of lifetime costs is however very skewed with 13% of the elderly consuming 90% of the resources. Thus, while the costs of nursing-home care can be catastrophic for an individual, spread across a group they are not unmanageable. Given the distribution of income and assets among the elderly, a sizeable proportion could readily afford the necessary premiums of different emerging insurance and delivery programmes. Alternative private and public models of long-term care must be evaluated in terms of the goals of a finance and delivery system for long-term care. PMID:3129256

  10. Interrelation of Preventive Care Benefits and Shared Costs under the Affordable Care Act (ACA

    Directory of Open Access Journals (Sweden)

    Robert Dixon

    2014-08-01

    Full Text Available With the implementation of the Affordable Care Act (ACA, access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures. Even with improved access to preventive care benefits, cost-sharing of other health services remains a major component of insurance plans. In order to treat identified conditions or diseases, cost-sharing comes into play. With the greater adoption of cost-sharing insurance plans, expenditures on the part of enrollee are anticipated to rise. Once the healthcare recipients realize the implication of early identification and resultant treatment costs, enrollment in preventive care may decline. Healthcare legislation and regulation should consider the full spectrum of care and the microeconomic costs associated with preventive treatment. Although the system at large may not realize the immediate impact, behavioral shifts on the part of healthcare consumers may alter healthcare. Rather than the current status quo of treating presenting conditions, preventive treatment is largely anticipated to require more resources and may impact the consumer’s financial capacity. This report will explore how these two concepts are co-dependent, and highlight the need for continued reform.

  11. The costs and service implications of substituting intermediate care for acute hospital care.

    Science.gov (United States)

    Mayhew, Leslie; Lawrence, David

    2006-05-01

    Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

  12. Cost-effectiveness of ruling out deep venous thrombosis in primary care versus care as usual

    NARCIS (Netherlands)

    A.J. ten Cate-Hoek; D.B. Toll; H.R. Büller; A.W. Hoes; K.G. Moons; R. Oudega; H.E. Stoffers; E.F. van der Velde; H.C. van Weert; M.H. Prins; M.A. Joore

    2009-01-01

    Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test com

  13. Racial and Ethnic Differences in Diabetes Care and Health Care Use and Costs

    OpenAIRE

    Lee, Jung-ah; Liu, Chuan-Fen; Sales, Anne E

    2006-01-01

    Introduction Previous studies have shown racial and ethnic differences in diabetes complication rates and diabetes control. The objective of this study was to examine racial and ethnic differences in diabetes care and health care use and costs for adults with diabetes using a nationally representative sample of the U.S. noninstitutionalized civilian population. Methods We performed a cross-sectional analysis of the 2000 Medical Expenditure Panel Survey (MEPS) and its related Diabetes Care Sur...

  14. Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

    Science.gov (United States)

    Seninger, Stephen; Smith, Dean G

    2004-01-01

    Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations.

  15. Innovation amidst radical cost containment in health care.

    Science.gov (United States)

    Beard, Edward L; Sharkey, Kim

    2013-01-01

    The changing health care environment is requiring nurse executives within a hospital setting to design and implement innovative workforce practices that will both improve patient outcomes and lower costs. Since registered nurses comprise the largest percentage of a hospital's workforce, finding ways to incorporate them in these efforts is essential. The Magnet Recognition Program through the American Nurses Credentialing Center is one successful evidence-based strategy that can be adopted to engage nurses in quality improvement processes. This article describes how two community hospitals used the principles of the Magnet Recognition Program to develop and implement new approaches to meet the health care imperative of providing safer, high-quality, cost-effective care.

  16. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    Science.gov (United States)

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  17. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    Science.gov (United States)

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  18. Creating patient value in glaucoma care : applying quality costing and care delivery value chain approaches

    NARCIS (Netherlands)

    D.F. de Korne (Dirk); J.C.A. Sol (Kees); T. Custers (Thomas); E. van Sprundel (Esther); B.M. van Ineveld (Martin); H.G. Lemij (Hans); N.S. Klazinga (Niek)

    2009-01-01

    textabstractPurpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost model (QC

  19. Cost reduction in absorption chillers: Phase 2

    Energy Technology Data Exchange (ETDEWEB)

    Leigh, R.W.

    1989-02-01

    A research program at Brookhaven National Laboratory (BNL) has addressed the possibility of dramatically lowering the first costs of absorption chillers through lowered material intensity and the use of lower cost materials, primarily in the heat exchangers which make up the bulk of the operating components of these systems. This must be done while retaining the best performance characteristics available today, a gross design point coefficient of performance (COP) of 1.3 and a net design (seasonal) average COP of 1.0 (0.90) in a directly fired, double effect unit. We have investigated several possible routes to these goals, and here report on these findings, focusing on the areas that appear most promising. The candidate technologies include the use of polymer film heat exchangers in several applications, the use of thin strips of new, corrosion resistant alloys to replace thicker, less impervious metals in applications exposed to gas flames, and copper or cupro-nickel foils in contact with system water. The use of such materials is only possible in the context of new heat exchanger and system designs, which are also discussed. To lend focus, we have concentrated on a directly fired double effect system providing capacity only. If successful, these techniques will also find wide applicability in heat pumps, cogeneration systems, solar cooling, heat recovery and chemical process heat transfer. 46 refs., 24 figs., 22 tabs.

  20. Cost drivers of inpatient mental health care: a systematic review.

    Science.gov (United States)

    Wolff, J; McCrone, P; Koeser, L; Normann, C; Patel, A

    2015-02-01

    Aims. New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence. Methods. A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted. Results. The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site. Conclusions. Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.

  1. Cost Analysis of Enhancing Linkages to HIV Care Following Jail: A Cost-Effective Intervention

    OpenAIRE

    Spaulding, Anne C.; Pinkerton, Steven D.; Superak, Hillary; Cunningham, Marc J.; Resch, Stephen; Jordan, Alison O.; Yang, Zhou

    2013-01-01

    We are not aware of published cost-effectiveness studies addressing community transitional programs for HIV-infected jail detainees. To address this gap, data from 9 sites of EnhanceLink, a project that enrolled HIV-infected releasees from jails across the US, were examined. Figures on the number of clients served, cost of linkage services, number of linkages and 6-month sustained linkages to community HIV care, and number of clients achieving viral suppression were assessed for subjects rele...

  2. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  3. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  4. Endogenous cost-effectiveness analysis and health care technology adoption.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2013-01-01

    Increased health care spending has placed pressure on public and private payers to prioritize spending. Cost-effectiveness (CE) analysis is the main tool used by payers to prioritize coverage of new therapies. We argue that reimbursement based on CE is subject to a form of the "Lucas critique"; the goals of CE policies may not materialize when firms affected by the policies respond optimally to them. For instance, because 'costs' in CE analysis reflect prices set optimally by firms rather than production costs, observed CE levels will depend on how firm pricing responds to CE policies. Observed CE is therefore endogenous. When CE is endogenously determined, policies aimed at lowering spending and improving overall CE may paradoxically raise spending and lead to the adoption of more resource-costly treatments. We empirically illustrate whether this may occur using data on public coverage decisions in the United Kingdom. PMID:23202262

  5. Phase transitions in a coevolving snowdrift game with costly rewiring

    Science.gov (United States)

    Zhang, W.; Li, Y. S.; Du, P.; Xu, C.; Hui, P. M.

    2014-11-01

    We propose and study a dissatisfied adaptive snowdrift game with a payoff parameter r that incorporates a cost for rewiring a connection. An agent, facing adverse local environment, may switch action without a cost or rewire an existing link with a cost a so as to attain a better competing environment. Detailed numerical simulations reveal nontrivial and nonmonotonic dependence of the frequency of cooperation and the densities of different types of links on a and r . A theory that treats the cooperative and noncooperative agents separately and accounts for spatial correlation up to neighboring agents is formulated. The theory gives results that are in good agreement with simulations. The frequency of cooperation fC is enhanced (suppressed) at high rewiring cost relative to that at low rewiring cost when r is small (large). For a given value of r , there exists a critical value of the rewiring cost below which the system evolves into a phase of frozen dynamics with isolated noncooperative agents segregated from a cluster of cooperative agents, and above which the system evolves into a connected population of mixed actions with continual dynamics. The phase boundary on the a -r phase space that separates the two phases with distinct structural, population and dynamical properties is mapped out. The phase diagram reveals that, as a general feature, for small r (small a ), the disconnected and segregated phase can survive over a wider range of a (r ) .

  6. Health-care cost of diabetes in South India: A cost of illness study

    OpenAIRE

    Akari, Sadanandam; Mateti, Uday Venkat; Kunduru, Buchi Reddy

    2013-01-01

    Objective: The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India. Methods: A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were inclu...

  7. Cost of care for cystic fibrosis: an investigation of cost determinants using national registry data.

    Science.gov (United States)

    Gu, Yuanyuan; García-Pérez, Sonia; Massie, John; van Gool, Kees

    2015-09-01

    Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Registry, individual annual health care costs were calculated and a regression analysis was carried out to examine the impact of multiple variables on the costs. A method of retransformation and a hypothetical patient were used for cost analysis. We show that an additional one unit improvement of FEV1pp (i.e., forced expiratory volume in 1 s as a percentage of predicted volume) reduces the costs by 1.4%, or for a hypothetical patient whose FEV1pp is 73 the cost reduction is A$252. The presence of chronic infections increases the costs by 69.9-163.5% (A$12,852-A$30,047 for the hypothetical patient) depending on the type of infection. The type of CF genetic mutation and the patient's age both have significant effects on the costs. In particular, being homozygous for p.F508del increases the costs by 26.8% compared to all the other gene mutations. We conclude that bacterial infections have a very strong influence on the costs, so reducing both the infection rates and the severity of the condition may lead to substantial cost savings. We also suggest that the patient's genetic profile should be considered as an important cost determinant.

  8. Cost-effectiveness of centralised and partly centralised care compared to usual care for patients with type 2 diabetes

    NARCIS (Netherlands)

    Van Der Heijden, A.A.W.; Feenstra, T.L.; De Bruijne, M.C.; Baan, C.A.; Donker, G.A.; Dekker, J.M.; Nijpels, G.

    2014-01-01

    Background and aims: Due to an ever increasing number of type 2 diabetes patients, innovations to control the increasing health care use and costs are needed. Results of diabetes care programs on the costs or (cost-) effectiveness are heterogeneous. The aim of this study is to compare the cost-effec

  9. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    Directory of Open Access Journals (Sweden)

    Jitender Sodhi

    2016-01-01

    Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

  10. Cost differentials of dental outpatient care across clinical dentistry branches

    Directory of Open Access Journals (Sweden)

    Jovana Rančić

    2015-03-01

    Full Text Available Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€.Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%, oral surgery (19.5% and radiology (17.4%, while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided, pulpitis (11.2% and impacted teeth (8.5%, while most expensive to treat were anomalies of tooth position (€ 648 ± 667, abnormalities of size and form of teeth (€ 508 ± 705 and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339.Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future

  11. Cost-benefit analysis: patient care at neurological intensive care unit.

    Science.gov (United States)

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  12. The hidden cost of 'free' maternity care in Dhaka, Bangladesh.

    Science.gov (United States)

    Nahar, S; Costello, A

    1998-12-01

    We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section. PMID:10346033

  13. Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); B.M. van Ineveld (Martin); T.E.M. Miltenburg (T. E M)

    1992-01-01

    markdownabstract__Abstract__ The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8500 per patient for breast cancer patien

  14. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    Science.gov (United States)

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. PMID:26910129

  15. Guided care: cost and utilization outcomes in a pilot study.

    Science.gov (United States)

    Sylvia, Martha L; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia M; Park, Margaret; Boult, Chad

    2008-02-01

    Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population. PMID:18279112

  16. Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review

    NARCIS (Netherlands)

    K.M. van Steenbergen-Weijenburg (Kirsten); C.M. van der Feltz-Cornelis (Christina); E.K. Horn (Eva); H.W. van Marwijk (Harm); A.T.F. Beekman (Aartjan); F.F.H. Rutten (Frans); L. van Hakkaart-van Roijen (Leona)

    2010-01-01

    textabstractBackground. The effectiveness of collaborative care for patients with major depressive disorder in primary care has been established. Assessing its cost-effectiveness is important for deciding on implementation. This review therefore evaluates the cost-effectiveness of collaborative care

  17. Adaptation of activity-based-costing (ABC) to calculate unit costs in Mental Health Care in Spain

    OpenAIRE

    Karen Moreno

    2007-01-01

    Background: To date, numerous cost-of-illness studies have been using methodologies that don't provide trustworthy results for decision making in mental health care. Objectives: The aims of this paper are design and implement a cost methodology by process of patient's care to calculate unit costs in mental health in Spain in 2005 and compare the results with the reached ones by traditional methods. Methods: We adapted Activity-Based-Costing to this field analyzing the organizational and manag...

  18. [Case management. The nursing business of care or cost].

    Science.gov (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management. PMID:1291932

  19. Sequential Antibiotic Therapy: Effective Cost Management and Patient Care

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    1995-01-01

    Full Text Available The escalating costs associated with antimicrobial chemotherapy have become of increasing concern to physicians, pharmacists and patients alike. A number of strategies have been developed to address this problem. This article focuses specifically on sequential antibiotic therapy (sat, which is the strategy of converting patients from intravenous to oral medication regardless of whether the same or a different class of drug is used. Advantages of sat include economic benefits, patient benefits and benefits to the health care provider. Potential disadvantages are cost to the consumer and the risk of therapeutic failure. A critical review of the published literature shows that evidence from randomized controlled trials supports the role of sat. However, it is also clear that further studies are necessary to determine the optimal time for intravenous to oral changeover and to identify the variables that may interfere with the use of oral drugs. Procedures necessary for the implementation of a sat program in the hospital setting are also discussed.

  20. Information Technology: A Tool to Cut Health Care Costs

    Science.gov (United States)

    Mukkamala, Ravi; Maly, K. J.; Overstreet, C. M.; Foudriat, E. C.

    1996-01-01

    Old Dominion University embarked on a project to see how current computer technology could be applied to reduce the cost and or to improve the efficiency of health care services. We designed and built a prototype for an integrated medical record system (MRS). The MRS is written in Tool control language/Tool kit (Tcl/Tk). While the initial version of the prototype had patient information hard coded into the system, later versions used an INGRES database for storing patient information. Currently, we have proposed an object-oriented model for implementing MRS. These projects involve developing information systems for physicians and medical researchers to enhance their ability for improved treatment at reduced costs. The move to computerized patient records is well underway, several standards exist for laboratory records, and several groups are working on standards for other portions of the patient record.

  1. Cost accounting, management control, and planning in health care.

    Science.gov (United States)

    Siegrist, R B; Blish, C S

    1988-02-01

    Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338

  2. What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients

    OpenAIRE

    Bovier Patrick A; Agoritsas Thomas; Deom Marie; Perneger Thomas V

    2010-01-01

    Abstract Background How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients. Methods Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral...

  3. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  4. 40 CFR 265.144 - Cost estimate for post-closure care.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a....280, and 265.310. (1) The post-closure cost estimate must be based on the costs to the owner...

  5. [Cost-effectiveness in Dutch mental health care: future because of ROM?

    NARCIS (Netherlands)

    Agthoven, M. van; Kolk, A. van der; Knegtering, H.; Delespaul, P.A.; Arends, J.; Jeurissen, P.P.T.; Krabbe, P.F.M.; Huijsman, R.; Luijk, R.; Beurs, E. de; Hakkaart-van Roijen, L.; Bruggeman, R.

    2015-01-01

    BACKGROUND: The document reporting Dutch mental health care negotiations for 2014 - 2017 calls for a cost decrease based on cost-effectiveness. Thanks to rom, the Dutch mental health care seems well prepared for cost-effectiveness research.
    AIM: Evaluate how valid cost-effectiveness resea

  6. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care.Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burd...

  7. Patients in a depression collaborative care model of care: comparison of 6-month cost utilization data with usual care.

    Science.gov (United States)

    Angstman, Kurt B; Williams, Mark D

    2010-04-01

    A collaborative care model (CCM) has been implemented for management of depression. This paper studies the impact that the CCM had on cost measures for the period of six months after initial diagnosis of depression compared to patients receiving usual care (UC). There was a significant increase in the CPT costs for the six months following diagnosis in the CCM group ($451.35 vs. $323.50, P < 0.001). The average CPT cost rank and CPT cost differential were also significantly increased in the CCM group. The adjusted means of the CPT costs were (when controlling for prior utilization) $452.11 for the CCM group and $322.09 for UC (P < 0.001). In the CCM group; there were 161 patients (73.5%) that achieved a clinical response for their depression compared to the UC group, which had a 15.1% (18/119) response rate (P < 0.001). There also was a significant difference between the groups in those who were symptoms free of their depression (PHQ-9 score < 5), with the CCM having 59.4% of the patients symptom-free compared to 10.9% of the UC group (P < 0.001). In this group of patients, CCM is associated with markedly improved clinical outcomes for depression, however with a modest short-term increase in CPT costs. PMID:23804062

  8. Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review

    Directory of Open Access Journals (Sweden)

    van Marwijk Harm WJ

    2010-01-01

    Full Text Available Abstract Background The effectiveness of collaborative care for patients with major depressive disorder in primary care has been established. Assessing its cost-effectiveness is important for deciding on implementation. This review therefore evaluates the cost-effectiveness of collaborative care for major depressive disorder in primary care. Methods A systematic search on economic evaluations of collaborative care was conducted in Pubmed and PsychInfo. Quality of the studies was measured with the Cochrane checklist and the CHEC-list for economic evaluations. Cost-effectiveness and costs per depression-free days were reported. Results 8 studies were found, involving 4868 patients. The quality of the cost effectiveness studies, according to the CHEC-list, could be improved. Generally, the studies did not include all relevant costs and did not perform sensitivity analysis. Only 4 out of 8 studies reported cost per QALY, 6 out of 8 reported costs per depression-free days. The highest costs per QALY reported were $49,500, the highest costs per depression-free day were $24. Conclusions Although studies did not fulfil all criteria of the CHEC-list, collaborative care is a promising intervention and it may be cost-effective. However, to conclude on the cost-effectiveness, depression research should follow economic guidelines to improve the quality of the economic evaluations.

  9. Utilization and Costs of Health Care after Geriatric Traumatic Brain Injury

    OpenAIRE

    Thompson, Hilaire J.; Weir, Sharada; Rivara, Frederick P; Wang, Jin; Sullivan, Sean D.; Salkever, David; MacKenzie, Ellen J.

    2012-01-01

    Despite the growing number of older adults experiencing traumatic brain injury (TBI), little information exists regarding their utilization and cost of health care services. Identifying patterns in the type of care received and determining their costs is an important first step toward understanding the return on investment and potential areas for improvement. We performed a health care utilization and cost analysis using the National Study on the Costs and Outcomes of Trauma (NSCOT) dataset. ...

  10. Costs and prospects for home based Long Term Care in Northern Italy: the Galca survey

    OpenAIRE

    Bettio, Francesca; Mazzotta, Fernanda; Solinas, Giovanni

    2007-01-01

    An important issue in the design of sustainable Long Term Care policies is the relative social cost of community or home based care versus institutional care. Here we undertake this cost comparison making use of the findings from the GALCA surveys on Long Term Care in Denmark, Ireland and Italy but confining attention to Italy. The survey for Italy was conducted in the municipality of Modena that may be considered broadly representative of Long Term Care conditions in the North of the country...

  11. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  12. Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada.

    Science.gov (United States)

    Yu, Mo; Guerriere, Denise N; Coyte, Peter C

    2015-11-01

    In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of

  13. Effects of different broiler production systems on health care costs in the Netherlands.

    Science.gov (United States)

    Gocsik, É; Kortes, H E; Lansink, A G J M Oude; Saatkamp, H W

    2014-06-01

    This study analyzed the effects of different broiler production systems on health care costs in the Netherlands. In addition to the conventional production system, the analysis also included 5 alternative animal welfare systems representative of the Netherlands. The study was limited to the most prevalent and economically relevant endemic diseases in the broiler farms. Health care costs consisted of losses and expenditures. The study investigated whether higher animal welfare standards increased health care costs, in both absolute and relative terms, and also examined which cost components (losses or expenditures) were affected and, if so, to what extent. The results show that health care costs represent only a small proportion of total production costs in each production system. Losses account for the major part of health care costs, which makes it difficult to detect the actual effect of diseases on total health care costs. We conclude that, although differences in health care costs exist across production systems, health care costs only make a minor contribution to the total production costs relative to other costs, such as feed costs and purchase of 1-d-old chicks.

  14. The Effects Of Cost-Sharing In Health Care: What Do We Know From Empirical Evidence?

    OpenAIRE

    Carrieri Vincenzo

    2010-01-01

    Political and academic debate about cost-sharing in health care is becoming very popular because of the massive health care expenditure growth. In this paper, we aim to validate the use of cost-sharing in health care by assessing the effects that different policies of cost-sharing have produced around the world. We review, then, several empirical papers dealing with cost-sharing effects with respect to three main issues: moral hazard-contrast, redistributive effects and health care cost-conta...

  15. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

    NARCIS (Netherlands)

    Schafer, W.L.; Boerma, W.G.; Kringos, D.S.; Maeseneer, J. De; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects

  16. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary c

  17. The Arizona Health Care Cost Containment System: A Prepayment Model for a National Health Service?

    OpenAIRE

    Orient, Jane M.

    1986-01-01

    The Arizona Health Care Cost Containment System (AHCCCS), the Arizona Medicaid alternative, is an experiment in contracting “prepaid” indigent health care to the lowest bidding group. The consequences have been substantial cost overruns and serious unanswered questions about the quality and avilability of care.

  18. Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

    Directory of Open Access Journals (Sweden)

    Ana Claudia Molina Cavassini

    2012-04-01

    Full Text Available OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System.

  19. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

  20. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Jitender Sodhi; Sidhartha Satpathy; D K Sharma; Rakesh Lodha; Arti Kapil; Nitya Wadhwa; Shakti Kumar Gupta

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India.Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertia...

  1. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Sodhi, Jitender; Satpathy, Sidhartha; D K Sharma; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty terti...

  2. Future European health care: cost containment, health care reform and scientific progress in drug research.

    Science.gov (United States)

    Emilien, G

    1997-01-01

    The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.

  3. Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

    Directory of Open Access Journals (Sweden)

    Thomas Grochtdreis

    Full Text Available For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP.In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

  4. Worker's comp meets managed care. In the quest for lower costs, a new niche emerges.

    Science.gov (United States)

    Schuckman, P V

    1998-01-01

    Niche markets such as Medicare, Medicaid and behavioral healthcare are looking to managed care to control costs and increase the quality of care provided. Now workers' compensation officials are looking to managed care with the same goals in mind. As managed care organizations begin marketing to these special populations, the information glut is growing. Information technology can aid managed care officials in the collection, organization and dissemination of the data. PMID:10177514

  5. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V.; Gupta, Shakti Kumar

    2016-01-01

    Context: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Statistical analysis was performed by Fisher's two tailed t-test. Results: Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  6. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

    Directory of Open Access Journals (Sweden)

    Virta Lena

    2012-02-01

    Full Text Available Abstract Background Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results 204 (103 women patients, mean age 48 (SD 11 years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16% remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389 during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

  7. Parents and the High Cost of Child Care: 2013 Report

    Science.gov (United States)

    Wood, Stephen; Kendall, Rosemary

    2013-01-01

    Every week in the United States, nearly 11 million children younger than age 5 are in some type of child care arrangement. On average, these children spend 36 hours a week in child care. While parents are children's first and most important teachers, child care programs provide early learning for millions of young children daily, having a profound…

  8. Comparing Aging in Place to Home Health Care: Impact of Nurse Care Coordination On Utilization and Costs.

    Science.gov (United States)

    Popejoy, Lori L; Galambos, Colleen; Stetzer, Frank; Popescu, Mihail; Hicks, Lanis; Khalilia, Mohammed A; Rantz, Marilyn J; Marek, Karen D

    2015-01-01

    The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care. This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs. This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people. The care coordinators in this study practiced nursing by routinely assessing and educating patients and families, assuring adequate service delivery, and communicating with the multidisciplinary health care team. Care coordination managed by registered nurses can influence utilization and cost outcomes, and impact health and functional abilities.

  9. The Emotional and Economic Costs of Bereavement in Health Care Settings

    Directory of Open Access Journals (Sweden)

    Janice L Genevro

    2010-09-01

    Full Text Available Research to date on grief and bereavement in health care providers has focused on those experiences from the perspective of the individual. We propose, however, that the emotional costs of bereavement in the health care setting are also health care systems issues. This paper focuses on the emotional costs of grief and bereavement in health care providers, and on the economic costs of bereavement and bereavement care in health care settings. Evidence regarding the costs and cost-effectiveness of bereavement interventions is limited. We summarise existing relevant research and offer an overview of the types of costs and cost information that would optimally be collected in research on bereavement in health care settings. We also propose an analytic framework that could be used to systematically consider the larger picture of bereavement in health care settings, how available evidence fits into this picture, and what evidence is needed to improve care. This approach is derived from health services research. It is hoped that the proposed framework will prove useful in stimulating new research questions, and in guiding research that not only advance

  10. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness. Health Technology Case Study 38.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    After a brief introduction delineating the scope of the case study, chapter 1 summarizes findings and conclusions about the costs and effectiveness of neonatal intensive care in the United States. Chapter 2 inventories the national supply of neonatal intensive care units and describes recent trends in use and costs. Chapter 3 reviews mortality and…

  11. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.

    NARCIS (Netherlands)

    Graff, M.J.L.; Adang, E.M.M.; Vernooij-Dassen, M.J.F.J.; Dekker, J.; Jonsson, L.; Thijssen, M.; Hoefnagels, W.H.L.; Olde Rikkert, M.G.M.

    2008-01-01

    OBJECTIVE: To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. DESIGN: Cost effectiveness study alongside a single blind randomised controlled trial. SETTING: Memory clinic,

  12. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

    International Nuclear Information System (INIS)

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

  13. The logic of transaction cost economics in health care organization theory.

    Science.gov (United States)

    Stiles, R A; Mick, S S; Wise, C G

    2001-01-01

    Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes. PMID:11293015

  14. Adaptation of activity-based-costing (ABC to calculate unit costs in Mental Health Care in Spain

    Directory of Open Access Journals (Sweden)

    Karen Moreno

    2007-06-01

    Full Text Available Background: To date, numerous cost-of-illness studies have been using methodologies that don't provide trustworthy results for decision making in mental health care. Objectives: The aims of this paper are design and implement a cost methodology by process of patient's care to calculate unit costs in mental health in Spain in 2005 and compare the results with the reached ones by traditional methods. Methods: We adapted Activity-Based-Costing to this field analyzing the organizational and management structure of Mental Health's public services in a region of Spain, Navarre, describing the processes of care to patient in each resource and calculating their cost. Results: We implemented this methodology in all resources and obtained unit cost per service. There are great differences between our results and the ones calculated by traditional systems. We display one example of these disparities contrasting our cost with the reached one by the methodology of Diagnostic Related Group (DRG. Conclusions: This cost methodology offers more advantages for management than traditional methods provide.

  15. Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal.

    OpenAIRE

    Marseille, E.

    1996-01-01

    Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost of US$5.06 per disability-adjusted life year (DALY). This places it among the most cost-effective of public health interventions. Sensitivity analysis indicates that cataract surg...

  16. Costs of quality management systems in long-term care organizations: an exploration.

    NARCIS (Netherlands)

    Wagner, C.; Merode, G.G. van; Oort, M. van

    2003-01-01

    The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a questionnair

  17. Effects of physician joint ventures on health care costs, access, and quality: exploring some issues.

    Science.gov (United States)

    Ahern, M; Scott, E

    1992-01-01

    Increasingly, physicians are joint-venturing with health care businesses such as physical therapy centers, diagnostic imaging centers, ambulatory surgical centers, and other services. Simultaneously, outpatient costs have been rising. Theoretical and empirical evidence, including results of an exploratory survey of experts, indicate that these two events are linked. Specifically, joint ventures between referring physicians and health care businesses often appear to increase costs, increase utilization, reduce quality of care, and reduce access.

  18. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day

    1998-09-01

    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  19. The state of the art of costing health care for economic evaluation.

    Science.gov (United States)

    Donaldson, C

    1990-01-01

    In this paper, the principles of costing health care for economic evaluation are outlined. Hypothetical and published examples are used to illustrate these principles. First, the economic concept of opportunity cost is defined. Secondly, the techniques of economic evaluation which follow from this definition are introduced: they are cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. Thirdly, a list of costs which should be considered for inclusion in either of these types of evaluation is provided, this listing being based on the concept of opportunity cost. Problems of measurement and valuation of costs are then outlined, focusing in particular on inflation, discounting, marginal costing, patient-based versus per diem costing, allocating overheads, costing capital and equipment and adjusting distorted market valuations. An example of sensitivity analysis is provided and also a checklist of questions to ask when setting up any costing exercise within an economic evaluation.

  20. Cost-Benefit Analysis in Social Care for Elderly People

    Science.gov (United States)

    Dutrenit, Jean-Marc

    2005-01-01

    Social care at home for elderly people is now growing rapidly in France. A new question is, What are better forms of care for the different partners concerned? The research presented here, and made for the Comity of Lille Employment Area with cooperation of the Caisse Primaire d'Assurance Maladiede Lille (the local board of the national social…

  1. An estimate of the global health care and lost productivity costs of dengue.

    Science.gov (United States)

    Selck, Frederic W; Adalja, Amesh A; Boddie, Crystal R

    2014-11-01

    Contemporary cost estimates of dengue fever are difficult to attain in many countries in which the disease is endemic. By applying publicly available health care costs and wage data to recently available country-level estimates of dengue incidence, we estimate the total cost of dengue to be nearly 40 billion dollars in 2011. PMID:25409275

  2. The effects of age, gender, and crash types on drivers' injury-related health care costs.

    Science.gov (United States)

    Shen, Sijun; Neyens, David M

    2015-04-01

    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.

  3. How responsive is female labour supply to child care costs: New australian estimates

    OpenAIRE

    Gong, Xiaodong; Breunig, Robert; King, Anthony

    2010-01-01

    The degree of responsiveness of Australian women's labour supply to child care cost has been a matter of some debate. There is a view that the level of responsiveness is very low or negligible, running counter to international and anecdotal evidence. In this paper we review the Australian and international literature on labour supply and child care, and provide improved Australian estimates of labour supply elasticities and child care demand elasticities with respect to gross child care price...

  4. Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable

    Directory of Open Access Journals (Sweden)

    Schmier JK

    2016-05-01

    Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel

  5. Transaction costs, externalities and information technology in health care.

    Science.gov (United States)

    Ferguson, B; Keen, J

    1996-01-01

    This paper discusses some of the economic issues which underpin the rationale for investment in information and communications technologies (ICTs). Information imperfections lead to significant transaction costs (search, negotiating and monitoring) which in turn confer a negative externality on parties involved in exchange. This divergence in private and social costs leads to a degree of resource misallocation (efficiency loss) which, uncorrected, results in a sub-optimal outcome. Traditional solutions to this problem are to rely upon direct government action to reduce the costs of transacting between market agents, or to employ tax/subsidy measures and other legislative action to achieve the desired market outcome. Three key policy questions are raised in the context of the NHS purchaser/provider relationship. Firstly, what is the optimum level of transaction costs; secondly, can ICTs assist in lowering the level of transaction costs to the optimum level; thirdly, who should bear the investment cost in reducing the level of transaction costs? The issue of property rights in different information systems is discussed and raises interesting policy questions about how much investment should be undertaken centrally rather than devolved to a more local level. In some ways this economic framework offers a post hoc justification of why different ICT systems have been introduced at various levels of the NHS. Essentially this reduces to the problem of externalities: providing good information confers a positive externality: not providing relevant, timely and accurate information confers a negative externality, by increasing further the level of transaction costs. The crucial role which ICT systems can play lies in attempting to reduce the level of transaction costs and driving the market towards what Dahlman has described as the transaction-cost-constrained equilibrium.

  6. Associations of multiplicity of comorbid health conditions, serious mental illness, and health care costs.

    Science.gov (United States)

    Lee, Sungkyu; Black, Denise; Held, Mary

    2016-08-01

    Using a nationally representative U.S. sample, this study analyzed the effects of serious mental illness (SMI) and comorbid medical conditions on the cost of health care. The results of path model indicated that SMI and comorbid health conditions each increased total health care costs. Additionally, individuals with SMI were likely to have more comorbid medical conditions, which in turn, increased total health care costs. Findings raise awareness of an increased risk of medical conditions among individuals with SMI and the concern of high expenditures associated with comorbid SMI and medical conditions. PMID:27285200

  7. Patient education after stoma creation may reduce health-care costs

    DEFF Research Database (Denmark)

    Danielsen, Anne Kjærgaard; Rosenberg, Jacob

    2014-01-01

    AND METHODS: Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment...... Scale six months after surgery. The secondary outcome was generic health-related quality of life measured with Short Form (SF)-36. In this secondary analysis, we calculated direct health-care costs for the first six months post-operatively from the perspective of the health-care system, including costs...... related to the hospital as well as primary health care. RESULTS: The overall cost related to establishing a patient education programme showed no significant increase in the overall average costs. However, we found a significant reduction in costs related to unplanned readmissions (p = 0.01) as well...

  8. Estimating costs of care for meningitis infections in low- and middle-income countries.

    Science.gov (United States)

    Portnoy, Allison; Jit, Mark; Lauer, Jeremy; Blommaert, Adriaan; Ozawa, Sachiko; Stack, Meghan; Murray, Jillian; Hutubessy, Raymond

    2015-05-01

    Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.

  9. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    Science.gov (United States)

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D.K.; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were 2,04,787 (US$ 3,413) and 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was 1,48,200 (95% CI 55,716 to 2,40,685, Pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care. PMID:27377508

  10. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra;

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....

  11. Cost of Pediatric Visceral Leishmaniasis Care in Morocco.

    Directory of Open Access Journals (Sweden)

    Nabil Tachfouti

    Full Text Available Visceral leishmaniasis (VL is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients.From March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient.We obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$ than hospitals keeping the patients for the whole treatment (636 US$. However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.

  12. Direct costs of chronic obstructive pulmonary disease among managed care patients

    Directory of Open Access Journals (Sweden)

    An

    2010-09-01

    Full Text Available Anand A Dalal1, Laura Christensen2, Fang Liu3, Aylin A Riedel31US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Health Economics Outcomes Research, i3 Innovus, Ann Arbor, MI, USA; 3Health Economics Outcomes Research, i3 Innovus, Eden Prairie, MN, USAPurpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD among commercially insured patients in the US.Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days, emergency department (ED, standard inpatient admission, and intensive care unit (ICU cohorts. Patient-level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD annual COPD-related health care costs (2008 US$ increased across the cohorts (P < 0.001, ranging from $2003 ($3238 to $43,461 ($76,159 per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD episode-level costs were $305 ($310 for an outpatient visit, $274 ($336 for an urgent outpatient visit, $327 ($65 for an ED visit, $9745 ($2968 for a standard admission, and $33,440 for an ICU stay.Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs

  13. Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults

    Directory of Open Access Journals (Sweden)

    Huong Q. Nguyen, PhD

    2008-01-01

    Full Text Available IntroductionOur study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years.MethodsThis retrospective cohort study used administrative and claims data from a Medicare Advantage plan. Participants (n = 4766 were enrolled in the plan for at least 1 year before participating in the plan-sponsored health club benefit (Silver Sneakers. Controls (n = 9035 were matched to participants by age and sex according to the index date of Silver Sneakers enrollment. Multivariate regression models were used to estimate health care use and costs and to make subgroup comparisons according to frequency of health club visits.ResultsCompared with controls, Silver Sneakers participants were older and more likely to be male, used more preventive services, and had higher total health care costs at baseline. Adjusted total health care costs for Silver Sneakers participants and controls did not differ significantly in year 1. By year 2, compared with controls, Silver Sneakers participants had significantly fewer inpatient admissions (−2.3%, 95% confidence interval, −3.3% to −1.2%; P < .001 and lower total health care costs (−$500; 95% confidence interval, −$892 to −$106; P = .01]. Silver Sneakers participants who averaged at least two health club visits per week over 2 years incurred at least $1252 (95% confidence interval, −$1937 to −$567; P < .001 less in health care costs in year 2 than did those who visited on average less than once per week.ConclusionRegular use of a health club benefit was associated with slower growth in total health care costs in the long term but not in the short term. These findings warrant additional prospective investigations to determine whether policies to offer health club benefits and promote physical activity among older adults can reduce increases in health care costs.

  14. Cost Analysis of a Home-Based Nurse Care Coordination Program

    OpenAIRE

    Marek, Karen Dorman; Stetzer, Frank; Adams, Scott J.; Bub, Linda Denison; Schlidt, Andrea; Colorafi, Karen Jiggins

    2014-01-01

    Objectives To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost. Design Randomized, controlled, three-arm longitudinal study. Setting Participant homes in a large Midwestern urban area. Participants Older adults identified as having difficulty managing their medications at discharge from Medicare H...

  15. The Cost of Universal Health Care in India: A Model Based Estimate

    OpenAIRE

    Prinja, Shankar; Bahuguna, Pankaj; Andrew D Pinto; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    Introduction As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. Methods We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessar...

  16. The health system cost of post-abortion care in Rwanda.

    Science.gov (United States)

    Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola

    2015-03-01

    Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs.

  17. Using GIS to profile health-care costs of VA Quality-Enhancement Research Initiative diseases.

    Science.gov (United States)

    Yu, Wei; Cowper, Diane; Berger, Magdalena; Kuebeler, Mark; Kubal, Joe; Manheim, Larry

    2004-06-01

    The Health Services Research and Development (HSR&D) Service at the Department of Veterans Affairs (VA) Health Care System launched a Quality Enhancement Research Initiative (QUERI) in 1998. This study estimated health-care costs of nine diseases under the QUERI project and analyzed geographic differences in health-care costs and utilization across 22 VA Integrated Service Networks (VISNs), using a geographic information system (GIS). Patients with these diseases were identified from diagnoses recorded between October 1999 and September 2000. Annual health-care costs for each disease were estimated in four categories: inpatient medical or surgical, other inpatient, outpatient, and outpatient pharmacy. Geographic differences of costs and health-care utilization across the 22 VISNs for chronic heart failure, diabetes, and spinal-cord injury were mapped using a GIS package. Average costs and patterns of health-care utilization varied substantially across the 22 VISNs. The observed differences in health-care utilization across geographic regions raised questions for further investigation. PMID:15446617

  18. Provision of Child Care: Cost Functions for Profit-Making and Not-for-Profit Day Care Centers

    OpenAIRE

    Swati Mukerjee; Ann Dryden Witte; Sheila Hollowell

    1990-01-01

    This paper estimates cost functions for day care centers in Massachusetts. The production technology assumed is the generalized homothetic Cobb-Douglas production function. The cost function dual to this production function is estimated separately for profit-making (P1Os) and not-for-profit (NPOs) organizations. The results are discussed in the context of current NPO literature. NPOs are found to be operating at higher average coats than PMOs for most output levels as predicted by the literat...

  19. The role of technology in reducing health care costs. Final project report

    Energy Technology Data Exchange (ETDEWEB)

    Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

    1997-08-01

    Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

  20. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E

    2011-02-01

    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323

  1. Under Pressure: Tackling Pension and Health Care Costs

    Science.gov (United States)

    Friery, John

    2010-01-01

    Fueled by declining revenue from the housing crisis, skyrocketing energy costs, and an economy in general disarray, the public is pressuring school administrators to make broader and deeper cuts in their operating budgets. As the baby boomers retire, put their houses on the market, and downsize, one will see more downward price pressure on home…

  2. Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania.

    Science.gov (United States)

    Kowalewski, Marga; Mujinja, Phare; Jahn, Albrecht

    2002-04-01

    Following the difficult economic situation various countries introduced health sector reforms, including user charges to finance the system. The assessment of user costs for maternity services in Tanzania was part of a larger study, which covered inputs, outputs and efficiency of services. The study was carried out from October 1997 to January 1998 in Mtwara urban and rural district in South Tanzania. One hundred and seven women attending a quarter of government health facilities were randomly selected and interviewed. Twenty one key informants were also interviewed and service procedures observed. Users of maternity services pay mainly for admission, drugs, other supplies and travel costs. Travel costs represent about half of these financial costs. The average total costs vary between US$11.60 for antenatal consultation and US$135.40 for caesarean section at the hospital. Unofficial payments are not included in the calculation. The amounts vary and payment is irregular. We therefore conclude that time costs are constantly higher than financial costs. High direct payments and the fear of unofficial costs are acute barriers to the use of maternity services. User costs can substantially be reduced by the re-organisation of service delivery especially at antenatal consultation. PMID:12476730

  3. Canadian Children and Youth in Care: The Cost of Fetal Alcohol Spectrum Disorder

    Science.gov (United States)

    Popova, Svetlana; Lange, Shannon; Burd, Larry; Rehm, Jürgen

    2014-01-01

    Background: A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. Objective: The purpose of the current study was to estimate the number of children (0-18 years) in care with FASD and to determine the associated cost by age…

  4. The nonhospital costs of care of patients with CF in The Netherlands : Results of a questionnaire

    NARCIS (Netherlands)

    Wildhagen, MF; Verheij, JBGM; Verzijl, JG; Gerritsen, J; Bakker, W; Hilderink, HBM; tenKate, LP; Tijmstra, T; Kooij, L; Habbema, JDF

    1996-01-01

    Cystic fibrosis (CF) causes a relatively high medical consumption, A large part of the treatment takes place at home, Because data regarding nonhospital care are lacking, we wished to determine the costs of care of patients with CF outside the hospital. A questionnaire was sent to 73 patients with C

  5. Light-Weight, Low-Cost, Single-Phase, Liquid-Cooled Cold Plate (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Narumanchi, S.

    2013-07-01

    This presentation, 'Light-Weight, Low-Cost, Single-Phase Liquid-Cooled Cold Plate,' directly addresses program goals of increased power density, specific power, and lower cost of power electronics components through improved thermal management.

  6. Evaluating Health Care Externality Costs Generated by Risky Consumption Goods

    OpenAIRE

    Cohen, Michael A.; Marina-Selini Katsaiti

    2009-01-01

    We present an overlapping-generations (OLG) macroeconomic model that applies a behavioral interpretation of preferences for goods that generate health risks. In this paper proneness to poor health is viewed as a cognitive miscalculation by economic agents between their expected health state over various consumption bundles and the actual health care they require for their health outcome. To model this the paper borrows insight from prospect theory and applies the reference-dependent preferenc...

  7. Evaluating Health Care Externality Costs Generated by Risky Consuption Goods

    OpenAIRE

    Michael Cohen; Marina-Selini Katsaiti

    2009-01-01

    We present an overlapping-generations (OLG) macroeconomic model that applies a behavioral interpretation of preferences for goods that generate health risks. In this paper proneness to poor health is viewed as a cognitive miscalculation by economic agents between their expected health state over various consumption bundles and the actual health care they require for their health outcome. To model this the paper borrows insight from prospect theory and applies the reference-dependent preferenc...

  8. The Child Care Industry: Cost Functions, Efficiency, and Quality

    OpenAIRE

    H. Naci Mocan

    1995-01-01

    Using a newly compiled data set, this paper provides insights into the characteristics of the child care industry. First, there is no difference in average quality of the services produced between nonprofit and for-profit centers. This indicates that nonprofit status cannot be taken as a signal of higher quality. Second, the hypothesis of relative inefficiency of nonprofit centers with respect to for-profits is unfounded. On the other hand, centers that receive public money, either from the s...

  9. Medicaid and the Cost of Improving Access to Nursing Home Care

    OpenAIRE

    Gertler, Paul J.

    1989-01-01

    In this paper I show that the Medicaid program can improve the access of financially indigent patients to nursing home care by raising the rate of return paid on Medicaid patients' care, but only at the cost of lower quality of care. To quantify the policy tradeoff, I derive expressions for the elasticity of access with respect to total Medicaid expenditures and the elasticity of access with respect to quality. These elasticities expressions are complicated by the fact that Medicaid payment f...

  10. Addressing the American health-care cost crisis: Role of the oncology community

    OpenAIRE

    Ramsey, SD; Ganz, PA; Shankaran, V; Peppercorn, J; Emanuel, E.

    2013-01-01

    Health-care cost growth is unsustainable, and the current level of spending is harming our economy and our patients. This commentary describes the scope of the health-care spending problem and the particular factors in cancer care that contribute to the problem, reflecting in part presentations and discussions from an Institute of Medicine National Cancer Policy Forum Workshop held in October 2012. Presenters at the workshop identified a number of steps that the oncology community can take to...

  11. Privatisation & marketisation of post-birth care: the hidden costs for new mothers

    OpenAIRE

    Benoit Cecilia; Stengel Camille; Phillips Rachel; Zadoroznyj Maria; Berry Sarah

    2012-01-01

    Abstract Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally with...

  12. The cost conundrum: financing the business of health care insurance.

    Science.gov (United States)

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  13. Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

    Science.gov (United States)

    Shankaran, Veena; Luu, Thanh Ha; Nonzee, Narissa; Richey, Elizabeth; McKoy, June M.; Graff Zivin, Joshua; Ashford, Alfred; Lantigua, Rafael; Frucht, Harold; Scoppettone, Marc; Bennett, Charles L.; Sheinfeld Gorin, Sherri

    2009-01-01

    Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective. PMID:19826133

  14. Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

    Directory of Open Access Journals (Sweden)

    Morriss Richard

    2012-07-01

    Full Text Available Abstract Background The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance. However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years with 100 normal attenders (6–22 appointments with GP over 2 years, from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will

  15. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    NARCIS (Netherlands)

    Peeters, J.M.; Mistiaen, P.; Francke, A.L.

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

  16. Predicting Health Care Cost Transitions Using a Multidimensional Adaptive Prediction Process.

    Science.gov (United States)

    Guo, Xiaobo; Gandy, William; Coberley, Carter; Pope, James; Rula, Elizabeth; Wells, Aaron

    2015-08-01

    Managing population health requires meeting individual care needs while striving for increased efficiency and quality of care. Predictive models can integrate diverse data to provide objective assessment of individual prospective risk to identify individuals requiring more intensive health management in the present. The purpose of this research was to develop and test a predictive modeling approach, Multidimensional Adaptive Prediction Process (MAPP). MAPP is predicated on dividing the population into cost cohorts and then utilizing a collection of models and covariates to optimize future cost prediction for individuals in each cohort. MAPP was tested on 3 years of administrative health care claims starting in 2009 for health plan members (average n=25,143) with evidence of coronary heart disease. A "status quo" reference modeling methodology applied to the total annual population was established for comparative purposes. Results showed that members identified by MAPP contributed $7.9 million and $9.7 million more in 2011 health care costs than the reference model for cohorts increasing in cost or remaining high cost, respectively. Across all cohorts, the additional accurate cost capture of MAPP translated to an annual difference of $1882 per member, a 21% improvement, relative to the reference model. The results demonstrate that improved future cost prediction is achievable using a novel adaptive multiple model approach. Through accurate prospective identification of individuals whose costs are expected to increase, MAPP can help health care entities achieve efficient resource allocation while improving care quality for emergent need individuals who are intermixed among a diverse set of health care consumers.

  17. Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

    OpenAIRE

    Jochen Profit; Diana Lee; Zupancic, John A.; LuAnn Papile; Cristina Gutierrez; Sue J Goldie; Eduardo Gonzalez-Pier; Joshua A Salomon

    2010-01-01

    Editors' Summary Background Most pregnancies last about 40 weeks but increasing numbers of babies are being born preterm, before they reach 37 weeks of gestation (the period during which a baby develops in its mother). In developed countries and some middle-income countries such as Mexico, improvements in the care of newborn babies (neonatal intensive care) mean that more preterm babies survive now than in the past. Nevertheless, preterm birth is still a major cause of infant death worldwide ...

  18. Out-of-hours primary care. Implications of organisation on costs

    Directory of Open Access Journals (Sweden)

    Wesseling Geertjan

    2006-05-01

    Full Text Available Abstract Background To perform out-of-hours primary care, Dutch general practitioners (GPs have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care. These differences may have implications on costs, however, until now this has not been investigated. This study was performed to provide insight in costs of these two different models of out-of-hours care. Methods Annual reports of two GP cooperatives (one separate from and one integrated with a hospital emergency department in 2003 were analysed on costs and use of out-of-hours care. Costs were calculated per capita. Comparisons were made between the two cooperatives. In addition, a comparison was made between the costs of the hospital ED of the integrated model before and after the set up of the GP cooperative were analysed. Results Costs per capita of the GP cooperative in the integrated model were slightly higher than in the separate model (ε 11.47 and ε 10.54 respectively. Differences were mainly caused by personnel and other costs, including transportation, interest, cleaning, computers and overhead. Despite a significant reduction in patients utilising ED care as a result of the introduction of the GP cooperative integrated within the ED, the costs of the ED remained the same. Conclusion The study results show that the costs of primary care appear to be more dependent on the size of the population the cooperative covers than on the way the GP cooperative is organised, i.e. separated versus integrated. In addition, despite the substantial reduction of patients, locating the GP cooperative at the same site as the ED was found to have little

  19. Measuring human capital cost through benchmarking in health care environment.

    Science.gov (United States)

    Kocakülâh, Mehmet C; Harris, Donna

    2002-01-01

    Each organization should seek to maximize its human capital investments, which ultimately lead to increased profits and asset efficiency. Service companies utilize less capital equipment and more human productivity, customer service, and/or delivery of service as the product. With the measurement of human capital, one can understand what is happening, exercise some degree of control, and make positive changes. Senior management lives or dies by the numbers and if Human Resources (HR) really wants to be a strategic business partner, HR must be judged by the same standards as everyone else in the health care organization. PMID:12462657

  20. Attitudes of nursing professionals in light of the cost of care with high-dependency patients

    OpenAIRE

    Antônio Fernandes Costa Lima; Valéria Castilho; Juliana Ribeiro Gonçalves

    2014-01-01

    The objective was to identify the attitudes of nurses regarding the results of a study on the cost of nursing care with high-dependency patients admitted to a university hospital. Eleven recorded interviews were transcribed, coded, and analyzed by the technique of content analysis and discussed in light of the theoretical framework on cost management. Respondents showed favorable attitudes as to having knowledge of the direct cost of human and material resources and how they contribute to man...

  1. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  2. Memphis Business Group on Health: a model for health care reform and cost containment.

    Science.gov (United States)

    Miller, D

    1994-01-01

    A market-driven, community-based, competitive health care model has effectively assisted Memphis employers to achieve their cost containment and health care reform objectives. Members of the Memphis Business Group on Health joined forces and successfully implemented a variety of programs and services that resulted in dramatic cost savings and reform of health care delivery systems. Programs included development of a purchasing alliance for negotiating contracts for hospital, medical, workers' compensation, psychiatric, and substance abuse care and other service and product options. Utilization management programs focused on appropriate consumption of resources and intensive management of critical cases. While increases in per employee costs averaged 14.7 percent per year for five years nationally, members of the Memphis Business Group on Health held their increases to an average of 6 percent per year. PMID:10132786

  3. Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia

    Directory of Open Access Journals (Sweden)

    Hari S. Iyer

    2014-01-01

    Full Text Available Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider’s perspective and are reported in 2011 USD. Results. For the patients who initiated ART ≤6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ≤6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs.

  4. Cost control in nursing homes by means of economies of scale and care profile optimization.

    Science.gov (United States)

    Hoess, Victoria; Bachler, Adi; Ostermann, Herwig; Staudinger, Roland

    2009-01-01

    The call to enlarge or merge nursing homes in order to lower costs rests on the assumption that economies of scale exist within the cost structure of these homes. Economies of scale means that an increasing number of residents will reduce the costs per person needing care. However, the existence and the extent of economies of scale as such in nursing homes are the subject of controversy because studies of this issue performed in nursing homes up to now have yielded contradictory results. In this study, researchers demonstrated economies of scale in Tyrolean, Austria, nursing homes and showed that the composition of the nursing home residents in respect to their care needs influences the development of the average costs. Changing the size of the facility and/or influencing the average care level can have a considerable influence on the progression of average costs in nursing homes. Cost reductions can be achieved by increasing the size of the facility or by improved distribution of the care levels of the persons in need of care.

  5. Health care costs associated with gestational diabetes mellitus among high-risk women – results from a randomised trial

    Directory of Open Access Journals (Sweden)

    Kolu Päivi

    2012-07-01

    Full Text Available Abstract Background The costs of gestational diabetes mellitus (GDM screening have been frequently reported, but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported. The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM. Methods The study was based on a cluster-randomised GDM prevention trial (N = 848 carried out at maternity clinics, combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care. Costs of outpatient visits to primary and secondary care, cost of inpatient hospital care before and after delivery, the use of insulin, delivery costs and babies’ stay in the neonatal intensive care unit were analysed. Women who developed GDM were compared to those who were not diagnosed with GDM. Results Total mean health care costs adjusted for age, body mass index and education were 25.1% higher among women diagnosed with GDM (€6,432 vs. €5,143, p  Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs. Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care.

  6. Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD: MaineCare (Medicaid Cost Savings

    Directory of Open Access Journals (Sweden)

    Michael P. Towey

    2012-06-01

    Full Text Available This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent MaineCare patients consecutively referred to Waldo County General Hospital (WCGH with suspected diagnosis of Vocal Cord Dysfunction (VCD were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice.  The study suggests that without access to speech therapy telepractice for patients with VCD, the ongoing medical costs to MaineCare will be ongoing and significant.

  7. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    Science.gov (United States)

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers.

  8. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    Science.gov (United States)

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

  9. Health care burden and cost associated with fetal alcohol syndrome: based on official Canadian data.

    Directory of Open Access Journals (Sweden)

    Svetlana Popova

    Full Text Available BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD is a group of disorders caused by prenatal alcohol exposure. From this group, Fetal Alcohol Syndrome (FAS is the only disorder coded in the International Classification of Diseases, version 10 (ICD-10. This coding was used to gain an understanding on the health care utilization and the mortality rate for individuals diagnosed with FAS, as well as to estimate the associated health care costs in Canada for the most recent available fiscal year (2008-2009. METHODS: Health care utilization data associated with a diagnosis of FAS were directly obtained from the Canadian Institute for Health Information (CIHI. Mortality data associated with a diagnosis of FAS were obtained from Statistics Canada. RESULTS: The total direct health care cost of acute care, psychiatric care, day surgery, and emergency department services associated with FAS in Canada in 2008-2009, based on the official CIHI data, was about $6.7 million. The vast majority of the most responsible diagnoses, which account for the majority of a patient's length of stay in hospital, fall within the ICD-10 category Mental and Behavioural Disorders (F00-F99. It was evident that the burden and cost of acute care hospitalizations due to FAS is increasing -1.6 times greater in 2008-2009, compared to 2002-2003. The mortality data due to FAS, obtained from Statistics Canada (2000-2008, may be underreported, and are likely invalid. DISCUSSION: The official data on the utilization of health care services by individuals diagnosed with FAS are likely to be underreported and therefore, the reported cost figures are most likely underestimated. The quantification of the health care costs associated with FAS is crucial for policy developers and decision makers alike, of the impact of prenatal alcohol exposure, with the ultimate goal of initiating preventive interventions to address FASD.

  10. Low Cost Heliostat Development Phase II Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Kusek, Stephen M.

    2014-04-21

    The heliostat field in a central receiver plant makes up roughly one half of the total plant cost. As such, cost reductions for the installed heliostat price greatly impact the overall plant cost and hence the plant’s Levelized Cost of Energy. The general trend in heliostat size over the past decades has been to make them larger. One part of our thesis has been that larger and larger heliostats may drive the LCOE up instead of down due to the very nature of the precise aiming and wind-load requirements for typical heliostats. In other words, it requires more and more structure to precisely aim the sunlight at the receiver as one increases heliostat mirror area and that it becomes counter-productive, cost-wise, at some point.

  11. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness. PMID:14999922

  12. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

  13. The economic cost of pathways to care in first episode psychosis.

    LENUS (Irish Health Repository)

    Heslin, Margaret

    2011-01-01

    Few studies have examined the economic cost of psychoses other than schizophrenia and there have been no studies of the economic cost of pathways to care in patients with their first episode of psychosis. The aims of this study were to explore the economic cost of pathways to care in patients with a first episode of psychosis and to examine variation in costs. Data on pathways to care for first episode psychosis patients referred to specialist mental health services in south-east London and Nottingham between 1997-2000. Costs of pathway events were estimated and compared between diagnostic groups. The average costs for patients in south-east London were £54 (CI £33-£75) higher, compared to patients in Nottingham. Across both centres unemployed patients had £25 (CI £7-£43) higher average costs compared to employed patients. Higher costs were associated with being unemployed and living in south-east London and these differences could not be accounted for by any single factor. This should be considered when the National Health Service (NHS) is making decisions about funding.

  14. Patient costs associated with accessing HIV/AIDS care in Malawi

    Directory of Open Access Journals (Sweden)

    Andrew D Pinto

    2013-03-01

    Full Text Available Introduction: The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub-Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti-retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC. Methods: A cross-sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using χ2 and t-tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data. Results: There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio-economic status, with higher educational attainment (p<0.001, personal income (p=0.007 and household income per person (p=0.005 in CC. Travel times were similar (p=0.65, as was time waiting at the clinic (p=0.63 and total time spent seeking care (p=0.65. There was a significant difference in travel-related expenses (p<0.001 related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini-bus to reach the clinic; in DC only 4% reported using a mini-bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out-of-pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1–182 MKW or US$0.59 represents the adjusted

  15. A cost-consequences analysis of a primary care librarian question and answering service.

    Directory of Open Access Journals (Sweden)

    Jessie McGowan

    Full Text Available BACKGROUND: Cost consequences analysis was completed from randomized controlled trial (RCT data for the Just-in-time (JIT librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs and Family Health Groups (FHGs. METHODS: We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. RESULTS: The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. CONCLUSIONS: The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

  16. Identifying potentially cost effective chronic care programs for people with COPD

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

    Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision

  17. Single-Phase Hybrid Switched Reluctance Motor for Low-Power Low-Cost Applications

    DEFF Research Database (Denmark)

    Lu, Kaiyuan; Rasmussen, Peter Omand; Jakobsen, Uffe

    2011-01-01

    This paper presents a new single-phase, Hybrid Switched Reluctance (HSR) motor for low-cost, low-power, pump or fan drive systems. Its single-phase configuration allows use of a simple converter to reduce the system cost. Cheap ferrite magnets are used and arranged in a special flux concentration...

  18. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. Th

  19. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)

    2003-01-01

    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  20. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization.

  1. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization. PMID:10350791

  2. Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan

    Science.gov (United States)

    Wells, Timothy S.; Bhattarai, Gandhi R.; Hawkins, Kevin; Cheng, Yan; Ruiz, Joann; Barnowski, Cynthia A.; Spivack, Barney; Yeh, Charlotte S.

    2016-01-01

    Purpose of the Study: Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Primary Practice Setting: Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). Methodology and Sample: The three groups included the highest needs, highest costs (the “highest group”), the high needs, high costs (the “high group”), and the “all other group.” Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. Results: The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. Implications for Case Management Practice: Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care. PMID:27301064

  3. Laser Atmospheric Wind Sounder (LAWS) phase 1. Volume 3: Project cost estimates

    Science.gov (United States)

    1990-01-01

    The laser atmospheric wind sounder (LAWS) cost modeling activities were initiated in phase 1 to establish the ground rules and cost model that would apply to both phase 1 and phase 2 cost analyses. The primary emphasis in phase 1 was development of a cost model for a LAWS instrument for the Japanese Polar Orbiting Platform (JPOP). However, the Space Station application was also addressed in this model, and elements were included, where necessary, to account for Space Station unique items. The cost model presented in the following sections defines the framework for all LAWS cost modeling. The model is consistent with currently available detail, and can be extended to account for greater detail as the project definition progresses.

  4. Multimorbidity in chronic disease: impact on health care resources and costs.

    Science.gov (United States)

    McPhail, Steven M

    2016-01-01

    Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person

  5. Multimorbidity in chronic disease: impact on health care resources and costs

    Science.gov (United States)

    McPhail, Steven M

    2016-01-01

    Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person

  6. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

    OpenAIRE

    Babigumira, Joseph B; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

    2009-01-01

    Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical ...

  7. Waist circumference and body mass index as predictors of health care costs

    DEFF Research Database (Denmark)

    Højgaard, Betina; Gyrd-Hansen, Dorte; Olsen, Kim Rose;

    2008-01-01

    BACKGROUND: In the present study we analyze the relationship between body mass index (BMI) and waist circumference (WC) and future health care costs. On the basis of the relation between these anthropometric measures and mortality, we hypothesized that for all levels of BMI increased WC implies....../PRINCIPAL FINDINGS: Data were obtained from the Danish prospective cohort study Diet, Cancer and Health. The population includes 15,334 men and 16,506 women 50 to 64 years old recruited in 1996 to 1997. The relationship between future health care costs and BMI and WC in combination was analyzed by use of categorized...... and continuous analyses. The analysis confirms Hypothesis 1, reflecting that an increased level of abdominal fat for a given BMI gives higher health care costs. Hypothesis 2, that BMI had a protective effect for a given WC, was only confirmed in the continuous analysis and for a subgroup of women (BMI

  8. Nuclear cardiology: Its role in cost effective care

    International Nuclear Information System (INIS)

    would not otherwise have been achieved if the early disease remained undetected. This publication presents a comprehensive overview of CVDs as a public health problem in developing countries, the relative role of nuclear cardiology methods within a scenario of unprecedented technology advances, and the evidence behind appropriateness recommendations. The potential expanding role of non-invasive functional imaging through the transition from diagnosis of obstructive CAD to defining the global burden of CVDs is also discussed, as well as the need for thorough training, education, and quality in nuclear cardiology practice. This report will be of interest for all medical practitioners involved in the management of CAD, including internists, cardiologists, and nuclear medicine physicians, as well as hospital administrators and health care stakeholders.

  9. Evaluation of wound care options in patients with recessive dystrophic epidermolysis bullosa: a costly necessity.

    Science.gov (United States)

    Kirkorian, Anna Yasmine; Weitz, Nicole A; Tlougan, Brook; Morel, Kimberly D

    2014-01-01

    Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic disorder in which mutations in collagen VII, the main component of the anchoring fibril, lead to skin fragility and to the development of acute and chronic wounds. Wound care and dressing changes are an important part of the daily lives of individuals with RDEB. Ideal wound care should improve wound healing, minimize pain, and improve quality of life. The objective of the current study was to review wound care options that might be used in a patient with RDEB and calculate the cost of these various options based on publicly available pricing of wound care products. There is a wide range of costs for wound care options in patients with RDEB. For example, a 1-day supply of dressing for a neonate boy with RDEB ranges from $10.64 for the least expensive option to $127.54 for the most expensive option. Wound care in patients with severe, generalized RDEB has not only a significant economic effect, but also directly affects quality of life in this patient population. Although randomized controlled trials evaluating different wound care products in patients with RDEB are lacking, small studies and expert opinion support the use of specialized nonadherent dressings that minimize skin trauma and promote wound healing. Until there is a cure, prospective studies are needed to assess pain, quality of life, and wound healing associated with the use of specialized wound care products for this life-altering condition.

  10. The cost of post-abortion care in developing countries: a comparative analysis of four studies

    Science.gov (United States)

    Vlassoff, Michael; Singh, Susheela; Onda, Tsuyoshi

    2016-01-01

    Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology—the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30–60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52–68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3–12% of the average cost of treating a PAC patient. PMID:27045001

  11. Costs and revenue of health care in a rural Zimbabwean district.

    Science.gov (United States)

    Vander Plaetse, B; Hlatiwayo, G; Van Eygen, L; Meessen, B; Criel, B

    2005-07-01

    The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no

  12. Solid phase studies and geochemical modelling of low-cost permeable reactive barriers

    Energy Technology Data Exchange (ETDEWEB)

    Bartzas, Georgios, E-mail: gbartzas@metal.ntua.gr [Laboratory of Metallurgy, School of Mining and Metallurgical Engineering, National Technical University of Athens, Zografos Campus, 15780 Athens (Greece); Komnitsas, Kostas [Department of Mineral Resources Engineering, Technical University of Crete, 73100 Chania (Greece)

    2010-11-15

    A continuous column experiment was carried out under dynamic flow conditions in order to study the efficiency of low-cost permeable reactive barriers (PRBs) to remove several inorganic contaminants from acidic solutions. A 50:50 w/w waste iron/sand mixture was used as candidate reactive media in order to activate precipitation and promote sorption and reduction-oxidation mechanisms. Solid phase studies of the exhausted reactive products after column shutdown, using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD), confirmed that the principal Fe corrosion products identified in the reactive zone are amorphous iron (hydr)oxides (maghemite/magnetite and goethite), intermediate products (sulfate green rust), and amorphous metal sulfides such as amFeS and/or mackinawite. Geochemical modelling of the metal removal processes, including interactions between reactive media, heavy metal ions and sulfates, and interpretation of the ionic profiles was also carried out by using the speciation/mass transfer computer code PHREEQC-2 and the WATEQ4F database. Mineralogical characterization studies as well as geochemical modelling calculations also indicate that the effect of sulfate and silica sand on the efficiency of the reactive zone should be considered carefully during design and operation of low-cost field PRBs.

  13. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India.

    Science.gov (United States)

    Ahuja, Rajeev B; Goswami, Prasenjit

    2013-06-01

    There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations carried out in the dedicated burns theatre. The total expenditure for the study period was Indian Rupees (Rs) 46,488,067 or US$ 845,237. At 1 US$=Rs 55 it makes the cost per patient to be US$ 1060.5. Almost 70% of cost of burn management resulted from salaries, followed by

  14. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

    OpenAIRE

    Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael

    2016-01-01

    Objectives The efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders. Design Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory...

  15. Economic Cost and Health Care Workforce Effects of School Closures in the U.S.

    OpenAIRE

    Lempel, Howard; Epstein, Joshua M.; Hammond, Ross A

    2009-01-01

    School closure is an important component of U.S. pandemic flu mitigation strategy, but has important costs. We give estimates of both the direct economic and health care impacts for school closure durations of 2, 4, 6, and 12 weeks under a range of assumptions. We find that closing all schools in the U.S. for four weeks could cost between $10 and $47 billion dollars (0.1-0.3% of GDP) and lead to a reduction of 6% to 19% in key health care personnel.

  16. The fall and rise of cost sharing in Kenya: the impact of phased implementation.

    Science.gov (United States)

    Collins, D; Quick, J D; Musau, S N; Kraushaar, K; Hussein, I M

    1996-03-01

    The combined effects of increasing demand for health services and declining real public resources have recently led many governments in the developing world to explore various health financing alternatives. Faced with a significant decline during the 1980s in its real per capita expenditures, the Kenya Ministry of Health (MOH) introduced a new cost sharing programme in December 1989. The programme was part of a comprehensive health financing strategy which also included social insurance, efficiency measures, and private sector development. Early implementation problems led to the suspension in September 1990 of the outpatient registration fee, the major revenue source at the time. In 1991, the Ministry initiated a programme of management improvement and gradual re-introduction of an outpatient fee, but this time as a treatment fee. The new programme was carried out in phases, beginning at the national and provincial levels and proceeding to the local level. The impact of these changes was assessed with national revenue collection reports, quality of care surveys in 6 purposively selected indicator districts, and time series analysis of monthly utilization in these same districts. In contrast to the significant fall in revenue experienced over the period of the initial programme, the later management improvements and fee adjustments resulted in steady increases in revenue. As a percentage of total non-staff expenditures, fiscal year 1993-1994 revenue is estimated to have been 37% at provincial general hospitals, 20% at smaller hospitals, and 21% at health centres. Roughly one third of total revenue is derived from national insurance claims. Quality of care measures, though in some respects improved with cost sharing, were in general somewhat mixed and inconsistent. The 1989 outpatient registration fee led to an average reduction in utilization of 27% at provincial hospitals, 45% at district hospitals, and 33% at health centres. In contrast, phased introduction of

  17. Seek and ye shall find: consumer search for objective health care cost and quality information.

    Science.gov (United States)

    Sick, Brian; Abraham, Jean M

    2011-01-01

    Significant investments have been made in developing and disseminating health care provider cost and quality information on the Internet with the expectation that stronger consumer engagement will lead consumers to seek providers who deliver high-quality, low-cost care. However, prior research shows that the awareness and use of such information is low. This study investigates how the information search process may contribute to explaining this result. The analysis reveals that the Web sites most likely to be found by consumers are owned by private companies and provide information based on anecdotal patient experiences. Web sites less likely to be found have government or community-based ownership, are based on administrative data, and contain a mixture of quality, cost, and patient experience information. Searches for information on hospitals reveal more cost and quality information based on administrative data, whereas searches that focus on clinics or physicians are more likely to produce information based on patient narratives.

  18. Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan.

    Science.gov (United States)

    Yamauchi, Yasuhiro

    2016-03-01

    Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care. PMID:26493427

  19. A comparative cost analysis of an integrated military telemental health-care service.

    Science.gov (United States)

    Grady, Brian J

    2002-01-01

    The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated. While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs.

  20. A comparative cost analysis of an integrated military telemental health-care service.

    Science.gov (United States)

    Grady, Brian J

    2002-01-01

    The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated. While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs. PMID:12419023

  1. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

    Science.gov (United States)

    Goold, S D

    1996-01-01

    Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

  2. Ethics of the Physician's Role in Health-Care Cost Control: AOA Critical Issues.

    Science.gov (United States)

    Bosco, Joseph; Iorio, Richard; Barber, Thomas; Barron, Chloe; Caplan, Arthur

    2016-07-20

    The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidence-based guidelines. We can do this and still continue to respect the primacy of patient welfare and the right of patients to act in their own self-interest. However, as evidenced by the use of high-volume centers of excellence, each strategy adapted to control costs must be vetted and must be monitored for its unintended ethical consequences.The solution to this complex problem must involve the input of all of the health-care stakeholders, including the patients, payers, and providers. Physicians ought to play a role in designing and executing a remedy. After all, we are the ones who best understand medicine and whose moral obligation is to the welfare of our patients. PMID:27440574

  3. Cost-effectiveness of supported self-management for CFS/ME patients in primary care

    OpenAIRE

    Richardson, Gerry; Epstein, David; Chew-Graham, Carolyn; Dowrick, Christopher; Bentall, Richard P.; Morriss, Richard K; Peters, Sarah; Riste, Lisa; Lovell, Karina; Dunn, Graham; Wearden, Alison J

    2013-01-01

    Background: Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. Methods: Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in ...

  4. What can the postanesthesia care unit manager do to decrease costs in the postanesthesia care unit?

    Science.gov (United States)

    Macario, A; Glenn, D; Dexter, F

    1999-10-01

    The economic structure of the PACU dictates whether a cost-reducing intervention (e.g., reducing the length of time patients stay in the PACU) is likely to decrease hospital costs. Cost-reducing interventions, such as changes in medical practice patterns (e.g., to reduce PACU length of stay), only impact variable costs. How PACU nurses are paid (e.g., salaried v hourly) affects which strategies to decrease PACU staffing costs will actually save money. For example, decreases in PACU labor costs resulting from increases in the number of patients that bypass the PACU vary depending on how the staff is compensated. The choice of anesthetic drugs and the elimination of low morbidity side effects of anesthesia, such as postoperative nausea, are likely to have little effect on the peak numbers of patients in a PACU and PACU staffing costs. Because the major determinant of labor productivity in the PACU is hour-to-hour and day-to-day variability in the timing of admissions from the operating room, a more even inflow of patients into the PACU could be attained by appropriate sequencing of cases in the operating room suite (e.g., have long cases scheduled at the beginning of the day). However, this mathematically proven solution may not be desirable. Surgeons, for example, may not want to lose control over the order of their cases. Guidelines for analysis of past daily peak numbers of patients are provided that will provide data to predict the minimum adequate number of nurses needed. Though many managers already do this manually on an ad hoc basis statistical methods summarized in this article may increase the accuracy.

  5. Cost-effectiveness of general practice care for low back pain: a systematic review

    OpenAIRE

    Lin, C.; De Haas, M; Maher, C. G.; Machado, L.A.C.; Tulder, van, R.J.M.

    2011-01-01

    Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies ...

  6. Chronic and Recurrent Depression in Primary Care: Socio-Demographic Features, Morbidity, and Costs

    Directory of Open Access Journals (Sweden)

    Elaine M. McMahon

    2012-01-01

    Full Text Available Background. Major depression is often chronic or recurrent and is usually treated within primary care. Little is known about the associated morbidity and costs. Objectives. To determine socio-demographic characteristics of people with chronic or recurrent depression in primary care and associated morbidity, service use, and costs. Method. 558 participants were recruited from 42 GP practices in the UK. All participants had a history of chronic major depression, recurrent major depression, or dysthymia. Participants completed questionnaires including the BDI-II, Work and Social Adjustment Scale, Euroquol, and Client Service Receipt Inventory documenting use of primary care, mental health, and other services. Results. The sample was characterised by high levels of depression, functional impairment, and high service use and costs. The majority (74% had been treated with an anti-depressant, while few had seen a counsellor (15% or a psychologist (3% in the preceding three months. The group with chronic major depression was most depressed and impaired with highest service use, whilst those with dysthymia were least depressed, impaired, and costly to support but still had high morbidity and associated costs. Conclusion. This is a patient group with very significant morbidity and high costs. Effective interventions to reduce both are required.

  7. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review.

    Science.gov (United States)

    Halpern, Neil A; Pastores, Stephen M

    2015-11-01

    This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs. PMID:26308432

  8. Low-Cost Phase Change Material for Building Envelopes

    Energy Technology Data Exchange (ETDEWEB)

    Abhari, Ramin [Renewable Energy Group

    2015-08-06

    A low-cost PCM process consisting of conversion of fats and oils to PCM-range paraffins, and subsequent “encapsulation” of the paraffin using conventional plastic compounding/pelletizing equipment was demonstrated. The PCM pellets produced were field-tested in a building envelope application. This involved combining the PCM pellets with cellulose insulation, whereby 33% reduction in peak heat flux and 12% reduction in heat gain was observed (average summertime performance). The selling price of the PCM pellets produced according to this low-cost process is expected to be in the $1.50-$3.00/lb range, compared to current encapsulated PCM price of about $7.00/lb. Whole-building simulations using corresponding PCM thermal analysis data suggest a payback time of 8 to 16 years (at current energy prices) for an attic insulation retrofit project in the Phoenix climate area.

  9. 105-B Reactor museum Phase 2 project supplement cost estimate

    International Nuclear Information System (INIS)

    This document serves as a supplement to BHI-0134, 105-B Reactor Museum Feasibility Assessment. The Phase 2 105-B Reactor assessment was performed to provide a basis for identifying and mitigating the hazards in specific areas of the B Reactor facility to support public tours

  10. Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration

    OpenAIRE

    Coyle, Yvonne M.; Miller, Alan M.; Paulson, R. Steven

    2013-01-01

    Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Canc...

  11. Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

    OpenAIRE

    Bachmann Max O

    2009-01-01

    Abstract Background Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. Method This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision...

  12. Access, quality, and costs of care at physician owned hospitals in the United States: observational study

    Science.gov (United States)

    Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

    2015-01-01

    Objective To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Design Observational study. Setting Acute care hospitals in 95 hospital referral regions in the United States, 2010. Participants 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Main outcome measures Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. Results The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Conclusion Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. PMID:26333819

  13. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Science.gov (United States)

    2013-04-11

    ... BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... the cost of inpatient medical services furnished by military treatment facilities through...

  14. Economic Impact of Dementia by Disease Severity: Exploring the Relationship between Stage of Dementia and Cost of Care in Taiwan.

    Directory of Open Access Journals (Sweden)

    Li-Jung Elizabeth Ku

    Full Text Available Given the shortage of cost-of-illness studies in dementia outside of the Western population, the current study estimated the annual cost of dementia in Taiwan and assessed whether different categories of care costs vary by severity using multiple disease-severity measures.This study included 231 dementia patient-caregiver dyads in a dementia clinic at a national university hospital in southern Taiwan. Three disease measures including cognitive, functional, and behavioral disturbances were obtained from patients based on medical history. A societal perspective was used to estimate the total costs of dementia according to three cost sub-categories. The association between dementia severity and cost of care was examined through bivariate and multivariate analyses.Total costs of care for moderate dementia patient were 1.4 times the costs for mild dementia and doubled from mild to severe dementia among our community-dwelling dementia sample. Multivariate analysis indicated that functional declines had a greater impact on all cost outcomes as compared to behavioral disturbance, which showed no impact on any costs. Informal care costs accounted for the greatest share in total cost of care for both mild (42% and severe (43% dementia patients.Since the total costs of dementia increased with severity, providing care to delay disease progression, with a focus on maintaining patient physical function, may reduce the overall cost of dementia. The greater contribution of informal care to total costs as opposed to social care also suggests a need for more publicly-funded long-term care services to assist family caregivers of dementia patients in Taiwan.

  15. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    Science.gov (United States)

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  16. Effects of different broiler production systems on health care costs in the Netherlands

    NARCIS (Netherlands)

    Gocsik, E.; Kortes, H.E.; Oude Lansink, A.G.J.M.; Saatkamp, H.W.

    2014-01-01

    This study analyzed the effects of different broiler production systems on health care costs in the Netherlands. In addition to the conventional production system, the analysis also included 5 alternative animal welfare systems representative of the Netherlands. The study was limited to the most pre

  17. A Comparative Analysis of the Costs of Substitute Care and Family Based Services. Monograph 2.

    Science.gov (United States)

    Hutchinson, Janet

    Family based services attempt to maintain and strengthen the client family and prevent family dissolution and the placement of a child or several children in substitute care. This study compared programs that serve children and their families in their home. Variances in program costs were attributed to differences in number of casework hours per…

  18. Long-term health care utilisation and costs after spinal fusion in elderly patients

    DEFF Research Database (Denmark)

    Andersen, Thomas; Bünger, Cody; Søgaard, Rikke

    2012-01-01

    PURPOSE: Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the long-term effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequ...

  19. Cost and health care resource use associated with noncompliance with oral bisphosphonate therapy

    DEFF Research Database (Denmark)

    Kjellberg, J; Jorgensen, A D; Vestergaard, P;

    2016-01-01

    We estimated the rate of compliance with oral bisphosphonates among Danish women and examined its association with health care resource use and cost. Approximately 30 % of Danish females aged >55 who take bisphosphonates are noncompliant, and noncompliance is significantly associated with increas...

  20. [Scientific evidence and the cost of innovations in the health-care system].

    Science.gov (United States)

    Porzsolt, Franz; Schreyögg, Jonas

    2009-08-01

    When depicting the relationship between evidence and the cost of an innovation in the health-care system, the overall risks of assessment, the redistribution of risks in a regulated market, and the ethical consequences must first be taken into account. There are also evidence-based criteria and economic considerations which are relevant when calculating the cost of an innovation. These topics can indicate, but not exhaustively deal with the complicated relationship between scientific evidence and calculating the cost of an innovation in the health-care system. The following three statements summarize the current considerations in the continuing discussion of this topic: *Scientific evidence undoubtedly exists which should be taken into consideration when calculating the cost of an innovation in the health-care system. *The existing scientific evidence is, however, not sufficient to reach such a decision. Additional information about the benefit perceived by the patient is required. *No standardized method exists to measure this additional information. Therefore, a definition problem also exists in the health-care system when setting a price according to scientific evidence.

  1. The relationship between staff skill mix, costs and outcomes in intermediate care services

    Directory of Open Access Journals (Sweden)

    Martin Graham P

    2010-07-01

    Full Text Available Abstract Background The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England. Methods We undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care. Results Increased skill mix (raising the number of different types of staff by one is associated with a 17% reduction in service costs (p = 0.011. There is weak evidence (p = 0.090 that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients. Conclusions This study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.

  2. Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

    Science.gov (United States)

    Lohr, B; Müller, I; Mai, M; Norris, D E; Schöffski, O; Hunfeld, K-P

    2015-02-01

    To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

  3. Privatisation & marketisation of post-birth care: the hidden costs for new mothers

    Directory of Open Access Journals (Sweden)

    Benoit Cecilia

    2012-10-01

    Full Text Available Abstract Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. Method The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum. Results Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. Discussion & conclusions While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are

  4. How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Chao, Te-Hsin; Yao, Yuh; Tu, Shu-Min; Wu, Chun-Ching; Chern, Jin-Yuan; Chao, Shiu-Hsiung; Shaw, Keh-Yuong

    2007-04-01

    Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment. PMID:17489499

  5. How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Chao, Te-Hsin; Yao, Yuh; Tu, Shu-Min; Wu, Chun-Ching; Chern, Jin-Yuan; Chao, Shiu-Hsiung; Shaw, Keh-Yuong

    2007-04-01

    Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment.

  6. Costs and Infant Outcomes After Implementation of a Care Process Model for Febrile Infants

    Science.gov (United States)

    Reynolds, Carolyn C.; Korgenski, Kent; Sheng, Xiaoming; Valentine, Karen J.; Nelson, Richard E.; Daly, Judy A.; Osguthorpe, Russell J.; James, Brent; Savitz, Lucy; Pavia, Andrew T.; Clark, Edward B.

    2012-01-01

    OBJECTIVE: Febrile infants in the first 90 days may have life-threatening serious bacterial infection (SBI). Well-appearing febrile infants with SBI cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common. METHODS: We developed and implemented an evidence-based care process model (EB-CPM) for the management of well-appearing febrile infants in the Intermountain Healthcare System. We report an observational study describing changes in (1) care delivery, (2) outcomes of febrile infants, and (3) costs before and after implementation of the EB-CPM in a children’s hospital and in regional medical centers. RESULTS: From 2004 through 2009, 8044 infants had 8431 febrile episodes, resulting in medical evaluation. After implementation of the EB-CPM in 2008, infants in all facilities were more likely to receive evidence-based care including appropriate diagnostic testing, determination of risk for SBI, antibiotic selection, decreased antibiotic duration, and shorter hospital stays (P < .001 for all). In addition, more infants had a definitive diagnosis of urinary tract infection or viral illness (P < .001 for both). Infant outcomes improved with more admitted infants positive for SBI (P = .011), and infants at low risk for SBI were more often managed without antibiotics (P < .001). Although hospital admissions were shortened by 27%, there were no cases of missed SBI. Health Care costs were also reduced, with the mean cost per admitted infant decreasing from $7178 in 2007 to $5979 in 2009 (−17%, P < .001). CONCLUSIONS: The EB-CPM increased evidence-based care in all facilities. Infant outcomes improved and costs were reduced, substantially improving value. PMID:22732178

  7. What is the potential for improving care and lowering cost for persons with dementia?

    Science.gov (United States)

    Davis, Karen; Willink, Amber; Amjad, Halima

    2016-03-01

    The increasing prevalence of dementia with population aging has heightened interest in understanding patterns of utilization and health expenditures in persons with dementia (PWD) among policy officials, practicing physicians, and health system. While a substantial part of this interest is concerned with the high costs of care for people diagnosed with dementia (Kelley et al., 2015), less attention has been focused on the costs and consequences of missed or delayed diagnosis in those who screen positive for dementia. The article on "Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?" by Michalowsky and colleagues (Michalowsky et al., 2015) in this issue makes a particularly important contribution in this regard.

  8. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

    OpenAIRE

    Renaud, Adrien; Basenya, Olivier; De Borman, Nicolas; Greindl, Isaline; Meyer-Rath, Gesine

    2009-01-01

    The incremental cost effectiveness of an integrated care package (i.e. medical care including antiretroviral therapy and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women Against Aids (SWAA) - Burundi, an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$ per Disability-Adjusted Life Year (DALY)...

  9. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

    OpenAIRE

    2009-01-01

    Abstract The incremental cost effectiveness of an integrated care package (i.e. medical care including antiretroviral therapy and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women Against Aids (SWAA) - Burundi, an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$ per Disability-Ad...

  10. Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

    Directory of Open Access Journals (Sweden)

    Abbass, Ibrahim

    2015-05-01

    Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

  11. A survey study to validate a four phases development model for integrated care in the Netherlands

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella); R.P. Vermeulen (Robert); C.T.B. Ahaus (Kees); R. Huijsman (Robbert)

    2013-01-01

    textabstractBackground: The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the

  12. A survey study to validate a four phases development model for integrated care in the Netherlands

    NARCIS (Netherlands)

    Minkman, Mirella M. N.; Vermeulen, Robbert P.; Ahaus, Kees T. B.; Huijsman, Robbert

    2013-01-01

    Background: The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidatio

  13. The costs of HIV/AIDS care at government hospitals in Zimbabwe

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Chapman, Glyn; Chitsike, Inam;

    2000-01-01

    and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities...... in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through...... of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference...

  14. Chronic obstructive pulmonary disease involves substantial health-care service and social benefit costs

    DEFF Research Database (Denmark)

    Jensen, Martin Bach; Fenger-Grøn, Morten; Fonager, Kirsten;

    2013-01-01

    a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio ....7 following bronchodilator administration] and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. RESULTS: Health care-related costs were 4,779 (2,404- 7,154) Danish kroner (DKK...... Lung Disease (GOLD grade). In participants age, the annual cost of social benefits and transfer payments was 15,901 (5,966-25,837) DKK higher and the total costs were 20,454 (7,559-33,350) DKK higher in those with COPD than in those without COPD; this was due mostly to the high cost...

  15. Estimated SW Costing by using FPA in Early Phase of SW Development

    Directory of Open Access Journals (Sweden)

    Saima Amber

    2014-03-01

    Full Text Available Costing of software is a critical activity that is performed by project manager or in some case by Business analyst. Projects are overrun due to erroneous estimation and budget. Therefore, its result is the cancellation or failure of in time project delivery. SW costing is done according to size, effort and schedule (time. These parameter has been changed throughout in the development cycle therefore it is difficult to measure exact/actual cost at the starting of the sw development. Actual software costing depends on the right estimated cost of project that should be estimated at early phases of SDLC. This research focus on the methodologies that can help to estimate right costing on the basis of functional requirements of the project during early phases of SW development. A survey is performed that make sure that how software estimation can be done in early stage of software development

  16. A review of the direct costs of rheumatoid arthritis: managed care versus fee-for-service settings.

    Science.gov (United States)

    Lubeck, D P

    2001-01-01

    Rheumatoid arthritis (RA) is a prevalent condition associated with pain, joint destruction and morbidity. Direct healthcare costs are 2 to 3 times higher than average costs for individuals of similar age and gender. Furthermore, utilisation and costs rise with age and disease duration. Managed care has become an increasingly popular way to organise and finance the delivery of healthcare. Studies comparing the quality of care in health maintenance organisations and fee-for-service settings have found few differences in outcomes, although reduced costs have been attributed to lower hospitalisation rates in patients with RA. We reviewed 10 studies of the direct costs of RA. In 1996 dollars, direct costs ranged from $US 2,299 per person per year in Canada to $US 13,549 in a US study focusing on patients who have been hospitalised only. Surprisingly, the contributions to direct costs--hospital care, medications and physician visits--remained relatively stable over time and the setting of care. Hospitalisation costs were the highest component of direct costs accounting, generally, for 60% or more of costs while only approximately 10% of patients with RA were hospitalised. The only exception was a managed care setting where hospitalisation costs were 16% of total direct costs. In managed care settings, costs of medications were proportionately higher than in fee-for-service settings. We conclude that in studies of the direct costs of RA the components of costs have remained relatively stable over time. This may change with the development and growing use of new RA medications including cyclo-oxygenase 2 inhibitors, interleukins, cytokines, treatments that inhibit tumour necrosis factor, and combination therapies. The effectiveness of managed care in controlling direct costs needs to be evaluated in more targeted studies. PMID:11596833

  17. Paternal care decreases foraging activity and body condition, but does not impose survival costs to caring males in a Neotropical arachnid.

    Directory of Open Access Journals (Sweden)

    Gustavo S Requena

    Full Text Available Exclusive paternal care is the rarest form of parental investment in nature and theory predicts that the maintenance of this behavior depends on the balance between costs and benefits to males. Our goal was to assess costs of paternal care in the harvestman Iporangaia pustulosa, for which the benefits of this behavior in terms of egg survival have already been demonstrated. We evaluated energetic costs and mortality risks associated to paternal egg-guarding in the field. We quantified foraging activity of males and estimated how their body condition is influenced by the duration of the caring period. Additionally, we conducted a one-year capture-mark-recapture study and estimated apparent survival probabilities of caring and non-caring males to assess potential survival costs of paternal care. Our results indicate that caring males forage less frequently than non-caring individuals (males and females and that their body condition deteriorates over the course of the caring period. Thus, males willing to guard eggs may provide to females a fitness-enhancing gift of cost-free care of their offspring. Caring males, however, did not show lower survival probabilities when compared to both non-caring males and females. Reduction in mortality risks as a result of remaining stationary, combined with the benefits of improving egg survival, may have played an important and previously unsuspected role favoring the evolution of paternal care. Moreover, males exhibiting paternal care could also provide an honest signal of their quality as offspring defenders, and thus female preference for caring males could be responsible for maintaining the trait.

  18. Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

    Directory of Open Access Journals (Sweden)

    Chan Wai

    2009-09-01

    Full Text Available Abstract Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

  19. The effect of age and time to death on primary care costs: the Italian experience.

    Science.gov (United States)

    Atella, Vincenzo; Conti, Valentina

    2014-08-01

    A large body of literature shows that time to death (TTD) is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of primary care costs (pharmaceuticals, diagnostic tests and specialist visits) in Italy, where they represent an important share (about 30%) of the total health care expenditure (HCE). Our analysis is based on a large sample of the Italian population (about 750,000 individuals), obtained from the Health Search-SiSSI database, which contains patient-level data collected routinely by General Practitioners in Italy since 2002. We study individuals aged 19 and older, over the period 2006-2009. By means of a two-part model which accounts for the presence of zero expenditure, our findings show that age represents the most important driver of primary care costs in Italy, although TTD remains a good predictor. These results suggest that age and TTD can have a different role in shaping health care costs according to the component of health expenditure examined. Therefore, our advice to policy makers is to use disaggregated models to better disentangle these contributions and to produce more reliable health spending forecasts.

  20. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    Science.gov (United States)

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  1. A comparative study to analyze the cost of curative care at primary health center in Ahmedabad

    Directory of Open Access Journals (Sweden)

    Mathur Neeta

    2010-01-01

    Full Text Available Objectives: To determine the unit cost of curative care provided at Primary Health Centers (PHCs and to examine the variation in unit cost in different PHCs. Materials and Methods: The present study was carried out in three PHCs of Ahmedabad district namely Sanathal, Nandej, and Uperdal, between 1 April, 2006 and 31 March, 2007. For estimating the cost of a health program, information on all the physical and human resources that were basic inputs to the PHC services were collected and grouped into two categories, non-recurrent (capital resources vehicles, buildings, etc. and recurrent resources (salaries, drugs, vaccines, contraceptives, maintenance, etc.. To generate the required data, two types of schedules were developed, daily time schedule and PHC/SC (Subcenter information schedule. Results: The unit cost of curative care was lowest (Rs. 29.43 for the Sanathal PHC and highest (Rs. 88.26 for the Uperdal PHC, followed by the Nandej PHC with Rs. 40.88, implying severe underutilization of curative care at the Uperdal PHC. Conclusions: Location of health facilities is a problem at many places. As relocation is not possible or even feasible, strengthening of infrastructure and facilities at these centers can be taken up immediately.

  2. IDC reengineering Phase 2 & 3 US industry standard cost estimate summary

    Energy Technology Data Exchange (ETDEWEB)

    Harris, James M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Huelskamp, Robert M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-01-01

    Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, using a commercial software cost estimation tool calibrated to US industry performance parameters. This is not a cost estimate for Sandia to perform the project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

  3. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  4. Comparative Effectiveness Research as Choice Architecture: The Behavioral Law and Economics Solution to the Health Care Cost Crisis

    OpenAIRE

    Korobkin, Russell

    2014-01-01

    The primary market-based approach to reining in health care costs is generally referred to in policy discussions as “consumer directed health care” (“CDHC”). The simple idea underlying CDHC is that patients will demand less care if they are burdened with a greater responsibility for paying the actual cost of that care than is common in our current system, in which costs are largely borne by public or private health insurance with little patient cost sharing. CDHC implicitly relies on the “rat...

  5. Importance of cost-effectiveness and value in cancer care and healthcare policy.

    Science.gov (United States)

    Kang, Ravinder; Goodney, Philip P; Wong, Sandra L

    2016-09-01

    The cost of cancer care has increased by five fold over the last three decades. As our healthcare system shifts from volume to value, greater scrutiny of interventions with clinical equipoise is required. Traditionally, QALYs and ICER have served as surrogate markers for value. However, this approach fails to incorporate all stakeholders' viewpoints. Prostate cancer, low risk DCIS, and thyroid cancer are used as a framework to discuss value and cost-effectiveness. J. Surg. Oncol. 2016;114:275-280. © 2016 Wiley Periodicals, Inc. PMID:27334052

  6. A Cost-Effective Model for Increasing Access to Mental Health Care at the Primary Care Level in Nigeria.

    Science.gov (United States)

    Omigbodun, Olayinka O.

    2001-09-01

    BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for

  7. Access to primary care and workers’ opportunity costs. Evidence from Italy

    OpenAIRE

    De Luca, Giuliana; Ponzo, Michela

    2009-01-01

    This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Data used in the analysis come from the 2004/2005 “Health conditions and recourse to health services” survey provided by the Italian National Institute of Statistics (ISTAT). We apply a ne...

  8. Costs of Pair Bonding and Paternal Care in Male Prairie Voles (Microtus ochrogaster)

    OpenAIRE

    Campbell, JC; Laugero, KD; van Westerhuyzen, JA; Hostetler, CM; Cohen, JD; Bales, KL

    2009-01-01

    The direct costs of paternal care are relatively well documented in primates, however little research has explored these effects in monogamous rodents. The present study examines the long-term effects that pairing and parenting have on male prairie voles. We hypothesized that there would be a significant weight loss over the course of pairing and parenting, presumably from the energetic demands that accompany these changes in social condition. In a longitudinal study, we followed ten male pra...

  9. Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

    OpenAIRE

    M.N. Saulez; Gummow, B.; Slovis, N.M.; T.D. Byars; M. Frazer; K. MacGillivray; F.T. Bain

    2007-01-01

    Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU). This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS) and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before th...

  10. Cost, outcomes, treatment pathways and challenges for diabetes care in Italy

    OpenAIRE

    Grimaccia, Federico; Kanavos, Panos

    2014-01-01

    Background: In Italy both incidence and prevalence of diabetes are increasing and age at diagnosis is decreasing in type 2 diabetes. Diabetes is one of the major causes of morbidity in Italy, causing several disabilities and affecting the economically active population. The objective of this paper is to identify and discuss costs, outcomes and some of the challenges of diabetes care in Italy in the context of recent policy changes. Methods: The study collected data and evidence from ...

  11. Excellence in cost-effective inpatient specialist palliative care in the NHS - a new model.

    Science.gov (United States)

    Grogan, Eleanor; Paes, Paul; Peel, Tim

    2016-02-01

    There is little in the literature describing hospital specialist palliative care units (PCUs) within the NHS. This paper describes how specialist PCUs can be set up within and be entirely funded by the NHS, and outlines some of the challenges and successes of the units. Having PCUs within hospitals has offered patients increased choice over their place of care and death; perhaps not surprisingly leading to a reduced death rate in the acute hospital. However, since the opening of the PCUs there has also been an increased home death rate. The PCUs are well received by patients, families and other staff within the hospital. We believe they offer a model for excellence in cost-effective inpatient specialist palliative care within the NHS.

  12. Adult attachment and the perceived cost of housework and child care

    DEFF Research Database (Denmark)

    Trillingsgaard, Tea; Sommer, Dion; Mathias, Lasgaard;

    2014-01-01

    Objective: This study examined the link between new mothers’ attachment orientation and the perceived cost of sole responsibility in housework and child care. Background: The transition to motherhood can be very stressful, and according to the Vulnerability Stress Adaptation Model (VSA model......), the way it affects the couple relationship is likely to depend on interacting factors from different domains of risk (e.g. individual and couple level). We expected interactions to appear between domains of attachment and labour division. The hypothesis was that sole responsibility in child care...... and housework would predict lower relationship satisfaction, particularly among mothers who were high on attachment insecurity. Methods: Data from self-report measures of adult attachment, child care, housework and relationship satisfaction were collected from 255 first-time mothers at six months postpartum...

  13. Japan's universal long-term care system reform of 2005: containing costs and realizing a vision.

    Science.gov (United States)

    Tsutsui, Takako; Muramatsu, Naoko

    2007-09-01

    Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies. PMID:17767690

  14. Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

    Directory of Open Access Journals (Sweden)

    Edward Broughton

    2014-01-01

    Full Text Available Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers’ perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%–34% and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249. The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

  15. IDC Reengineering Phase 2 & 3 Rough Order of Magnitude (ROM) Cost Estimate Summary (Leveraged NDC Case).

    Energy Technology Data Exchange (ETDEWEB)

    Harris, James M.; Prescott, Ryan; Dawson, Jericah M.; Huelskamp, Robert M.

    2014-11-01

    Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, based on leveraging a fully funded, Sandia executed NDC Modernization project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

  16. ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics

    Directory of Open Access Journals (Sweden)

    Bruce A Larson

    2013-01-01

    Full Text Available Introduction: After almost 10 years of PEPFAR funding for antiretroviral therapy (ART treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability. Methods: Using patient-level data from medical records (n=120/site, we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of Kenya (a clinic at a government hospital, a hospital run by a large agricultural company and a mission hospital. Costs included ARV and non-ARV drugs, laboratory tests, salaries to personnel providing patient care, and infrastructure and other fixed costs. We report the average cost per patient during the first 12 months after ART initiation, stratified by site, and the average cost per patient achieving the primary outcome, retention in care 12 months after treatment initiation. Results: The cost per patient initiated on ART was $206, $252 and $213 at Sites 1, 2 and 3, respectively. The proportion of patients remaining in care at 12 months was similar across all sites (0.82, 0.80 and 0.84. Average costs for the subset of patients who remained in care at 12 months was also similar (Site 1, $229; Site 2, $287; Site 3, $237. Patients not retained in care cost substantially less (Site 1, $104; Site 2, $113; Site 3, $88. For the subset of patients who remained in care at 12 months, ART medications accounted for 51%, 44% and 50% of the costs, with the remaining costs split between non-ART medications (15%, 11%, 10%, laboratory tests (14%, 15%, 15%, salaries to personnel providing patient care (9%, 11%, 12% and fixed costs (11%, 18%, 13%. Conclusions: At all three sites, 12-month retention in care compared favourably to retention rates reported in the literature from other low-income African countries. The cost of providing treatment was very low, averaging $224 in the first

  17. Co-payments for health care: what is their real cost?

    Science.gov (United States)

    Laba, Tracey-Lea; Usherwood, Tim; Leeder, Stephen; Yusuf, Farhat; Gillespie, James; Perkovic, Vlado; Wilson, Andrew; Jan, Stephen; Essue, Beverley

    2015-02-01

    Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by individuals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system.

  18. Co-payments for health care: what is their real cost?

    Science.gov (United States)

    Laba, Tracey-Lea; Usherwood, Tim; Leeder, Stephen; Yusuf, Farhat; Gillespie, James; Perkovic, Vlado; Wilson, Andrew; Jan, Stephen; Essue, Beverley

    2015-02-01

    Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by individuals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system. PMID:25362348

  19. Cost-effectiveness of supported self-management for CFS/ME patients in primary care

    Directory of Open Access Journals (Sweden)

    Richardson Gerry

    2013-01-01

    Full Text Available Abstract Background Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. Methods Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR and supportive listening (SL delivered by primary care nurses, and treatment as usual (TAU delivered by the general practitioner (GP in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis. Results Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population. Conclusions This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with ‘treatment as usual’ in primary care is unlikely to be acceptable to patients and practitioners. Trial registration The trial registration number is IRCTN74156610

  20. The future of nuclear power in France. An analysis of the costs of phasing-out

    Energy Technology Data Exchange (ETDEWEB)

    Malischek, Raimund; Trueby, Johannes

    2014-11-15

    Nuclear power is an important pillar in electricity generation in France. However, France's nuclear power plant fleet is ageing, and the possibility of reducing its share in power generation or even a complete phaseout has been increasingly discussed. Our research therefore focuses on three questions: First, what are the costs of phasing-out nuclear power in France under different scenarios? Second, who has to bear these costs, i.e., how much of the costs will be passed on to the rest of the European power system? And third, what effect does the uncertainty regarding future nuclear policy in France have on system costs? Applying a stochastic optimization model for the European electricity system, we show that additional system costs in France of a nuclear phase-out amount up to 76 billion EURO{sub 2010}. Additional costs are mostly borne by the French power system. Surprisingly, we find that the costs of uncertainty are rather limited. Based on our results, we conclude that a commitment regarding nuclear policy reform is only mildly beneficial in terms of system costs.

  1. The next phase of Title VII funding for training primary care physicians for America's health care needs.

    Science.gov (United States)

    Phillips, Robert L; Turner, Barbara J

    2012-01-01

    Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk.

  2. The impact of BPO on cost reduction in mid-sized health care systems.

    Science.gov (United States)

    Perry, Andy; Kocakülâh, Mehmet C

    2010-01-01

    At the convergence of two politico-economic "hot topics" of the day--outsourcing and the cost of health care-lie opportunities for mid-sized health systems to innovate, collaborate, and reduce overhead. Competition in the retail health care market can serve as both an impetus and an inhibitor to such measures, though. Here we are going to address the motivations, influences, opportunities, and limitations facing mid-sized, US non-profit health systems in business process outsourcing (BPO). Advocates cite numerous benefits to BPO, particularly in cost reduction and strategy optimization. BPO can elicit cost savings due to specialization among provider firms, returns to scale and technology, standardization and automation, and gains in resource arbitrage (off-shoring capabilities). BPO can also free an organization of non-critical tasks and focus resources on core competencies (treating patients). The surge in BPO utilization has rarely extended to the back-office functions of many mid-sized health systems. Health care providers, still a largely fragmented bunch with many rural, independent non-profit systems, have not experienced the consolidation and organizational scale growth to make BPO as attractive as other industries. Smaller firms, spurning merger and acquisition pressure from large, tertiary health systems, often wish to retain their autonomy and identity; hence, they face a competitive cost disadvantage compared to their larger competitors. This article examines the functional areas for these health systems in which BPO is not currently utilized and dissects the various methods available in which to practice BPO. We assess the ongoing adoption of BPO in these areas as well as the barriers to adoption, and identify the key processes that best represent opportunity for success. An emphasis is placed on a collaborative model with other health systems compared to a single system, unilateral BPO arrangement.

  3. The impact of BPO on cost reduction in mid-sized health care systems.

    Science.gov (United States)

    Perry, Andy; Kocakülâh, Mehmet C

    2010-01-01

    At the convergence of two politico-economic "hot topics" of the day--outsourcing and the cost of health care-lie opportunities for mid-sized health systems to innovate, collaborate, and reduce overhead. Competition in the retail health care market can serve as both an impetus and an inhibitor to such measures, though. Here we are going to address the motivations, influences, opportunities, and limitations facing mid-sized, US non-profit health systems in business process outsourcing (BPO). Advocates cite numerous benefits to BPO, particularly in cost reduction and strategy optimization. BPO can elicit cost savings due to specialization among provider firms, returns to scale and technology, standardization and automation, and gains in resource arbitrage (off-shoring capabilities). BPO can also free an organization of non-critical tasks and focus resources on core competencies (treating patients). The surge in BPO utilization has rarely extended to the back-office functions of many mid-sized health systems. Health care providers, still a largely fragmented bunch with many rural, independent non-profit systems, have not experienced the consolidation and organizational scale growth to make BPO as attractive as other industries. Smaller firms, spurning merger and acquisition pressure from large, tertiary health systems, often wish to retain their autonomy and identity; hence, they face a competitive cost disadvantage compared to their larger competitors. This article examines the functional areas for these health systems in which BPO is not currently utilized and dissects the various methods available in which to practice BPO. We assess the ongoing adoption of BPO in these areas as well as the barriers to adoption, and identify the key processes that best represent opportunity for success. An emphasis is placed on a collaborative model with other health systems compared to a single system, unilateral BPO arrangement. PMID:22329330

  4. Health care seeking and treatment cost in a rural community of West Bengal, India

    Directory of Open Access Journals (Sweden)

    Raykarmakar P, Mondal TK, Sarkar TK, Chakrabarty A

    2012-01-01

    Full Text Available Background: Availability and accessibility of health care is important for overall health status of any community. Both physical and financial accessibility is equally important. Present study was undertaken to find out the health care seeking, treatment cost and financing option in a rural community of Burdwan district, West Bengal, India.Methods: Community based descriptive observational study was conducted in four villages of Bhatar block of Burdwan district, West Bengal in September-November 2011by interviewing the head of the household with the help of a pre-designed and pre-tested questionnaire.Results: In acute condition and injury most frequently sought health care institution was Primary health centre or government hospital, followed by private practitioners, quack and medicine shop and in chronic illnesses almost equal percentages sought treatment from government and private facilities. In both condition majorities sought treatment from practitioners of modern medicine and very few sought treatment from Ayurveda and Homoeopathic practitioners. They spent about 15% of their family income for treatment. Cost of treatment was more in private facilities. Medicine accounted for 70% of treatment cost followed by investigation and consultation cost. Out of pocket expenditure was the most common financing option (93.6% and in 5.6% cases they borrowed money or sale assets and in 0.8% cases government health insurance were the financing option.Conclusions: Organization of community based health insurance or government insurance with contribution from public is urgently needed to protect the poor from slipping into poverty and indebtedness.

  5. COPD management costs according to the frequency of COPD exacerbations in UK primary care

    Directory of Open Access Journals (Sweden)

    Punekar YS

    2014-01-01

    two or more moderate-to-severe exacerbations, respectively.Conclusion: Disease management strategies focused on reducing costs in primary care may help reduce total COPD costs significantly.Keywords: chronic obstructive pulmonary disease, frequent exacerbations, infrequent exacerbations, health resources, health care costsCorrigendum for this paper has been published

  6. Caring for frail older people in the last phase of life – the general practitioners’ view

    OpenAIRE

    Geiger, Karin; Schneider, Nils; Bleidorn, Jutta; Klindtworth, Katharina; Jünger, Saskia; Müller-Mundt, Gabriele

    2016-01-01

    Background Frail older people are an increasingly important group in primary care due to demographic change. For these patients, a palliative care approach may be useful to sustain the quality of life in the last phase of their lives. While general practitioners (GPs) play a key role in the primary care for older patients, general palliative care is still in its infancy and little is known in Germany about caring for frail older people towards the end of life. This study aims to explore the t...

  7. Good agreement between questionnaire and administrative databases for health care use and costs in patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Robertson M Clare

    2011-04-01

    Full Text Available Abstract Background Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representation of health care costs; however the validity and feasibility of such methods have not been firmly established. This study was conducted to assess the validity and feasibility of using a patient-completed questionnaire to capture health care use and costs for patients with osteoarthritis, and to compare the research costs of the data-capture methods. Methods We designed a patient questionnaire and applied it in a clinical trial. We captured equivalent data from four administrative databases. We evaluated aspects of the questionnaire's validity using sensitivity and specificity, Lin's concordance correlation coefficient (ρc, and Bland-Altman comparisons. Results The questionnaire's response rate was 89%. Acceptable sensitivity and specificity levels were found for all types of health care use. The numbers of visits and the majority of medications reported by patients were in agreement with the database-derived estimates (ρc > 0.40. Total cost estimates from the questionnaire agreed with those from the databases. Patient-reported co-payments agreed with administrative records with respect to GP office transactions, but not pharmaceutical co-payments. Research costs for the questionnaire-based method were less than one-third of the costs for the databases method. Conclusion A patient-completed questionnaire is feasible for capturing health care use and costs for patients with osteoarthritis, and data collected using it mostly agree with administrative databases. Caution should be exercised when applying unit costs and collecting co-payment data.

  8. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

    Science.gov (United States)

    Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael

    2016-01-01

    Objectives The efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders. Design Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. A patient was defined as uncoordinated if he or she visited at least 1 specialist without a referral from a general practitioner within a quarter. Outcomes were compared with propensity score matching analysis. Participants The study encompassed all statutorily insured patients in Bavaria contacting at least 1 ambulatory specialist in the first quarter of 2011 (n=3 616 510). Primary and secondary outcome measures Primary outcome was total costs of ambulatory care; secondary outcomes were financial claims of general physicians, specialists and for medication. Results The average age was 55.3 years for coordinated patients (CP, n=1 629 302), 48.3 years for UP (n=1 825 840). CP more frequently had chronic diseases (85.4%) as compared with UP (67.5%). The total unadjusted financial claim per patient was higher for UP (€234.52) than for CP (€224.41); the total adjusted difference was −€9.65 (95% CI −11.64 to −7.67), indicating lower costs for CP. The cost differences increased with increasing age. Total adjusted difference per patient with mental diseases as documented with an International Classification of Diseases (ICD)-10 F-diagnosis, was −€20.31 (95% CI −26.43 to −14.46). Conclusions Coordination of care is associated with lower ambulatory healthcare expenditures and is of particular importance for patients who are more vulnerable to medical interventions, especially for elderly and patients with mental disorders

  9. Excess Medical Care Costs Associated with Physical Inactivity among Korean Adults: Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Jin-Young Min

    2016-01-01

    Full Text Available Physical inactivity is a major risk factor for chronic diseases and premature death. The increased health risks associated with physical inactivity may also generate a heavier economic burden to society. We estimated the direct medical costs attributable to physical inactivity among adultsusing data from the 2002–2010 Korean National Health Insurance Service-National Sample Cohort. A total of 68,556 adults whose reported physical activity status did not change during the study period was included for this study. Propensity scores for inactive adults were used to match 23,645 inactive groups with 23,645 active groups who had similar propensity scores. We compared medical expenditures between the two groups using generalized linear models with a gamma distribution and a log link. Direct medical costs were based on the reimbursement records of all medical facilities from 2005 to 2010. The average total medical costs for inactive individuals were $1110.5, which was estimated to be 11.7% higher than the costs for physically active individuals. With respect to specific diseases, the medical costs of inactive people were significantly higher than those of active people, accounting for approximately 8.7% to 25.3% of the excess burden. Physical inactivity is associated with considerable medical care expenditures per capita among Korean adults.

  10. Excess Medical Care Costs Associated with Physical Inactivity among Korean Adults: Retrospective Cohort Study.

    Science.gov (United States)

    Min, Jin-Young; Min, Kyoung-Bok

    2016-01-01

    Physical inactivity is a major risk factor for chronic diseases and premature death. The increased health risks associated with physical inactivity may also generate a heavier economic burden to society. We estimated the direct medical costs attributable to physical inactivity among adults using data from the 2002-2010 Korean National Health Insurance Service-National Sample Cohort. A total of 68,556 adults whose reported physical activity status did not change during the study period was included for this study. Propensity scores for inactive adults were used to match 23,645 inactive groups with 23,645 active groups who had similar propensity scores. We compared medical expenditures between the two groups using generalized linear models with a gamma distribution and a log link. Direct medical costs were based on the reimbursement records of all medical facilities from 2005 to 2010. The average total medical costs for inactive individuals were $1110.5, which was estimated to be 11.7% higher than the costs for physically active individuals. With respect to specific diseases, the medical costs of inactive people were significantly higher than those of active people, accounting for approximately 8.7% to 25.3% of the excess burden. Physical inactivity is associated with considerable medical care expenditures per capita among Korean adults. PMID:26797622

  11. The Direct Medical Costs of Outpatient Cares of Type 2 Diabetes in Iran: A Retrospective Study

    Science.gov (United States)

    Davari, Majid; Boroumand, Zahra; Amini, Masoud; Aslani, Abolfazl; Hosseini, Mohsen

    2016-01-01

    Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC) by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients’ profiles manually. The incidence of major diabetes complications were also examined from the subjects’ profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients’ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country. PMID:27217937

  12. The direct medical costs of outpatient cares of Type 2 diabetes in Iran: A retrospective study

    Directory of Open Access Journals (Sweden)

    Majid Davari

    2016-01-01

    Full Text Available Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients′ profiles manually. The incidence of major diabetes complications were also examined from the subjects′ profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%, and neuropathy (39% were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients′ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country.

  13. Costs of denied health care services and of the lawsuits filed to obtain them in Medellín, 2009

    Directory of Open Access Journals (Sweden)

    Emmanuel Nieto L

    2011-07-01

    Full Text Available Objective: to retrace the legal route of writs for the protection of constitutional rights involving health care services and to determine the cost of such processes and those of the health care services invoked in a sample of such writs taken in Medellín city. Methods: a descriptive study with a qualitative focus for retracing the legal route of the writs, and a quantitative approach for the purpose of cost estimation. The 2009 SOAT (Mandatory Car Insurance fees were used for assessing the cost of the health care services. As for the assessment of the legal costs, we used the micro-costing approach together with the activity-based costing methodology. Results: for each $100 corresponding to the cost of the services denied by the health care services provider, the Medellín judicial system spent around $48 on each legal process. In more than half of the cases, the cost of the legal action was higher than the services’ cost. Discussion: the cost of the legal process involving the writs for the protection of constitutional rights regarding health care services that were filed in the country between 1999 and 2009 could represent 2% of the budget circulating throughout the entire health system. This cost is just a part of the transaction costs generated by the health care services providers’ breach of the social contract established by the Colombian Constitution. Furthermore, in most cases there is also a breach of the private contract between these service providers and the health system users.

  14. Prevention under the Affordable Care Act (ACA: Has the ACA Overpromised and under Delivered?; Comment on “Interrelation of Preventive Care Benefits and Shared Costs under the Affordable Care Act (ACA”

    Directory of Open Access Journals (Sweden)

    Carol Molinari

    2014-08-01

    Full Text Available This policy brief discusses preventive care benefits and cost-sharing included in health insurance provisions of the Affordable Care Act (ACA legislation and highlights some consequences to Americans and the country in terms of healthcare costs and value.

  15. Multi-objective optimization approach for cost management during product design at the conceptual phase

    Science.gov (United States)

    Durga Prasad, K. G.; Venkata Subbaiah, K.; Narayana Rao, K.

    2014-03-01

    The effective cost management during the conceptual design phase of a product is essential to develop a product with minimum cost and desired quality. The integration of the methodologies of quality function deployment (QFD), value engineering (VE) and target costing (TC) could be applied to the continuous improvement of any product during product development. To optimize customer satisfaction and total cost of a product, a mathematical model is established in this paper. This model integrates QFD, VE and TC under multi-objective optimization frame work. A case study on domestic refrigerator is presented to show the performance of the proposed model. Goal programming is adopted to attain the goals of maximum customer satisfaction and minimum cost of the product.

  16. Architects and Design-Phase Cost Estimates: Design Professionals Should Reconsider the Value of Third-Party Estimates

    Science.gov (United States)

    Coakley, John

    2010-01-01

    Professional cost estimators are widely used by architects during the design phases of a project to provide preliminary cost estimates. These estimates may begin at the conceptual design phase and are prepared at regular intervals through the construction document phase. Estimating professionals are frequently tasked with "selling" the importance…

  17. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra;

    2014-01-01

    Objective. To examine the costs to the public health care system of couples in medically assisted reproduction. Design. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Setting. Specialized public fertility clinics in Denmark. Sample. Seven hund...

  18. In consumer-directed health plans, a majority of patients were unaware of free or low-cost preventive care.

    Science.gov (United States)

    Reed, Mary E; Graetz, Ilana; Fung, Vicki; Newhouse, Joseph P; Hsu, John

    2012-12-01

    Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care. We surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model. PMID:23213148

  19. Phase-sensitive detection in the undergraduate lab using a low-cost microcontroller

    Science.gov (United States)

    Schultz, K. D.

    2016-07-01

    Phase-sensitive detection is an important experimental technique that allows signals to be extracted from noisy data. Commercial lock-in amplifiers, often used for phase-sensitive detection, are expensive and host a bewildering array of controls that may intimidate a novice user. Low-cost microcontrollers such as the Arduino family of devices might seem like a good match for learning about such devices, but making a self-contained device that includes a reference signal, a voltage input, a signal mixer, a filter, and a display is difficult. Here, we present the construction of a phase-sensitive detector (PSD) using an Arduino.

  20. Retention in care and outpatient costs for children receiving antiretroviral therapy in Zambia: a retrospective cohort analysis.

    Directory of Open Access Journals (Sweden)

    Callie A Scott

    Full Text Available BACKGROUND: There are few published estimates of the cost of pediatric antiretroviral therapy (ART in Africa. Our objective was to estimate the outpatient cost of providing ART to children remaining in care at six public sector clinics in Zambia during the first three years after ART initiation, stratified by service delivery site and time on treatment. METHODS: Data on resource utilization (drugs, diagnostics, outpatient visits, fixed costs and treatment outcomes (in care, died, lost to follow up were extracted from medical records for 1,334 children at six sites who initiated ART at 50% at four sites. At the two remaining sites, outpatient visits and fixed costs together accounted for >50% of outpatient costs. The distribution of costs is slightly skewed, with median costs 3% to 13% lower than average costs during the first year after ART initiation depending on site. CONCLUSIONS: Outpatient costs for children initiating ART in Zambia are low and comparable to reported outpatient costs for adults. Outpatient costs and retention in care vary widely by site, suggesting opportunities for efficiency gains. Taking advantage of such opportunities will help ensure that targets for pediatric treatment coverage can be met.

  1. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    Science.gov (United States)

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  2. Kentucky Senate Bill 68 Cost Estimate (Adoption/Foster Care Ban)

    OpenAIRE

    Goldberg, Naomi G.; Badgett, M.V. Lee

    2009-01-01

    This memo estimates the impact on children and the cost to the State of Kentucky of Senate Bill 68, “The Child Welfare Adoption Act,” which would prohibit unmarried cohabiting couples—including both different-sex couples and same-sex couples— from fostering or adopting children. We use past data to estimate the number of children in foster care who were placed with unmarried couples as a way to estimate the number of impacted children in the first year the proposed legislation would take effe...

  3. Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

    Directory of Open Access Journals (Sweden)

    Joakim Ramsberg

    Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

  4. Evaluation of Low-Cost Topologies for Two-Phase Induction Motor Drives, in Industrial Applications

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Lungeanu, Florin; Skaug, Kenneth;

    2002-01-01

    This paper investigates and compares the potential of the two-phase induction motors to accommodate variable speed operation in ac drive. The analysis is based on both theory and experimental work, showing a conflict between the performances on one side, and the cost/complexity for such ac drives...... is a compromise between practical factors....

  5. SOLVENT NANOFILTRATION USING LOW-COST INORGANIC MEMBRANE MODULES - PHASE I

    Science.gov (United States)

    This Phase I project addresses: (1) development of fully inorganic nanofiltration (NF) membrane modules that have the attributes of low-cost, excellent chemical resistance in aggressive organic and aqueous media and high thermal stability; and (2) demonstration of the perfo...

  6. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    Science.gov (United States)

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  7. Radiology in managed care environment: Opportunities for cost savings in an HMO

    International Nuclear Information System (INIS)

    Purpose: A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. Materials and methods: We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were documented in Microsoft Excel trademark and analyzed by non-parametric tests using SPSS trademark 8.0 (Statistical Package for the Social Sciences) for Windows trademark. Results: The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. (orig.)

  8. Applications of life cycle assessment and cost analysis in health care waste management

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Sebastiao Roberto, E-mail: soares@ens.ufsc.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Finotti, Alexandra Rodrigues, E-mail: finotti@ens.ufsc.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Prudencio da Silva, Vamilson, E-mail: vamilson@epagri.sc.gov.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); EPAGRI, Rod. Admar Gonzaga 1347, Itacorubi, Florianopolis, Santa Catarina 88034-901 (Brazil); Alvarenga, Rodrigo A.F., E-mail: alvarenga.raf@gmail.com [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Ghent University, Department of Sustainable Organic Chemistry and Technology, Coupure Links 653/9000 Gent (Belgium)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Three Health Care Waste (HCW) scenarios were assessed through environmental and cost analysis. Black-Right-Pointing-Pointer HCW treatment using microwave oven had the lowest environmental impacts and costs in comparison with autoclave and lime. Black-Right-Pointing-Pointer Lime had the worst environmental and economic results for HCW treatment, in comparison with autoclave and microwave. - Abstract: The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$ 0.12 kg{sup -1} for the waste treated with microwaves, US$ 1.10 kg{sup -1} for the waste treated by the autoclave and US$ 1.53 kg{sup -1} for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible

  9. Applications of life cycle assessment and cost analysis in health care waste management

    International Nuclear Information System (INIS)

    Highlights: ► Three Health Care Waste (HCW) scenarios were assessed through environmental and cost analysis. ► HCW treatment using microwave oven had the lowest environmental impacts and costs in comparison with autoclave and lime. ► Lime had the worst environmental and economic results for HCW treatment, in comparison with autoclave and microwave. - Abstract: The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$ 0.12 kg−1 for the waste treated with microwaves, US$ 1.10 kg−1 for the waste treated by the autoclave and US$ 1.53 kg−1 for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.

  10. [Patient-individual care pathways in phase D neurological rehabilitation].

    Science.gov (United States)

    Waldmann, G; Schubert, M; Hummelsheim, H

    2007-08-01

    The "patient-individual neurological care pathways" are a concept for qualified decision-making about rational rehabilitative strategies in the treatment of neurological diseases. Such clinical pathways include available scientific evidence and treatment guidelines. In neurological rehabilitation all treatments have a decidedly interdisciplinary character. All members of the team need highly specialized knowledge, a high potential for teamwork, as well as efficient organisation of work time. Here, computer aided decision-making tools such as the "patient-individual neurological care pathways" facilitate rational decisions and reduce the need for reorganization of therapies. In rehabilitation of neurological patients a symptom-oriented and function-related perspective of the individual treatment goals is indispensable for optimal choice of therapy approaches. This function-oriented classification of patients and creation of individual treatment plans are realized within the Excel-based care pathways. This system has been proved on the one hand as an instrument for streamlining and optimisation and, on the other, as a useful tutoring tool in the medical rehabilitation process. PMID:17721839

  11. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

    Science.gov (United States)

    Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

    2016-01-01

    Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

  12. Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

    Directory of Open Access Journals (Sweden)

    Oliván-Blázquez Bárbara

    2009-11-01

    Full Text Available Abstract Background Strategies adopted by health administrations and directed towards drug cost control in primary care (PC can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs regarding current cost control measures as well as their proposals for improving the effectiveness of these measures. Methods A qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader. Results GPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures. Conclusion Future investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns

  13. Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use.

    Science.gov (United States)

    Culyer, Anthony J

    2016-10-01

    There is misunderstanding about both the meaning and the role of cost-effectiveness thresholds in policy decision making. This article dissects the main issues by use of a bookshelf metaphor. Its main conclusions are as follows: it must be possible to compare interventions in terms of their impact on a common measure of health; mere effectiveness is not a persuasive case for inclusion in public insurance plans; public health advocates need to address issues of relative effectiveness; a 'first best' benchmark or threshold ratio of health gain to expenditure identifies the least effective intervention that should be included in a public insurance plan; the reciprocal of this ratio - the 'first best' cost-effectiveness threshold - will rise or fall as the health budget rises or falls (ceteris paribus); setting thresholds too high or too low costs lives; failure to set any cost-effectiveness threshold at all also involves avertable deaths and morbidity; the threshold cannot be set independently of the health budget; the threshold can be approached from either the demand side or the supply side - the two are equivalent only in a health-maximising equilibrium; the supply-side approach generates an estimate of a 'second best' cost-effectiveness threshold that is higher than the 'first best'; the second best threshold is the one generally to be preferred in decisions about adding or subtracting interventions in an established public insurance package; multiple thresholds are implied by systems having distinct and separable health budgets; disinvestment involves eliminating effective technologies from the insured bundle; differential weighting of beneficiaries' health gains may affect the threshold; anonymity and identity are factors that may affect the interpretation of the threshold; the true opportunity cost of health care in a community, where the effectiveness of interventions is determined by their impact on health, is not to be measured in money - but in health

  14. Costs and benefits of competitive traits in females: aggression, maternal care and reproductive success.

    Directory of Open Access Journals (Sweden)

    Kristal E Cain

    Full Text Available Recent research has shown that female expression of competitive traits can be advantageous, providing greater access to limited reproductive resources. In males increased competitive trait expression often comes at a cost, e.g. trading off with parental effort. However, it is currently unclear whether, and to what extent, females also face such tradeoffs, whether the costs associated with that tradeoff overwhelm the potential benefits of resource acquisition, and how environmental factors might alter those relationships. To address this gap, we examine the relationships between aggression, maternal effort, offspring quality and reproductive success in a common songbird, the dark-eyed junco (Junco hyemalis, over two breeding seasons. We found that compared to less aggressive females, more aggressive females spent less time brooding nestlings, but fed nestlings more frequently. In the year with better breeding conditions, more aggressive females produced smaller eggs and lighter hatchlings, but in the year with poorer breeding conditions they produced larger eggs and achieved greater nest success. There was no relationship between aggression and nestling mass after hatch day in either year. These findings suggest that though females appear to tradeoff competitive ability with some forms of maternal care, the costs may be less than previously thought. Further, the observed year effects suggest that costs and benefits vary according to environmental variables, which may help to account for variation in the level of trait expression.

  15. Costs and benefits of competitive traits in females: aggression, maternal care and reproductive success.

    Science.gov (United States)

    Cain, Kristal E; Ketterson, Ellen D

    2013-01-01

    Recent research has shown that female expression of competitive traits can be advantageous, providing greater access to limited reproductive resources. In males increased competitive trait expression often comes at a cost, e.g. trading off with parental effort. However, it is currently unclear whether, and to what extent, females also face such tradeoffs, whether the costs associated with that tradeoff overwhelm the potential benefits of resource acquisition, and how environmental factors might alter those relationships. To address this gap, we examine the relationships between aggression, maternal effort, offspring quality and reproductive success in a common songbird, the dark-eyed junco (Junco hyemalis), over two breeding seasons. We found that compared to less aggressive females, more aggressive females spent less time brooding nestlings, but fed nestlings more frequently. In the year with better breeding conditions, more aggressive females produced smaller eggs and lighter hatchlings, but in the year with poorer breeding conditions they produced larger eggs and achieved greater nest success. There was no relationship between aggression and nestling mass after hatch day in either year. These findings suggest that though females appear to tradeoff competitive ability with some forms of maternal care, the costs may be less than previously thought. Further, the observed year effects suggest that costs and benefits vary according to environmental variables, which may help to account for variation in the level of trait expression. PMID:24204980

  16. Affordable Care Act's Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage.

    Science.gov (United States)

    Carlin, Caroline S; Fertig, Angela R; Dowd, Bryan E

    2016-09-01

    Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. We examined the impact of this change on women's patterns of choosing prescription contraceptive methods. Using claims data for a sample of midwestern women ages 18-46 with employer-sponsored coverage, we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice, and our findings about long-term methods may have implications for rates of unintended pregnancy that require further study. PMID:27605640

  17. Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    M.N. Saulez

    2007-06-01

    Full Text Available Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU. This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate. The WBC count, total CO2 (TCO2 and alkaline phosphatase (ALP were significantly higher (P < 0.05 and anion gap lower in survivors compared with nonsurvivors. A logistic regression model that included WBC count, hematocrit, albumin / globulin ratio, ALP, TCO2, potassium, sodium and lactate, was able to correctly predict mortality in 84 % of cases. Only anion gap proved to be an independent predictor of neonatal mortality in this study. In the study population, the overall mortality rate was 34 % with greatest mortality rates reported in the first 48 hours and again on day 6 of hospitalisation. Amongst the various clinical diagnoses, mortality was highest in foals after forced extraction during correction of dystocia. Median cost per day was higher for nonsurvivors while total cost was higher in survivors.

  18. COPD exacerbation frequency and its association with health care resource utilization and costs

    Directory of Open Access Journals (Sweden)

    Dhamane AD

    2015-12-01

    Full Text Available Amol D Dhamane,1 Chad Moretz,2 Yunping Zhou,2 Kate Burslem,1 Kim Saverno,2 Gagan Jain,1 Andrew Renda,3 Shuchita Kaila1 1Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA; 2Comprehensive Health Insights Inc., Louisville, KY, USA; 3Humana Inc., Louisville, KY, USA Background: Chronic obstructive pulmonary disease (COPD exacerbations account for a substantial proportion of COPD-related costs.Objective: To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU and costs in patients with COPD in a Medicare population.Methods: A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40–89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period. Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three. HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models.Results: Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001. In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy were more than twofold greater in

  19. Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings

    OpenAIRE

    Johansen Inger; Lindbak Morten; Stanghelle Johan K; Brekke Mette

    2012-01-01

    Background The optimal setting and content of primary health care rehabilitation of older people is not known. Our aim was to study independence, institutionalization, death and treatment costs 18 months after primary care rehabilitation of older people in two different settings. Methods Eighteen months follow-up of an open, prospective study comparing the outcome of multi-disciplinary rehabilitation ...

  20. Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk

    NARCIS (Netherlands)

    Cleveringa, Frits G. W.; Welsing, Paco M. J.; van den Donk, Maureen; Gorter, Kees J.; Niessen, Louis W.; Rutten, Guy E. H. M.; Redekop, William K.

    2010-01-01

    OBJECTIVE - The Diabetes Care Protocol (DCP), a multifaceted Computerized decision support diabetes management intervention, reduces cardiovascular risk Of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. RESEARCH DESIGN AND METHODS -

  1. Cost-effectiveness of the diabetes care protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk

    NARCIS (Netherlands)

    F.G.W. Cleveringa (Frits G.); P.M.J. Welsing (Paco); M. van den Donk (Maureen); K.J. Gorter; L.W. Niessen (Louis Wilhelmus); G.E.H.M. Rutten (Guy); W.K. Redekop (Ken)

    2010-01-01

    textabstractOBJECTIVE- The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. RESEARCH DESIGN AND

  2. Cost-Optimal Design of a 3-Phase Core Type Transformer by Gradient Search Technique

    Science.gov (United States)

    Basak, R.; Das, A.; Sensarma, A. K.; Sanyal, A. N.

    2014-04-01

    3-phase core type transformers are extensively used as power and distribution transformers in power system and their cost is a sizable proportion of the total system cost. Therefore they should be designed cost-optimally. The design methodology for reaching cost-optimality has been discussed in details by authors like Ramamoorty. It has also been discussed in brief in some of the text-books of electrical design. The paper gives a method for optimizing design, in presence of constraints specified by the customer and the regulatory authorities, through gradient search technique. The starting point has been chosen within the allowable parameter space the steepest decent path has been followed for convergence. The step length has been judiciously chosen and the program has been maneuvered to avoid local minimal points. The method appears to be best as its convergence is quickest amongst different optimizing techniques.

  3. Extending Foster Care to Age 21: Weighing the Costs to Government against the Benefits to Youth. Chapin Hall Issue Brief

    Science.gov (United States)

    Peters, Clark M.; Dworsky, Amy; Courtney, Mark E.; Pollack, Harold

    2009-01-01

    The Fostering Connections to Success and Increasing Adoptions Act of 2008 allows states to claim federal reimbursement for the costs of caring for and supervising Title IV-E eligible foster youth until their 21st birthday. This issue brief provides preliminary estimates of what the potential costs to government and the benefits to young people…

  4. Wide Variability in Emergency Physician Admission Rates: A New Target To Reduce Healthcare Costs Without Adversely Affecting Quality of Care

    OpenAIRE

    Richman, Mark; Guterman, Jeffrey James; Lundberg, Scott Ryan; Talan, David Andrew; Gross-Schulman, Sandra Geri; Wang, Chien-Ju; Scheib, Geoffrey Paul

    2016-01-01

    INTRODUCTION Attending physician judgment is the traditional standard of care for Emergency Department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. METHODS We sought to determine the impact of variability in admission decisions on cost and quality. We performed a retrospective observational study of patients presenting to a u...

  5. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

    OpenAIRE

    Márcia Pinto; Aline Piovezan Entringer; Ricardo Steffen; Anete Trajman

    2015-01-01

    ABSTRACT We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smea...

  6. Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit

    Directory of Open Access Journals (Sweden)

    Manish Singh Sharma

    2012-01-01

    Full Text Available Objectives: The routine use of prophylactic antibiotics in neurosurgery has been shown to significantly reduce surgical site infection rates. The documentation of non-surgical site, nosocomial infections in neurosurgical patients remains limited, despite this being a stimulus for prolific antibiotic usage. The actual quantum of antibiotic use in neurosurgery and its role in infection control remain both undocumented and controversial. The authors address this issue with a cost-effectiveness study using historical controls. Materials and Methods: Bacteriologically positive body fluid samples were used to quantify infection rates in the year 2006 and compared with those in the year 1997. Itemized drug lists obtained from dedicated neurosurgical intensive care units and wards were used to quantify antibiotic usage and calculate their costs. Results were compared using both historical and internal controls. The monetary conversion factor used was INR 40=US$1. Results: A total of 3114 consecutive elective and emergency neurosurgical procedures were performed during the study period. 329 patients (10.6% were recorded to have bacteriologically positive body fluid samples, and 100,250 units of antibiotics were consumed costing Rs. 14,378,227.5 ($359,455.7. On an average, an operated patient received 32.2 units of antibiotics valued at Rs. 4,617 ($115.4. The crude infection rates were recorded to have reduced significantly in comparison to 1997, but did not differ between mirror intra-departmental units with significantly different antibiotic usage. Conclusions: Antibiotics accounted for 31% of the per capita cost of consumables for performing a craniotomy in the year 2006. This estimate should be factored into projecting future package costs.

  7. Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland

    Directory of Open Access Journals (Sweden)

    Huber CA

    2014-10-01

    Full Text Available Carola A Huber,1 Peter Diem,2 Matthias Schwenkglenks,3 Roland Rapold,1 Oliver Reich1 1Department of Health Sciences, Helsana Group, Zürich, Switzerland; 2Department of Endocrinology, Diabetes and Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; 3Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland Background: Estimating the prevalence of comorbidities and their associated costs in patients with diabetes is fundamental to optimizing health care management. This study assesses the prevalence and health care costs of comorbid conditions among patients with diabetes compared with patients without diabetes. Distinguishing potentially diabetes- and nondiabetes-related comorbidities in patients with diabetes, we also determined the most frequent chronic conditions and estimated their effect on costs across different health care settings in Switzerland. Methods: Using health care claims data from 2011, we calculated the prevalence and average health care costs of comorbidities among patients with and without diabetes in inpatient and outpatient settings. Patients with diabetes and comorbid conditions were identified using pharmacy-based cost groups. Generalized linear models with negative binomial distribution were used to analyze the effect of comorbidities on health care costs. Results: A total of 932,612 persons, including 50,751 patients with diabetes, were enrolled. The most frequent potentially diabetes- and nondiabetes-related comorbidities in patients older than 64 years were cardiovascular diseases (91%, rheumatologic conditions (55%, and hyperlipidemia (53%. The mean total health care costs for diabetes patients varied substantially by comorbidity status (US$3,203–$14,223. Patients with diabetes and more than two comorbidities incurred US$10,584 higher total costs than patients without comorbidity. Costs were significantly higher in patients with

  8. ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics

    OpenAIRE

    Larson, Bruce A.; Margaret Bii; Sarah Henly-Thomas; Kelly McCoy; Fredrick Sawe; Douglas Shaffer; Sydney Rosen

    2013-01-01

    Introduction: After almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability. Methods: Using patient-level data from medical records (n=120/site), we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of Kenya (a c...

  9. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  10. Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan.

    Directory of Open Access Journals (Sweden)

    Naseem Salahuddin

    2016-02-01

    Full Text Available Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP. Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG, assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV per patient, whereas Thai Red Cross intradermal (TRC-id regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen.This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded.Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique.

  11. Estimating Lifetime Costs of Social Care: A Bayesian Approach Using Linked Administrative Datasets from Three Geographical Areas.

    Science.gov (United States)

    Steventon, Adam; Roberts, Adam

    2015-12-01

    We estimated lifetime costs of publicly funded social care, covering services such as residential and nursing care homes, domiciliary care and meals. Like previous studies, we constructed microsimulation models. However, our transition probabilities were estimated from longitudinal, linked administrative health and social care datasets, rather than from survey data. Administrative data were obtained from three geographical areas of England, and we estimated transition probabilities in each of these sites flexibly using Bayesian methods. This allowed us to quantify regional variation as well as the impact of structural and parameter uncertainty regarding the transition probabilities. Expected lifetime costs at age 65 were £20,200-27,000 for men and £38,700-49,000 for women, depending on which of the three areas was used to calibrate the model. Thus, patterns of social care spending differed markedly between areas, with mean costs varying by almost £10,000 (25%) across the lifetime for people of the same age and gender. Allowing for structural and parameter uncertainty had little impact on expected lifetime costs, but slightly increased the risk of very high costs, which will have implications for insurance products for social care through increasing requirements for capital reserves. PMID:25385010

  12. Estimating Lifetime Costs of Social Care: A Bayesian Approach Using Linked Administrative Datasets from Three Geographical Areas.

    Science.gov (United States)

    Steventon, Adam; Roberts, Adam

    2015-12-01

    We estimated lifetime costs of publicly funded social care, covering services such as residential and nursing care homes, domiciliary care and meals. Like previous studies, we constructed microsimulation models. However, our transition probabilities were estimated from longitudinal, linked administrative health and social care datasets, rather than from survey data. Administrative data were obtained from three geographical areas of England, and we estimated transition probabilities in each of these sites flexibly using Bayesian methods. This allowed us to quantify regional variation as well as the impact of structural and parameter uncertainty regarding the transition probabilities. Expected lifetime costs at age 65 were £20,200-27,000 for men and £38,700-49,000 for women, depending on which of the three areas was used to calibrate the model. Thus, patterns of social care spending differed markedly between areas, with mean costs varying by almost £10,000 (25%) across the lifetime for people of the same age and gender. Allowing for structural and parameter uncertainty had little impact on expected lifetime costs, but slightly increased the risk of very high costs, which will have implications for insurance products for social care through increasing requirements for capital reserves.

  13. ESBLs producing Enterobacteriaceae in critical care areas – a clinical and cost analysis from a tertiary health care centre

    Directory of Open Access Journals (Sweden)

    Hena Rani

    2012-04-01

    Full Text Available Objective: ESBLs pose a major threat in clinical therapeutics. In the present study we have tried to do clinical analysis of one hundred ESBLs producing Enterobacteriaceae isolates from various clinical specimens from patients admitted in critical care areas. Methods: ESBLs detection was done by CLSI, DDS and Vitek methods. Clinical analysis of each patient was done by regularly visiting in CCA and reviewing patient’s status and medical records. Results: All of the 13 patients on foley’s catheter grew ESBLs positive isolates and amongst 10 non catheterized patients, 9 grew ESBLs negative isolates. Thirteen out of 14 patients on CVP/arterial line grew ESBLs positive isolates. Out of 24 patients who underwent surgery, 22 grew ESBLs positive isolate. Forty seven out of 68 patients who were on 3rd or 4th generation cephalosporins within last 1 month of giving the sample grew ESBLs positive isolates. Conclusion: We have found a statistically significant (p<0.0.05 relationship in between foley’s catheterization and production of ESBLs from urinary isolates. There was no statistically significant association in between CVP/arterial line and blood culture isolates. We did not find difference in mortality rates in between patients infected with ESBLs positive or negative isolates. The mortality in patients was associated with their primary illness or associated co-morbid conditions. We found that the detection of ESBLs is important for the de-escalation of therapy thereby saving net cost of treatment.

  14. Development and first assessment of a questionnaire for health care utilization and costs for cardiac patients

    Directory of Open Access Journals (Sweden)

    Hahmann Harry

    2008-09-01

    Full Text Available Abstract Background The valid and reliable measurement of health service utilization, productivity losses and consequently total disease-related costs is a prerequisite for health services research and for health economic analysis. Although administrative data sources are usually considered to be the most accurate, their use is limited as some components of utilization are not systematically captured and, especially in decentralized health care systems, no single source exists for comprehensive utilization and cost data. The aim of this study was to develop and test a questionnaire for the measurement of disease-related costs for patients after an acute cardiac event (ACE. Methods To design the questionnaire, the literature was searched for contributions to the assessment of utilization of health care resources by patient-administered questionnaires. Based on these findings, we developed a retrospective questionnaire appropriate for the measurement of disease-related costs over a period of 3 months in ACE patients. Items were generated by reviewing existing guidelines and by interviewing medical specialists and patients. In this study, the questionnaire was tested on 106 patients, aging 35–65 who were admitted for rehabilitation after ACE. It was compared with prospectively measured data; selected items were compared with administrative data from sickness funds. Results The questionnaire was accepted well (response rate = 88%, and respondents completed the questionnaire in an average time of 27 minutes. Concordance between retrospective and prospective data showed an intraclass correlation (ICC ranging between 0.57 (cost of medical intake and 0.9 (hospital days with the other main items (physician visits, days off work, medication clustering around 0.7. Comparison between self-reported and administrative data for days off work and hospitalized days were possible for n = 48. Respective ICCs ranged between 0.92 and 0.94, although differences in

  15. Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

    Directory of Open Access Journals (Sweden)

    Gabriela B Gomez

    Full Text Available While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI in rural Nigeria.We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program's scale up within the State's healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730. Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible

  16. Antibiotic prescription and cost patterns in a general intensive care unit

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    Krivoy N

    2007-06-01

    Full Text Available Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed. Methods: Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002. Results: A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8% and Imipenem/Cilastin (11.2% were the most prescribed medications; while, in 2003, Vancomycin (12.6% and Imipenem/Cilastin (11.3% were prescribed, respectively. Total defined daily dose (DDD and Drug Utilization 90% (DU90% index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1 and 1777.57 and 2079.61 DU90%, respectively (p>0.1. The Median Total Cost /100 admission days (CI 95% were NIS13,310 (11,110;18,420 and NIS13,860 (6,710;18,020 (p=0.66, respectively. Conclusions: Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses.

  17. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system.

    Science.gov (United States)

    Solomon, Daniel H; Patrick, Amanda R; Schousboe, John; Losina, Elena

    2014-07-01

    Fractures related to osteoporosis are associated with $20 billion in cost in the United States, with the majority of cost born by federal health-care programs, such as Medicare and Medicaid. Despite the proven fracture reduction benefits of several osteoporosis treatments, less than one-quarter of patients older than 65 years of age who fracture receive such care. A postfracture liaison service (FLS) has been developed in many health systems but has not been widely implemented in the United States. We developed a Markov state-transition computer simulation model to assess the cost-effectiveness of an FLS using a health-care system perspective. Using the model, we projected the lifetime costs and benefits of FLS, with or without a bone mineral density test, in men and women who had experienced a hip fracture. We estimated the costs and benefits of an FLS, the probabilities of refracture while on osteoporosis treatment, as well as the utilities associated with various health states from published literature. We used multi-way sensitivity analyses to examine impact of uncertainty in input parameters on cost-effectiveness of FLS. The model estimates that an FLS would result in 153 fewer fractures (109 hip, 5 wrist, 21 spine, 17 other), 37.43 more quality-adjusted life years (QALYs), and save $66,879 compared with typical postfracture care per every 10,000 postfracture patients. Doubling the cost of the FLS resulted in an incremental cost-effectiveness ratio (ICER) of $22,993 per QALY. The sensitivity analyses showed that results were robust to plausible ranges of input parameters; assuming the least favorable values of each of the major input parameters results in an ICER of $112,877 per QALY. An FLS targeting patients post-hip fracture should result in cost savings and reduced fractures under most scenarios. PMID:24443384

  18. Statistical characteristics of L1 carrier phase observations from four low-cost GPS receivers

    DEFF Research Database (Denmark)

    Cederholm, Jens Peter

    2010-01-01

    Statistical properties of L1 carrier phase observations from four low-cost GPS receivers are investigated through a case study. The observations are collected on a zero baseline with a frequency of 1 Hz and processed with a double difference model. The carrier phase residuals from an ambiguity...... mean value close to zero and the sample variance is time invariant. The residuals from one type of receiver deviate from being normally distributed, whereas the residuals from the remaining receivers are close to being normally distributed. Two of the receivers deliver uncorrelated carrier phase...... observations. Some of the carrier phase observations from the other two receivers are serially correlated. The correlation is receiver specific and is related to the individual channels of the receivers....

  19. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

    Directory of Open Access Journals (Sweden)

    Torbica Aleksandra

    2010-05-01

    Full Text Available Abstract Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases and patients without CLABSI (controls were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143; 56% of the cases and 57% of the controls were females (p = 0.922. The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p Conclusions CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

  20. Cooperative medical insurance and the cost of care in Shandong, PR China: perspectives of patients and community members.

    Science.gov (United States)

    Mahmood, Mohammad Afzal; Raulli, Alexandra; Yan, Wang; Dong, Han; Aiguo, Zhang; Ping, Dong

    2015-03-01

    This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China's economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies.

  1. Cooperative medical insurance and the cost of care in Shandong, PR China: perspectives of patients and community members.

    Science.gov (United States)

    Mahmood, Mohammad Afzal; Raulli, Alexandra; Yan, Wang; Dong, Han; Aiguo, Zhang; Ping, Dong

    2015-03-01

    This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China's economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies. PMID:20702447

  2. CHANGES IN THE COSTS OF HYPERTENSIVE CRISIS THERAPY DUE TO OPTIMIZATION OF DRUG SUPPLY IN THE PRE-ADMISSION CARE

    Directory of Open Access Journals (Sweden)

    N. I. Gaponova

    2012-01-01

    Full Text Available Aim. To assess the changes in the costs of treatment of patients with hypertensive crisis (HC in pre-admission care in Moscow from 2005 to 2010. Material and methods. Comparative analysis of the treatment costs was performed depending on outcomes in patients with HC at Moscow Emergency Medical Care Station named after A.S. Puchkov. HC arresting excluding the need of admission was taken into account in addition to antihypertensive effect and safety in evaluation of pre-admission care efficacy. Results. Introduction in practice of modern algorithms of emergency pre-admission care, supply of ambulance crews with modern antihypertensive drugs reduced the rate of admission from 71% in 2005 to 44% in 2010 among patients with HC. Total savings amounted to 403,691,808 rubles. Conclusion. Introduction of modern technologies in the emergency pre-admission care for patients with HC is economically reasonable.

  3. CHANGES IN THE COSTS OF HYPERTENSIVE CRISIS THERAPY DUE TO OPTIMIZATION OF DRUG SUPPLY IN THE PRE-ADMISSION CARE

    Directory of Open Access Journals (Sweden)

    N. I. Gaponova

    2015-12-01

    Full Text Available Aim. To assess the changes in the costs of treatment of patients with hypertensive crisis (HC in pre-admission care in Moscow from 2005 to 2010. Material and methods. Comparative analysis of the treatment costs was performed depending on outcomes in patients with HC at Moscow Emergency Medical Care Station named after A.S. Puchkov. HC arresting excluding the need of admission was taken into account in addition to antihypertensive effect and safety in evaluation of pre-admission care efficacy. Results. Introduction in practice of modern algorithms of emergency pre-admission care, supply of ambulance crews with modern antihypertensive drugs reduced the rate of admission from 71% in 2005 to 44% in 2010 among patients with HC. Total savings amounted to 403,691,808 rubles. Conclusion. Introduction of modern technologies in the emergency pre-admission care for patients with HC is economically reasonable.

  4. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

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    Bosmans Judith E

    2012-02-01

    Full Text Available Abstract Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004. Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743 in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434. After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected to €463 (corrected in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.

  5. Paying for primary care: a cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada.

    Science.gov (United States)

    Rudoler, David; Laporte, Audrey; Barnsley, Janet; Glazier, Richard H; Deber, Raisa B

    2015-01-01

    Policy-makers desire an optimal balance of financial incentives to improve productivity and encourage improved quality in primary care, while also avoiding issues of risk-selection inherent to capitation-based payment. In this paper we analyze risk-selection in capitation-based payment by using administrative data for patients (n = 11,600,911) who were rostered (i.e., signed an enrollment form, or received a majority of care) with a primary care physician (n = 8621) in Ontario, Canada in 2010/11. We analyze this data using a relative distribution approach and compare distributions of patient costs and morbidity across primary care payment models. Our results suggest a relationship between being in a capitation-based payment scheme and having low cost patients (and presumably healthy patients) compared to fee-for-service physicians. However, we do not have evidence that physicians in capitation-based models are reducing the care they provide to sick and high cost patients. These findings suggest there is a relationship between payment type and risk-selection, particularly for low-cost and healthy patients. PMID:25461858

  6. Cost-effective aperture arrays for SKA Phase 1: single or dual-band?

    CERN Document Server

    Colegate, T M; Gunst, A W

    2012-01-01

    An important design decision for the first phase of the Square Kilometre Array is whether the low frequency component (SKA1-low) should be implemented as a single or dual-band aperture array; that is, using one or two antenna element designs to observe the 70-450 MHz frequency band. This memo uses an elementary parametric analysis to make a quantitative, first-order cost comparison of representative implementations of a single and dual-band system, chosen for comparable performance characteristics. A direct comparison of the SKA1-low station costs reveals that those costs are similar, although the uncertainties are high. The cost impact on the broader telescope system varies: the deployment and site preparation costs are higher for the dual-band array, but the digital signal processing costs are higher for the single-band array. This parametric analysis also shows that a first stage of analogue tile beamforming, as opposed to only station-level, all-digital beamforming, has the potential to significantly redu...

  7. A standardized relative resource cost model for medical care: application to cancer control programs.

    Science.gov (United States)

    O'Keeffe-Rosetti, Maureen C; Hornbrook, Mark C; Fishman, Paul A; Ritzwoller, Debra P; Keast, Erin M; Staab, Jenny; Lafata, Jennifer Elston; Salloum, Ramzi

    2013-01-01

    Medicare data represent 75% of aged and permanently disabled Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, but the data omit 25% of beneficiaries enrolled in Medicare Advantage health maintenance organizations (HMOs). Little research has examined how longitudinal patterns of utilization differ between HMOs and FFS. The Burden of Cancer Study developed and implemented an algorithm to assign standardized relative costs to HMO and Medicare FFS data consistently across time and place. Medicare uses 15 payment systems to reimburse FFS providers for covered services. The standardized relative resource cost algorithm (SRRCA) adapts these various payment systems to utilization data. We describe the rationale for modifications to the Medicare payment systems and discuss the implications of these modifications. We applied the SRRCA to data from four HMO sites and the linked Surveillance, Epidemiology, and End Results-Medicare data. Some modifications to Medicare payment systems were required, because data elements needed to categorize utilization were missing from both data sources. For example, data were not available to create episodes for home health services received, so we assigned costs per visit based on visit type (nurse, therapist, and aide). For inpatient utilization, we modified Medicare's payment algorithm by changing it from a flat payment per diagnosis-related group to daily rates for diagnosis-related groups to differentiate shorter versus longer stays. The SRRCA can be used in multiple managed care plans and across multiple FFS delivery systems within the United States to create consistent relative cost data for economic analyses. Prior to international use of the SRRCA, data need to be standardized.

  8. Intoxicated children at an intensive care unit: popular medicine risks, complications and costs

    Directory of Open Access Journals (Sweden)

    Consuelo de Rovetto

    2009-09-01

    Full Text Available Introduction: The Hospital Universitario del Valle (HUV at the Pediatrics Intensive Care Unit (PICU admits intoxicated patients, erroneously medicated by «teguas» or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case seriesObjective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers («teguas» or family members, leading to admission at the PICU, and to describe complications and hospital costs of these events.Methodology: Clinical charts of patients admitted to the PICU with diagnosis of exogenous intoxication during May 2001 to September 2004, were reviewed. Of 28 registered cases during that time, only 14 clinical charts were recovered. Variables evaluated included: age, gender, proceeding, administered substance, person responsible for the administration, complications, days of mechanical ventilation, total days at the intensive care unit and average costs. Of the 14 medical records with exogenous intoxications only 5 cases were involuntary and 9 were related to the administration of substances by quacks or family members; these are the ones reported in this series.Results: We report a total of 9 intoxicated patients, 5 girls and 4 boys, with an age range from 1 to 24 months, all from Cali. Topical administered substances: alcohol 6/9, vinegar 1/9; oral: aspirin 2/9, paico 1/9, and unidentified herbs 1/9. Administered substances by teguas: 6 patients; 3 by family members. All patients had metabolic acidosis with an increased anion gap: 27 in average (range from 21 to 32. All required mechanical ventilation (2 to 32 day range. Average hospital day costs were $6’657,800 pesos (around U$3,000.oo. Three patients died and 4 presented acute renal failure, 2 convulsions, 2 nosocomial infections, 1 subglotic stenosis.Conclusions and

  9. Intoxicated children at an intensive care unit: popular medicine risks, complications and costs.

    Directory of Open Access Journals (Sweden)

    Consuelo de Rovetto

    2009-12-01

    Full Text Available Introduction: The Hospital Universitario del Valle (HUV at the Pediatrics Intensive Care Unit (PICU admits intoxicated patients, erroneously medicated by «teguas» or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case series Objective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers («teguas» or family members, leading to admission at the PICU, and to describe complications and hospital costs of these events. Methodology: Clinical charts of patients admitted to the PICU with diagnosis of exogenous intoxication during May 2001 to September 2004, were reviewed. Of 28 registered cases during that time, only 14 clinical charts were recovered. Variables evaluated included: age, gender, proceeding, administered substance, person responsible for the administration, complications, days of mechanical ventilation, total days at the intensive care unit and average costs. Of the 14 medical records with exogenous intoxications only 5 cases were involuntary and 9 were related to the administration of substances by quacks or family members; these are the ones reported in this series. Results: We report a total of 9 intoxicated patients, 5 girls and 4 boys, with an age range from 1 to 24 months, all from Cali. Topical administered substances: alcohol 6/9, vinegar 1/9; oral: aspirin 2/9, paico 1/9, and unidentified herbs 1/9. Administered substances by teguas: 6 patients; 3 by family members. All patients had metabolic acidosis with an increased anion gap: 27 in average (range from 21 to 32. All required mechanical ventilation (2 to 32 day range. Average hospital day costs were $6’657,800 pesos (around U$3,000.oo. Three patients died and 4 presented acute renal failure, 2 convulsions, 2 nosocomial infections, 1 subglotic stenosis. Conclusions and

  10. Payroll costs not identified by phase in construction work done with no third subcontracted

    Directory of Open Access Journals (Sweden)

    Rubén Antonio González Franco

    2012-05-01

    Full Text Available The Social Insurance Regulations applicable to the construction companies with regard to meeting high work requires the owner to generate high for each construction phase and thus to check the amounts of materials, machinery and equipment, as well as labor applied at the same stage, all in order to validate that it complies 100% with the payment of worker-employer contributions by the employer, guidelines in the specific case of SMEs practice becomes more complex, controls as these companies have no proof phased costs in two areas in particular, as are exercised costs of materials and workmanship for housing, which is why this research aims to solve the problem of generating clear guidelines to comply with the verification of payment of contributions in the field of labor when it is exerciseddirectly, and through the application of direct interviews and questionnaires to the units of analysis consists of businessmen, representatives, directors or business accountants SMEs construction, staff of the National Chamber of construction Industry and the Mexican Social Security Institute head of the Department of construction, who will answer questions the same instrument provides, and with this it was determined that in fact the perception of these SMEs is required to leave a standard criterion for testing and would be more appropriate apportionment of costs proportionately based on hire dates and termination dates of the work keeping track of costs identifying overall, leaving an identification number in the working papers for further review by the authority.

  11. Low-Cost Phased Array Antenna for Sounding Rockets, Missiles, and Expendable Launch Vehicles

    Science.gov (United States)

    Mullinix, Daniel; Hall, Kenneth; Smith, Bruce; Corbin, Brian

    2012-01-01

    A low-cost beamformer phased array antenna has been developed for expendable launch vehicles, rockets, and missiles. It utilizes a conformal array antenna of ring or individual radiators (design varies depending on application) that is designed to be fed by the recently developed hybrid electrical/mechanical (vendor-supplied) phased array beamformer. The combination of these new array antennas and the hybrid beamformer results in a conformal phased array antenna that has significantly higher gain than traditional omni antennas, and costs an order of magnitude or more less than traditional phased array designs. Existing omnidirectional antennas for sounding rockets, missiles, and expendable launch vehicles (ELVs) do not have sufficient gain to support the required communication data rates via the space network. Missiles and smaller ELVs are often stabilized in flight by a fast (i.e. 4 Hz) roll rate. This fast roll rate, combined with vehicle attitude changes, greatly increases the complexity of the high-gain antenna beam-tracking problem. Phased arrays for larger ELVs with roll control are prohibitively expensive. Prior techniques involved a traditional fully electronic phased array solution, combined with highly complex and very fast inertial measurement unit phased array beamformers. The functional operation of this phased array is substantially different from traditional phased arrays in that it uses a hybrid electrical/mechanical beamformer that creates the relative time delays for steering the antenna beam via a small physical movement of variable delay lines. This movement is controlled via an innovative antenna control unit that accesses an internal measurement unit for vehicle attitude information, computes a beam-pointing angle to the target, then points the beam via a stepper motor controller. The stepper motor on the beamformer controls the beamformer variable delay lines that apply the appropriate time delays to the individual array elements to properly

  12. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes

    DEFF Research Database (Denmark)

    Tao, L; Wilson, E C F; Wareham, N J;

    2015-01-01

    Aims To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Methods Cost–utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people...... with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were......, falling to £37 500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981. Conclusion Given conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared...

  13. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B;

    2009-01-01

    of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated...... using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. RESULTS: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private...

  14. Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care.

    Science.gov (United States)

    Litaker, David; Mion, Lorraine; Planavsky, Loretta; Kippes, Christopher; Mehta, Neil; Frolkis, Joseph

    2003-08-01

    Increasing demand to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care. The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care. One hundred fifty-seven patients with hypertension and diabetes mellitus were randomly assigned to their primary care physician and a nurse practitioner or their primary care physician alone. Costs for personnel directly involved in patient management, calculated from hourly rates and encounter time with patients, and pre- and post-study glycosylated hemoglobin (HbA(1c)), high-density lipoprotein cholesterol (HDL-c), satisfaction with care and health-related quality of life (HRQoL) were assessed. Although 1-year costs for personnel were higher in the team-treated group, participants experienced significant improvements in mean HbA(1c) ( - 0.7%, p = 0.02) and HDL-c ( + 2.6 mg dL( - 1), p = 0.02). Additionally, satisfaction with care improved significantly for team-treated subjects in several sub-scales whereas the mean change over time in HRQoL did not differ significantly between groups. This study demonstrates the value of a complementary team approach to chronic disease management in improving patient-derived and clinical outcomes at modest incremental costs.

  15. Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

    Directory of Open Access Journals (Sweden)

    Kathryn Schnippel

    Full Text Available Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model.The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs, breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD.Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts; the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to

  16. An Instantaneous Low-Cost Point-of-Care Anemia Detection Device

    Directory of Open Access Journals (Sweden)

    Jaime Punter-Villagrasa

    2015-02-01

    Full Text Available We present a small, compact and portable device for point-of-care instantaneous early detection of anemia. The method used is based on direct hematocrit measurement from whole blood samples by means of impedance analysis. This device consists of a custom electronic instrumentation and a plug-and-play disposable sensor. The designed electronics rely on straightforward standards for low power consumption, resulting in a robust and low consumption device making it completely mobile with a long battery life. Another approach could be powering the system based on other solutions like indoor solar cells, or applying energy-harvesting solutions in order to remove the batteries. The sensing system is based on a disposable low-cost label-free three gold electrode commercial sensor for 50 µL blood samples. The device capability for anemia detection has been validated through 24 blood samples, obtained from four hospitalized patients at Hospital Clínic. As a result, the response, effectiveness and robustness of the portable point-of-care device to detect anemia has been proved with an accuracy error of 2.83% and a mean coefficient of variation of 2.57% without any particular case above 5%.

  17. Interventional CT and MRI: a challenge for safety and cost reduction in the health care system

    Science.gov (United States)

    Groenemeyer, Dietrich H.; Seibel, Rainer M.

    1995-10-01

    For increasing safety in guidance techniques of endoscopes and instruments, fast radiologic imaging should be integrated. Magnetic resonance imaging (MRI), computer tomography (CT) and electron beam tomography (EBT) scanners permit transparency of the operative field; CT and EBT can be combined with fluoroscopy and ultrasound units. MRI avoids x ray exposure, but entails the possibility for 3 D localization. Open access and keyhole imaging allows nearly real time guidance of instruments. Combining minimally invasive techniques using endoscopes and tomographic guidance these technologies improve surgical access and reduce complications. This offers a safe access into the body and leads to the new field of interventional and surgical tomography. Important cost reduction for health care systems is possible, especially in the outpatient treatment of common diseases like disk herniation, back and tumor pain, metastasis, or arteriosclerosis. For realizing a long term cost reduction effect, these techniques have to be integrated in a quality management combining prevention, modern diagnosis, minimal access techniques and, if necessary, hospital stay with maximal access treatments as well as rehabilitation and secondary/tertiary prevention.

  18. Cost of care: A study of patients hospitalized for treatment of psychotic illness

    Directory of Open Access Journals (Sweden)

    P P Rejani

    2015-01-01

    Full Text Available Background: Combination of ill health and poverty poses special challenges to health care providers. Mental illness and costs are linked in terms of long-term treatment and lost productivity, and it affects social development. The purpose of the present study is to assess the economic burden of poor families when a family member needs hospitalization due to psychosis. Materials and Methods: The information was gathered from caregivers of 100 psychotic inpatients of Medical College Hospital of Kerala during a period of 6 months. Data regarding components of expenses such as cost of medicine, laboratory investigations, food, travel, and other miscellaneous expenses during their inpatient period were collected by direct personal interview using specially designed proforma. The data were analyzed using Epi-info software. The patients below the poverty line (BPL were compared with those above poverty line (APL. Results: There was no significant difference between patients from BPL and APL in respect of amounts spent on the studied variables except for laboratory investigations during the hospital stay. Conclusions: The results showed that the studied subjects are facing financial difficulties not only due to hospitalization, but also due to the recurrent expense of their ongoing medication. The study recommends the need of financial support from the government for the treatment of psychotic patients.

  19. Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

    Science.gov (United States)

    Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

    2013-01-01

    Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain

  20. Retrospective claims analysis of best supportive care costs and survival in a US metastatic renal cell population

    Directory of Open Access Journals (Sweden)

    Henk HJ

    2013-07-01

    Full Text Available Henry J Henk,1 Connie Chen,2 Agnes Benedict,3 Jane Sullivan,1 April Teitelbaum1 1Optum, Eden Prairie, MN, USA; 2Pfizer Inc, New York, NY, USA; 3United BioSource Corporation, London, UK Introduction: Survival and best supportive care (BSC costs for patients with metastatic renal cell carcinoma (mRCC, after stopping therapy, are poorly characterized yet an important aspect of patient care. This study examined survival and costs associated with BSC after one or two lines of therapy (LOTs for mRCC. Methods: A retrospective cohort analysis used claims data from commercially insured or Medicare Advantage Prescription Drug (MAPD plan enrollees of a large United States health plan with an index RCC diagnosis (ICD-9-CM 189.0 between January 1, 2007 and June 30, 2010; initiating any of the following therapies 30 days pre-index date through disenrollment from plan: sunitinib, temsirolimus, sorafenib, bevacizumab, everolimus, pazopanib, cytokines. LOT was identified using prescription fill and administration dates. Health care costs represent health plan- plus patient-paid amounts. Results: The cohort (n = 274 was 73% male, with a mean age of 63.3 years (SD 11.1, with 80% commercially insured (20% MAPD, and 68% starting BSC following one LOT. Mean BSC duration was longer following one than two LOTs (223 [SD 260], 176 [SD 163] days. Median survival from the start of BSC was similar following one and two LOTs (126 and 118 days. Total BSC costs following one and two LOTs averaged US$50,188 (SD $96,984 and $37,295 (SD $51,102. Monthly costs for BSC following one and two LOTs ($10,151 and $10,566 were not substantially lower than costs while on treatment ($14,621 and $16,957. Inpatient hospital costs represented 47% and 49% following one and two LOTs, with ambulatory costs of approximately 36% following each LOT. Conclusion: Our study found similar survival and monthly costs for BSC following either one or two LOTs, with almost half of the cost reflecting

  1. Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal

    NARCIS (Netherlands)

    Chimbindi, N.; Bor, J.; Newell, M.L.; Tanser, F.; Baltussen, R.M.P.M.; Hontelez, J.; Vlas, S.J. de; Lurie, M.; Pillay, D.; Barnighausen, T.

    2015-01-01

    BACKGROUND: HIV and tuberculosis (TB) services are provided free of charge in many sub-Saharan African countries, but patients still incur costs. METHODS: Patient-exit interviews were conducted in primary health care clinics in rural South Africa with representative samples of 200 HIV-infected patie

  2. Definition and preliminary design of the Laser Atmospheric Wind Sounder (LAWS) phase 1. Volume 3: Program cost estimates

    Science.gov (United States)

    1990-01-01

    Cost estimates for phase C/D of the laser atmospheric wind sounder (LAWS) program are presented. This information provides a framework for cost, budget, and program planning estimates for LAWS. Volume 3 is divided into three sections. Section 1 details the approach taken to produce the cost figures, including the assumptions regarding the schedule for phase C/D and the methodology and rationale for costing the various work breakdown structure (WBS) elements. Section 2 shows a breakdown of the cost by WBS element, with the cost divided in non-recurring and recurring expenditures. Note that throughout this volume the cost is given in 1990 dollars, with bottom line totals also expressed in 1988 dollars (1 dollar(88) = 0.93 1 dollar(90)). Section 3 shows a breakdown of the cost by year. The WBS and WBS dictionary are included as an attachment to this report.

  3. Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods.

    Science.gov (United States)

    van den Berg, Bernard; Brouwer, Werner; van Exel, Job; Koopmanschap, Marc; van den Bos, Geertrudis A M; Rutten, Frans

    2006-02-01

    This paper reports the results of the application of the opportunity costs and proxy good methods to determine a monetary value of informal care. We developed a survey in which we asked informal caregivers in The Netherlands to indicate the different types of time forgone (paid work, unpaid work and leisure) in order to be able to provide care. Moreover, we asked informal caregivers how much time they spent on a list of 16 informal care tasks during the week before the interview. Data were obtained from surveys in two different populations: informal caregivers and their care recipients with stroke and with rheumatoid arthritis (RA). A total of 218 care recipients with stroke and their primary informal caregivers completed a survey as well as 147 caregivers and their care recipients with RA. The measurement of care according to both methods is more problematic compared to the valuation. This is especially the case for the opportunity costs method and for the housework part in the proxy good method. More precise guidelines are necessary for the consistent application of both methods in order to ensure comparability of results and of economic evaluations of health care.

  4. Design and fabrication of a low cost Darrieus vertical axis wing turbine system. Phase I. Technical report

    Energy Technology Data Exchange (ETDEWEB)

    None,

    1979-06-22

    The contract has two phases, a design phase and a fabrication and installation phase. Presented is the work completed in Phase I, the design phase. The Sandia 17 m was used as the background machine from which design information was drawn. By concentrating the modifications on an existing design, emphasis was focused on component cost reduction rather than selection of optimal configuration or operating modes. The resulting design is a stretched version of the Sandia 17 m preserving the same rotor diameter and many other good features, but in the meantime lighter in weight, larger in capacity, and anticipated to be more cost effective.

  5. Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

    Directory of Open Access Journals (Sweden)

    Reynolds MR

    2013-01-01

    Full Text Available Matthew R Reynolds,1 Jonas Nilsson,2 Örjan Åkerborg,2 Mehul Jhaveri,3 Peter Lindgren2,41Beth Israel Deaconess Medical Center, VA Boston Healthcare System, Boston, MA, USA; 2OptumInsight, Stockholm, Sweden; 3sanofi-aventis Inc, Bridgewater, NJ, USA; 4Institute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenBackground: The first antiarrhythmic drug to demonstrate a reduced rate of cardiovascular hospitalization in atrial fibrillation/flutter (AF/AFL patients was dronedarone in a placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter (ATHENA trial. The potential cost-effectiveness of dronedarone in this patient population has not been reported in a US context. This study assesses the cost-effectiveness of dronedarone from a US health care payers’ perspective.Methods and results: ATHENA patient data were applied to a patient-level health state transition model. Probabilities of health state transitions were derived from ATHENA and published data. Associated costs used in the model (2010 values were obtained from published sources when trial data were not available. The base-case model assumed that patients were treated with dronedarone for the duration of ATHENA (mean 21 months and were followed over a lifetime. Cost-effectiveness, from the payers' perspective, was determined using a Monte Carlo microsimulation (1 million fictitious patients. Dronedarone plus standard care provided 0.13 life years gained (LYG, and 0.11 quality-adjusted life years (QALYs, over standard care alone; cost/QALY was $19,520 and cost/LYG was $16,930. Compared to lower risk patients, patients at higher risk of stroke (Congestive heart failure, history of Hypertension, Age ≥ 75 years, Diabetes mellitus, and past history of Stroke or transient ischemic attack (CHADS2 scores 3

  6. Comparative effectiveness research as choice architecture: the behavioral law and economics solution to the health care cost crisis.

    Science.gov (United States)

    Korobkin, Russell

    2014-02-01

    With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs. PMID:24446572

  7. Reducing the Societal Burden of Depression: A Review of Economic Costs, Quality of Care and Effects of Treatment

    OpenAIRE

    Donohue, Julie M.; Harold Alan Pincus

    2007-01-01

    Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the `business case' for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for ...

  8. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System.

    Science.gov (United States)

    Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete

    2015-01-01

    We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil. PMID:26785963

  9. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System.

    Science.gov (United States)

    Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete

    2015-01-01

    We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil.

  10. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

    Directory of Open Access Journals (Sweden)

    Márcia Pinto

    2015-12-01

    Full Text Available ABSTRACT We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System. In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil.

  11. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

    Science.gov (United States)

    Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete

    2015-01-01

    ABSTRACT We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil. PMID:26785963

  12. Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care.

    Science.gov (United States)

    Jellema, Petra; van der Roer, Nicole; van der Windt, Daniëlle A W M; van Tulder, Maurits W; van der Horst, Henriëtte E; Stalman, Wim A B; Bouter, Lex M

    2007-11-01

    An intervention that can prevent low back pain (LBP) becoming chronic, may not only prevent great discomfort for patients, but also save substantial costs for the society. Psychosocial factors appear to be of importance in the transition of acute to chronic LBP. The aim of this study was to compare the cost-effectiveness of an intervention aimed at psychosocial factors to usual care in patients with (sub)acute LBP. The study design was an economic evaluation alongside a cluster-randomized controlled trial, conducted from a societal perspective with a follow-up of 1 year. Sixty general practitioners in 41 general practices recruited 314 patients with non-specific LBP of less than 12 weeks' duration. General practitioners in the minimal intervention strategy (MIS) group explored and discussed psychosocial prognostic factors. Usual care (UC) was not protocolized. Clinical outcomes were functional disability (Roland-Morris Disability Questionnaire), perceived recovery and health-related quality of life (EuroQol). Cost data consisted of direct and indirect costs and were measured by patient cost diaries and general practitioner registration forms. Complete cost data were available for 80% of the patients. Differences in clinical outcomes between both the groups were small and not statistically significant. Differences in cost data were in favor of MIS. However, the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data. This study presents conflicting points of view regarding the cost-effectiveness of MIS. We conclude that (Dutch) general practitioners, as yet, should not replace their usual care by this new intervention. PMID:17659363

  13. Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees

    Directory of Open Access Journals (Sweden)

    Galbraith Alison A

    2011-05-01

    Full Text Available Abstract Background Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Methods We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income. Results The test-retest reliability was moderate for the majority of questions (0.41 - 0.60 and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey. Conclusions In this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information

  14. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

    OpenAIRE

    Brennan, Aline; Jackson, Arthur; Horgan, Mary; Bergin, Colm J; Browne, John P

    2015-01-01

    BACKGROUND: It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. METHODS: A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Irelan...

  15. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Directory of Open Access Journals (Sweden)

    Joke Bilcke

    Full Text Available This is one of the first studies to (1 describe the out-of-hospital burden of influenza-like-illness (ILI and clinically diagnosed flu, also for patients not seeking professional medical care, (2 assess influential background characteristics, and (3 formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever, a longer duration of illness, more use of medication (especially antibiotics and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  16. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  17. Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5–6 symptoms over a 6-day period; required 1.6 physician visits and 86–91% took medication. An average episode amounted to €51–€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  18. Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

    Science.gov (United States)

    Marcus, Tessa; Memon, Shehla; Bam, Nomonde; Hugo, Jannie

    2013-01-01

    Abstract Background Re-engineering primary health care is a cornerstone of the health sector reform initiated nationally in South Africa in 2009. Using the concept of ward based NGO-run health posts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011. Objectives This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district. Method Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health care providers’ understanding, perception and experience of COPC. Results Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities. Conclusion COPC touched a responsive nerve in the health care system, both nationally and locally. It was seen as an effective way to respond to South Africa's crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

  19. Safety Evaluations Under the Proposed US Safe Cosmetics and Personal Care Products Act of 2013 : Animal Use and Cost Estimates

    OpenAIRE

    Knight, Jean; Rovida, Costanza

    2014-01-01

    The proposed Safe Cosmetics and Personal Care Products Act of 2013 calls for a new evaluation program for cosmetic ingredients in the US, with the new assessments initially dependent on expanded animal testing. This paper considers possible testing scenarios under the proposed Act and estimates the number of test animals and cost under each scenario. It focuses on the impact for the first 10 years of testing, the period of greatest impact on animals and costs. The analysis suggests the first ...

  20. Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

    OpenAIRE

    Neilson, Aileen R; Bruhn, Hanne; Christine M. Bond; Elliott, Alison M; Smith, Blair H; Hannaford, Philip C; Holland, Richard; Amanda J Lee; Watson, Margaret; Wright, David; McNamee, Paul

    2015-01-01

    Objectives To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT. Design Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI). Setting Six general practices: Grampian (3); East Anglia (3). Participants 125 pat...

  1. Development of a Cost-Effective Database Software for Psychiatric Research: A Study From Tertiary Care Teaching Hospital

    OpenAIRE

    Sabu Karakkamandapam; Narayanan Sree Kumaran Nair; PSVN Sharma

    2010-01-01

    Background: Technological progression made drastic changes in health care. Still there is a growing concern about proper utilization of health information within hospitals for various research activities. Huge volumes of such health information in majority of hospitals are redundant due to lack of appropriate and cost-effective technological tools for retrieving relevant health information for research purpose. Objective: To develop a cost-effective and user-friendly computerized medical reco...

  2. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs

    Directory of Open Access Journals (Sweden)

    Grete Moth

    2013-01-01

    Full Text Available Introduction. General practitioners (GP answer calls to the Danish out-of-hours primary care service (OOH in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97 employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees the costs could be reduced by 26.2% though excluding administrative costs of a new organisation. Conclusion. Substituting GPs with nurses in OOH primary care may increase the cost in fees compared to a model with only GPs. Further research is needed involving more influencing factors, such as costs due to nurse training and running the organisation.

  3. Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis.

    Science.gov (United States)

    Mac Giolla Phadraig, Caoimhin; Nunn, June; Guerin, Suzanne; Normand, Charles

    2016-04-01

    Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of 162 care-staff, in comparison to doing nothing. Considering scaled up first round training, it cost between €58,000 and €64,000 to train the whole population of staff, from a combined dental and disability service perspective. Less than €15,000-€20,000 of this was additional to the cost of doing nothing (incremental cost). From a dental perspective, a further, second training cycle including all staff would cost between €561 and €3484 (capital costs) and €5815 (operating costs) on a two yearly basis. This study indicates that the program was a cost-effective means of improving self-reported measures and possibly oral health, relative to doing nothing. This was mainly due to low cost, rather than the large effect. In this instance, the use of cost effectiveness analysis has produced evidence, which may be more useful to decision makers than that arising from traditional methods of evaluation. There is a need for CEAs of effective interventions to allow comparison

  4. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  5. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Salchev, P.; Schäfer, W.; Boerma, W.; Groenewegen, P.

    2011-01-01

    Today, strengthening primary care is worldwide probably higher than ever on the agenda of scientist and policy makers (1). Primary care is expected to be an effective response to effects of the current economic crisis on health and health care. The policy strategy towards primary care reinforcement

  6. Applications of life cycle assessment and cost analysis in health care waste management.

    Science.gov (United States)

    Soares, Sebastião Roberto; Finotti, Alexandra Rodrigues; da Silva, Vamilson Prudêncio; Alvarenga, Rodrigo A F

    2013-01-01

    The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$0.12 kg(-1) for the waste treated with microwaves, US$1.10 kg(-1) for the waste treated by the autoclave and US$1.53 kg(-1) for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.

  7. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula

    OpenAIRE

    Alejandro Sanz-Paris; Diana Boj-Carceller; Beatriz Lardies-Sanchez; Leticia Perez-Fernandez; Alfonso J. Cruz-Jentoft

    2016-01-01

    Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before a...

  8. The "Cost of Caring" in Youths' Friendships: Considering Associations among Social Perspective Taking, Co-Rumination, and Empathetic Distress

    Science.gov (United States)

    Smith, Rhiannon L.; Rose, Amanda J.

    2011-01-01

    The current research considered the costs of caring in youths' friendships. The development of a new construct, empathetic distress, allowed for a direct test of the commonly held belief that females suffer greater vicarious distress in response to close others' stressors and problems than do males. Empathetic distress refers to one's strongly…

  9. The Role of Vitality in the Relationship between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity

    NARCIS (Netherlands)

    Hartman, L.; Dongen, J.M. van; Hildebrandt, V.H.; Strijk, J.E.

    2016-01-01

    Purpose: To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs. Design: Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1). Set

  10. 76 FR 15349 - Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Science.gov (United States)

    2011-03-21

    ... BUDGET Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... furnished by military treatment facilities through the Department of Defense (DoD). The rates have...

  11. 75 FR 24754 - Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military...

    Science.gov (United States)

    2010-05-05

    ... BUDGET Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third Persons AGENCY: Office... inpatient medical services furnished by military treatment facilities through the Department of Defense...

  12. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

    NARCIS (Netherlands)

    J. Berdowski; M.J. Kuiper; M.G.W. Dijkgraaf; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac ca

  13. Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective

    DEFF Research Database (Denmark)

    Liedberg, Fredrik; Gerdtham, Ulf; Gralén, Katarina;

    2016-01-01

    in the intervention and the control group, respectively (P=0.03). The median health-care costs were lower in the intervention group (655 (IQR 655-655) EUR) than in the control group (767 (IQR 490-1096) EUR) (P=0.002). CONCLUSIONS: Direct access to urologic expertise and fast-track diagnostics is motivated...

  14. Local cost sharing in Bamako Initiative systems in Benin and Guinea: assuring the financial viability of primary health care.

    Science.gov (United States)

    Soucat, A; Levy-Bruhl, D; Gbedonou, P; Drame, K; Lamarque, J P; Diallo, S; Osseni, R; Adovohekpe, P; Ortiz, C; Debeugny, C; Knippenberg, R

    1997-06-01

    The fourth in a series of five, this article presents and analyses data on cost recovery and community cost-sharing, two key aspects of the Bamako Initiative which have been implemented in Benin and Guinea since 1986. The data come from approximately 400 health centres and result from the six-monthly monitoring sessions conducted from 1989 to 1993. Community involvement in the financing of local operating costs in the two national scale programmes is also described. In Benin and Guinea, a user fee system generates the community financed revenue with the aim of covering local operating costs including drugs. Health worker salaries remain the responsibility of the government and donor funding covers vaccine and investment costs. Village health committees manage and control resources and revenue. The community is also involved in decision making, strategy definition and quality control. In Benin in 1993, community financing revenue amounted to about US$0.6 per capita per year and generally covered all local recurrent non salary costs except vaccines and left a surplus. Although total costs and revenues were slightly lower in Guinea for the same period, over-all user fee revenue (around US$0.3 per capita per year) covered local recurrent costs (not including salaries or vaccines). A comparison of costs and revenue between regions and individual health centres revealed important differences in cost recovery ratios. In Benin, some centres recovered more than twice the local costs targeted for community financing. Twenty-five per cent of centres in Guinea did not manage to cover their designated local recurrent costs. The longitudinal analysis showed that the level of cost recovery remained stable over time even as preventive care (and especially EPI) coverage rose significantly. To better understand the most important characteristics affecting cost recovery levels, best performing health centres in terms of cost-recovery levels in 1993 were compared to worst performing

  15. Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program

    Directory of Open Access Journals (Sweden)

    Lalonde L

    2014-07-01

    Full Text Available Lyne Lalonde,1–4 Manon Choinière,3,5 Élisabeth Martin,2,3 Djamal Berbiche,2,3 Sylvie Perreault,1,6 David Lussier7–91Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada; 3Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, QC, Canada; 4Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada; 5Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 6Sanofi Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, QC, Canada; 7Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada; 8Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 9Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, CanadaBackground: The economic burden of chronic noncancer pain (CNCP remains insufficiently documented in primary care.Purpose: To evaluate the annual direct health care costs and productivity costs associated with moderate to severe CNCP in primary care patients taking into account their pain disability.Materials and methods: Patients reporting noncancer pain for at least 6 months, at a pain intensity of 4 or more on a 0 (no pain to 10 (worst possible pain intensity scale, and at a frequency of at least 2 days a week, were recruited from community pharmacies. Patients' characteristics, health care utilization, and productivity losses (absenteeism and presenteeism were documented using administrative databases, pharmacies' renewal charts, telephone, and self-administered questionnaires. Patients were stratified by tertile of pain disability measured by the Brief Pain Inventory questionnaire

  16. Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

    Science.gov (United States)

    Heffernan, Alastair; Barber, Ella; Thomas, Ranjeeta; Fraser, Christophe; Pickles, Michael; Cori, Anne

    2016-01-01

    Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness. PMID:27391129

  17. Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

    Directory of Open Access Journals (Sweden)

    Alastair Heffernan

    Full Text Available Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3% of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness.

  18. Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

    Science.gov (United States)

    Heffernan, Alastair; Barber, Ella; Thomas, Ranjeeta; Fraser, Christophe; Pickles, Michael; Cori, Anne

    2016-01-01

    Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness.

  19. Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

    Science.gov (United States)

    Fattore, G; Percudani, M; Pugnoli, C; Contini, A; Beecham, J

    2000-01-01

    The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

  20. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

    Science.gov (United States)

    Heinrich, Sven; Deister, Arno; Birker, Thomas; Hierholzer, Cornelia; Weigelt, Ina; Zeichner, Dirk; Angermeyer, Matthias C; Roick, Christiane; König, Hans-Helmut

    2011-01-30

    Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

  1. Quality of GP-care as perceived by cancer patients in different phases of the illness.

    OpenAIRE

    Hopman, P.

    2013-01-01

    Background: Health care for cancer patients, particularly follow-up and aftercare, is more and more considered a task of general practitioners (GPs). It is therefore important to know how cancer patients in general, and in different phases of the illness, experience the quality of GP-care. Methods: We asked (by means of a survey) a heterogeneous group of 353 cancer patients of the Dutch ‘Panel Living with Cancer’ (post diagnosis time-span: 1-15 years) how they had experienced specific aspects...

  2. Systematic review of the cost-effectiveness of implementing guidelines on low back pain management in primary care

    DEFF Research Database (Denmark)

    Jensen, Cathrine Elgaard; Jensen, Martin Bach; Riis, Allan;

    2016-01-01

    OBJECTIVE: The primary aim is to identify, summarise and quality assess the available literature on the cost-effectiveness of implementing low back pain guidelines in primary care. The secondary aim is to assess the transferability of the results to determine whether the identified studies can be...... included in a comparison with a Danish implementation study to establish which strategy procures most value for money. DESIGN: Systematic review. DATA SOURCES: The search was conducted in Embase, PubMed, Cochrane Library, NHS Economic Evaluation Database, Scopus, CINAHL and EconLit. No restrictions were...... comparing implementation strategies, (2) the guideline must concern treatment of low back pain in primary care and (3) the economic evaluation should contain primary data on cost and cost-effectiveness. RESULTS: The title and abstract were assessed for 308 studies; of these, three studies were found...

  3. The cost of changing physical activity behaviour: evidence from a "physical activity pathway" in the primary care setting

    Directory of Open Access Journals (Sweden)

    Bull Fiona C

    2011-05-01

    Full Text Available Abstract Background The 'Physical Activity Care Pathway' (a Pilot for the 'Let's Get Moving' policy is a systematic approach to integrating physical activity promotion into the primary care setting. It combines several methods reported to support behavioural change, including brief interventions, motivational interviewing, goal setting, providing written resources, and follow-up support. This paper compares costs falling on the UK National Health Service (NHS of implementing the care pathway using two different recruitment strategies and provides initial insights into the cost of changing physical activity behaviour. Methods A combination of a time driven variant of activity based costing, audit data through EMIS and a survey of practice managers provided patient-level cost data for 411 screened individuals. Self reported physical activity data of 70 people completing the care pathway at three month was compared with baseline using a regression based 'difference in differences' approach. Deterministic and probabilistic sensitivity analyses in combination with hypothesis testing were used to judge how robust findings are to key assumptions and to assess the uncertainty around estimates of the cost of changing physical activity behaviour. Results It cost £53 (SD 7.8 per patient completing the PACP in opportunistic centres and £191 (SD 39 at disease register sites. The completer rate was higher in disease register centres (27.3% vs. 16.2% and the difference in differences in time spent on physical activity was 81.32 (SE 17.16 minutes/week in patients completing the PACP; so that the incremental cost of converting one sedentary adult to an 'active state' of 150 minutes of moderate intensity physical activity per week amounts to £ 886.50 in disease register practices, compared to opportunistic screening. Conclusions Disease register screening is more costly than opportunistic patient recruitment. However, additional costs come with a higher

  4. Grid connected integrated community energy system. Phase II: final state 2 report. Cost benefit analysis, operating costs and computer simulation

    Energy Technology Data Exchange (ETDEWEB)

    1978-03-22

    A grid-connected Integrated Community Energy System (ICES) with a coal-burning power plant located on the University of Minnesota campus is planned. The cost benefit analysis performed for this ICES, the cost accounting methods used, and a computer simulation of the operation of the power plant are described. (LCL)

  5. How much does mental health discrimination cost: valuing experienced discrimination in relation to healthcare care costs and community participation

    OpenAIRE

    Evans-Lacko, S; Clement, S.; Corker, E; Brohan, E.; Dockery, L.; Farrelly, S.; Hamilton, S.; Pinfold, V.; Rose, D.; Henderson, C.; Thornicroft, G; McCrone, P

    2015-01-01

    Aims. This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England. Methods. We use data from the Mental Illness-Related Investigations on Discrimination (MIRIAD) study (n = 202) and a subsample of the Viewpoint study (n = 190). We examin...

  6. 42 CFR 423.908. - Phased-down State contribution to drug benefit costs assumed by Medicare.

    Science.gov (United States)

    2010-10-01

    ... costs assumed by Medicare. 423.908. Section 423.908. Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE... Provisions § 423.908. Phased-down State contribution to drug benefit costs assumed by Medicare. This...

  7. 78 FR 76791 - Availability of Version 4.0 of the Connect America Fund Phase II Cost Model; Adopting Current...

    Science.gov (United States)

    2013-12-19

    ... workbook. Buried excavation costs are used. A toggle allows the user to exclude manholes (the current... COMMISSION 47 CFR Part 54 Availability of Version 4.0 of the Connect America Fund Phase II Cost Model; Adopting Current Default Inputs in Final Version of Model AGENCY: Federal Communications Commission....

  8. Weighing up the costs of seeking health care for dengue symptoms: a grounded theory study of backpackers' decision-making processes.

    Science.gov (United States)

    Vajta, Bálint; Holberg, Mette; Mills, Jane; McBride, William J H

    2015-01-01

    Dengue fever, a mosquito-borne virus, is an ongoing public health issue in North Queensland. Importation of dengue fever by travellers visiting or returning to Australia can lead to epidemics. The mosquito can acquire the virus in the symptomatic viraemic phase, so timely recognition of cases is important to prevent epidemics. There is a gap in the literature about backpackers' knowledge of dengue fever and the decision-making process they use when considering utilising the Australian health-care system. This study uses grounded theory methods to construct a theory that explains the process backpackers use when seeking health care. Fifty semi-structured interviews with backpackers, hostel receptionists, travel agents and pharmacists were analysed, resulting in identification of a core category: 'weighing up the costs of seeking health care'. This core category has three subcategories: 'self-assessment of health status', 'wait-and-see' and 'seek direction'. Findings from this study identified key areas where health promotion material and increased access to health-care professionals could reduce the risk of backpackers spreading dengue fever. PMID:26509208

  9. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    Directory of Open Access Journals (Sweden)

    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  10. Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

    Directory of Open Access Journals (Sweden)

    Sabes-Figuera Ramon

    2012-08-01

    Full Text Available Abstract Background Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET and counselling (COUN with usual care plus a self-help booklet (BUC for people presenting with chronic fatigue. Methods A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. Results Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result. Conclusion This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC. Clinical Trial Registration number at ISRCTN register: 72136156

  11. Resource Utilisation and Costs of Depressive Patients in Germany: Results from the Primary Care Monitoring for Depressive Patients Trial

    Directory of Open Access Journals (Sweden)

    Christian Krauth

    2014-01-01

    Full Text Available Background. Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective. Materials and Methods. Data were collected from the primary care monitoring for depressive patients trial (PRoMPT of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period. Results. Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year. Conclusion. The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage.

  12. The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System

    OpenAIRE

    Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W. Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.

    2008-01-01

    Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72.

  13. A pilot study to explore the feasibility of using theClinical Care Classification System for developing a reliable costing method for nursing services.

    Science.gov (United States)

    Dykes, Patricia C; Wantland, Dean; Whittenburg, Luann; Lipsitz, Stuart; Saba, Virginia K

    2013-01-01

    While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services.

  14. Health Care Costs Associated with Ankylosing Spondylitis in Turkey: An Analysis from Nationwide Real-World Data

    Directory of Open Access Journals (Sweden)

    Onur Baser

    2013-01-01

    Full Text Available Objectives. To explore health care costs associated with ankylosing spondylitis (AS in Turkey. Methods. Research-identified data from a system that processes claims for all Turkish health insurance funds were analyzed. Adult prevalent and incident AS patients with two AS visits at least 60 days apart, identified between June 1, 2010 and December 31, 2010, with at least 1 year of continuous health plan enrollment for the baseline and follow-up years were included in the study. Pharmacy, outpatient, and inpatient claims were compiled over the study period for the selected patients. Generalized linear models were used to estimate the expected annual costs, controlling for baseline demographic and clinical characteristics. Results. A total of 2.986 patients were identified, of which 603 were incident cases and 2.383 prevalent cases. The mean ages were 39 and 41 years, respectively, and 44% and 38% were women for incident and prevalent cases. Prevalent patients had higher comorbidity scores (5.01 versus 2.24, P<0.001 and were more likely to be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs (77% versus 72%, P<0.001 or biologics (35% versus 8%, P<0.006 relative to incident patients. Seventy-seven percent of prevalent patients were prescribed NSAIDs, followed by biologic and disease-modifying antirheumatic drugs (DMARDs. Total annual medical costs for incident AS patients were €2.253 and €4.233 for prevalent patients. Pharmacy costs accounted for a significant portion of total costs (88% for prevalent patient, 77% for incident patient, followed by physician office visit costs. Prior comorbidities and treatment type also significantly contributed to overall costs. Conclusion. Annual expenditures for AS patients in Turkey were comparable relative to European countries. Pharmaceutical expenditures cover a significant portion of the overall costs. Comparative effectiveness studies are necessary to further decrease health care costs of AS

  15. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation

    Science.gov (United States)

    Wijeysundera, Harindra C; Li, Lindsay; Braga, Vevien; Pazhaniappan, Nandhaa; Pardhan, Anar M; Lian, Dana; Leeksma, Aric; Peterson, Ben; Cohen, Eric A; Forsey, Anne; Kingsbury, Kori J

    2016-01-01

    Objective Transcatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures. Design All patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately. Results Our cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures. Conclusions We found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.

  16. Short-term benefits, but transgenerational costs of maternal loss in an insect with facultative maternal care.

    Science.gov (United States)

    Thesing, Julia; Kramer, Jos; Koch, Lisa K; Meunier, Joël

    2015-10-22

    A lack of parental care is generally assumed to entail substantial fitness costs for offspring that ultimately select for the maintenance of family life across generations. However, it is unknown whether these costs arise when parental care is facultative, thus questioning their fundamental importance in the early evolution of family life. Here, we investigated the short-term, long-term and transgenerational effects of maternal loss in the European earwig Forficula auricularia, an insect with facultative post-hatching maternal care. We showed that maternal loss did not influence the developmental time and survival rate of juveniles, but surprisingly yielded adults of larger body and forceps size, two traits associated with fitness benefits. In a cross-breeding/cross-fostering experiment, we then demonstrated that maternal loss impaired the expression of maternal care in adult offspring. Interestingly, the resulting transgenerational costs were not only mediated by the early-life experience of tending mothers, but also by inherited, parent-of-origin-specific effects expressed in juveniles. Orphaned females abandoned their juveniles for longer and fed them less than maternally-tended females, while foster mothers defended juveniles of orphaned females less well than juveniles of maternally-tended females. Overall, these findings reveal the key importance of transgenerational effects in the early evolution of family life. PMID:26490790

  17. Big data in health care: using analytics to identify and manage high-risk and high-cost patients.

    Science.gov (United States)

    Bates, David W; Saria, Suchi; Ohno-Machado, Lucila; Shah, Anand; Escobar, Gabriel

    2014-07-01

    The US health care system is rapidly adopting electronic health records, which will dramatically increase the quantity of clinical data that are available electronically. Simultaneously, rapid progress has been made in clinical analytics--techniques for analyzing large quantities of data and gleaning new insights from that analysis--which is part of what is known as big data. As a result, there are unprecedented opportunities to use big data to reduce the costs of health care in the United States. We present six use cases--that is, key examples--where some of the clearest opportunities exist to reduce costs through the use of big data: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems. We discuss the types of insights that are likely to emerge from clinical analytics, the types of data needed to obtain such insights, and the infrastructure--analytics, algorithms, registries, assessment scores, monitoring devices, and so forth--that organizations will need to perform the necessary analyses and to implement changes that will improve care while reducing costs. Our findings have policy implications for regulatory oversight, ways to address privacy concerns, and the support of research on analytics. PMID:25006137

  18. Big data in health care: using analytics to identify and manage high-risk and high-cost patients.

    Science.gov (United States)

    Bates, David W; Saria, Suchi; Ohno-Machado, Lucila; Shah, Anand; Escobar, Gabriel

    2014-07-01

    The US health care system is rapidly adopting electronic health records, which will dramatically increase the quantity of clinical data that are available electronically. Simultaneously, rapid progress has been made in clinical analytics--techniques for analyzing large quantities of data and gleaning new insights from that analysis--which is part of what is known as big data. As a result, there are unprecedented opportunities to use big data to reduce the costs of health care in the United States. We present six use cases--that is, key examples--where some of the clearest opportunities exist to reduce costs through the use of big data: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems. We discuss the types of insights that are likely to emerge from clinical analytics, the types of data needed to obtain such insights, and the infrastructure--analytics, algorithms, registries, assessment scores, monitoring devices, and so forth--that organizations will need to perform the necessary analyses and to implement changes that will improve care while reducing costs. Our findings have policy implications for regulatory oversight, ways to address privacy concerns, and the support of research on analytics.

  19. Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Robberstad Bjarne

    2009-04-01

    Full Text Available Abstract Background Little is known about the costs of HIV care in Ethiopia. Objective To estimate the average per person year (PPY cost of care for HIV patients with and without anti-retroviral therapy (ART in a district hospital. Methods Data on costs and utilization of HIV-related services were taken from Arba Minch Hospital (AMH in southern Ethiopia. Mean annual outpatient and inpatient costs and corresponding 95% confidence intervals (CI were calculated. We adopted a district hospital perspective and focused on hospital costs. Findings PPY average (95% CI costs under ART were US$235.44 (US$218.11–252.78 and US$29.44 (US$24.30–34.58 for outpatient and inpatient care, respectively. Estimates for the non-ART condition were US$38.12 (US$34.36–41.88 and US$80.88 (US$63.66–98.11 for outpatient and inpatient care, respectively. The major cost driver under the ART scheme was cost of ART drugs, whereas it was inpatient care and treatment in the non-ART scheme. Conclusion The cost profile of ART at a district hospital level may be useful in the planning and budgeting of implementing ART programs in Ethiopia. Further studies that focus on patient costs are warranted to capture all patterns of service use and relevant costs. Economic evaluations combining cost estimates with clinical outcomes would be useful for ranking of ART services.

  20. Blister pouches for effective reagent storage and release for low cost point-of-care diagnostic applications

    Science.gov (United States)

    Smith, Suzanne; Sewart, Rene; Land, Kevin; Roux, Pieter; Gärtner, Claudia; Becker, Holger

    2016-03-01

    Lab-on-a-chip devices are often applied to point-of-care diagnostic solutions as they are low-cost, compact, disposable, and require only small sample volumes. For such devices, various reagents are required for sample preparation and analysis and, for an integrated solution to be realized, on-chip reagent storage and automated introduction are required. This work describes the implementation and characterization of effective liquid reagent storage and release mechanisms utilizing blister pouches applied to various point-of-care diagnostic device applications. The manufacturing aspects as well as performance parameters are evaluated.

  1. Rumble over jailhouse healthcare. As states broaden outsourcing to private vendors, critics question quality of care and cost savings.

    Science.gov (United States)

    Kutscher, Beth; Meyer, Harris

    2013-09-01

    The trend for states to outsource prison healthcare has met opposition from inmate advocates and legal aid groups. They fear quality of care will suffer, while others debate whether outsourcing care saves any money. Corizon, the largest U.S. private prison healthcare provider, says it definitely delivers savings. "We are the model because we've been doing capitated rates since we've been in business. Our cost per individual is significantly less than in the 'free world,' "says Corizon CEO Rich Hallworth.

  2. The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health.

    Directory of Open Access Journals (Sweden)

    Per Fink

    Full Text Available BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21 and severe Health anxiety (N = 81 and Hypochondriasis according to the DSM-IV (N = 59 were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968. Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale. They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36. The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred

  3. Hospital costs associated with nosocomial infections in a pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Áurea Morillo-García

    2015-07-01

    Conclusions: NI was associated with an increase in total cost, which implies that the prevention of these infections through specific interventions could be cost-effective and would help to increase the safety of healthcare systems.

  4. Phase-Sensitive Detection in the undergraduate lab using a low-cost microcontroller

    CERN Document Server

    Schultz, K D

    2015-01-01

    Phase-sensitive detection (PSD) is an important experimental technique that allows signals to be extracted from noisy data. PSD is also used in modulation spectroscopy and is used in the stabilization of optical sources. Commercial lock-in amplifiers that use PSD are often expensive and host a bewildering array of controls that may intimidate a novice user. Low-cost microcontrollers such as the Arduino family of devices seem like a good match for learning about PSD; however, making a self-contained device (reference signal, voltage input, mixing, filtering, and display) is difficult, but in the end the project teaches students "tricks" to turn the Arduino into a true scientific instrument.

  5. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial

    DEFF Research Database (Denmark)

    Eklund, Andreas; Axén, Iben; Kongsted, Alice;

    2014-01-01

    are collected at baseline and at follow-up as well as weekly, using SMS text messages. DISCUSSION: This study investigates a manual strategy (chiropractic maintenance care) for recurrent and persistent LBP and aims to answer questions regarding the effect and cost-effectiveness of this preventive approach...... of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies. METHODS: This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating...

  6. Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.J.; Defloor, T.; Engelshoven, I. van; Ramshorst, B. van; Buskens, E.

    2009-01-01

    The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was c

  7. Economic evaluation of pressure ulcer care : A Cost Minimization Analysis of Preventive Strategies

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.; Defloor, T.; van Engelshoven, I.; van Ramshorst, B.; Buskens, E.

    2009-01-01

    The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was c

  8. The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women.

    Science.gov (United States)

    Valentine, Sarah E; Elsesser, Steven; Grasso, Chris; Safren, Steven A; Bradford, Judith B; Mereish, Ethan; O'Cleirigh, Conall

    2015-12-01

    Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women. PMID:26438415

  9. The practice of safety, quality, schedule, cost management of Sanmen NPP phase I

    International Nuclear Information System (INIS)

    Sanmen NPP Phase I is the first AP1000 project in the world, and the target construction period of the first unit is 56 months. All these pose great challenge to owner namely Sanmen Nuclear Power Company, Ltd. (ab. SMNPC). After exploration and practice for years, SMNPC has set up a project-oriented management system. With regard to safety management, a systematic safety management mechanism has been implemented innovatively. With regard to quality management, the safety grade and QA grade of non-safety related but contributing greatly to Plant safetyand new requirement of reliability assurance programhas been proposed. With regard to schedule control, a coordination, management and control mechanism by different levels has been established based on the design and modularization construction features of the first AP1000 unit; A method which correlate payment with key schedule control item and integrate bill of quantity statistics and schedule has been proposed. With regard to cost control, a four-level control system has been implemented; a complete work procedure has been established in areas as planning and Budget account Request, contract budget and settlement, fund collecting and risk management. Earned Value Management approach has been applied in the first time to integrate cost management and schedule management. SMNPC, with endeavors of all parties, will make the first AP1000 Unit a successful paragon. (authors)

  10. Innovative grinding wheel design for cost-effective machining of advanced ceramics. Phase I, final report

    Energy Technology Data Exchange (ETDEWEB)

    Licht, R.H.; Ramanath, S.; Simpson, M.; Lilley, E.

    1996-02-01

    Norton Company successfully completed the 16-month Phase I technical effort to define requirements, design, develop, and evaluate a next-generation grinding wheel for cost-effective cylindrical grinding of advanced ceramics. This program was a cooperative effort involving three Norton groups representing a superabrasive grinding wheel manufacturer, a diamond film manufacturing division and a ceramic research center. The program was divided into two technical tasks, Task 1, Analysis of Required Grinding Wheel Characteristics, and Task 2, Design and Prototype Development. In Task 1 we performed a parallel path approach with Superabrasive metal-bond development and the higher technical risk, CVD diamond wheel development. For the Superabrasive approach, Task 1 included bond wear and strength tests to engineer bond-wear characteristics. This task culminated in a small-wheel screening test plunge grinding sialon disks. In Task 2, an improved Superabrasive metal-bond specification for low-cost machining of ceramics in external cylindrical grinding mode was identified. The experimental wheel successfully ground three types of advanced ceramics without the need for wheel dressing. The spindle power consumed by this wheel during test grinding of NC-520 sialon is as much as to 30% lower compared to a standard resin bonded wheel with 100 diamond concentration. The wheel wear with this improved metal bond was an order of magnitude lower than the resin-bonded wheel, which would significantly reduce ceramic grinding costs through fewer wheel changes for retruing and replacements. Evaluation of ceramic specimens from both Tasks 1 and 2 tests for all three ceramic materials did not show evidence of unusual grinding damage. The novel CVD-diamond-wheel approach was incorporated in this program as part of Task 1. The important factors affecting the grinding performance of diamond wheels made by CVD coating preforms were determined.

  11. Economic cost of home-telemonitoring care for BiPAP-assisted ALS individuals.

    Science.gov (United States)

    Lopes de Almeida, J Pedro; Pinto, Anabela; Pinto, Susana; Ohana, Benjamim; de Carvalho, Mamede

    2012-10-01

    Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40 consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital, office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs considered days of wages lost due to absenteeism. G1 included 20 patients aged 60 ± 10 years and G2 included 19 patients aged 62 ± 13 years. Results showed that no differences were found regarding clinical/demographic characteristics at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64% average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant), telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year. PMID:22873565

  12. Late-stage, primary open-angle glaucoma in Europe: social and health care maintenance costs and quality of life of patients from 4 countries

    DEFF Research Database (Denmark)

    Thygesen, J.; Aagren, M.; Arnavielle, S.;

    2008-01-01

    maintenance costs of late-stage glaucoma amounted to euro830 (+/-445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (+/-0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also...... positively correlated to health care costs, but negatively correlated to costs of home help. CONCLUSIONS: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential...... savings from a better preventive treatment are to be found for social care payers rather than health care payers Udgivelsesdato: 2008/6...

  13. Identifying potentially cost effective chronic care programs for people with COPD

    OpenAIRE

    Steuten, L M G; Lemmens, K M M; A P Nieboer; H JM Vrijhoef

    2008-01-01

    L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To revie...

  14. The impact of child care costs and availability on mothers’ labor supply

    OpenAIRE

    Daniela Del Boca

    2015-01-01

    In this paper we review recent literature on the link between child care and women’s labor supply. The growing labor market participation of women has raised many concerns since it implies less time spent with the children and greater reliance on external forms of care. Focusing on studies examining the US, Canada and several European countries, we compare and discuss their methodologies and empirical results as well as their implications for child care policies. Most of the results suggest t...

  15. No Pipe Dream: Achieving Care That Is Accountable for Cost, Quality, and Outcomes.

    Science.gov (United States)

    Terrell, Grace E

    2016-01-01

    The April 2015 passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act is accelerating the move of the US health care industry from traditional fee-for-service provider payments to alternative payment methods that are focused on value rather than volume of services. Medicaid, private employers, and consumer groups are also developing similar payment models. Learning from the experience of the 27 early accountable care organizations in North Carolina, such as Cornerstone Health Care, will help to accelerate the transformation that will be necessary across the health care delivery ecosystem in our state. PMID:27422949

  16. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

  17. Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

    Directory of Open Access Journals (Sweden)

    Hans-Friedemann Kinkel

    2013-01-01

    Full Text Available Background: Re-engineering primary health care is a cornerstone of the health sector reforminitiated nationally in South Africa in 2009. Using the concept of ward based NGO-run healthposts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC through ward based outreach teams (WBOT in seven wards during 2011.Objectives: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.Method: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health careproviders’ understanding, perception and experience of COPC.Results: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.Conclusion: COPC touched a responsive nerve in the health care system, both nationallyand locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

  18. Coste por proceso en el tratamiento quirúrgico del cáncer de piel Cost per episode of care in the surgical treatment of skin cancer

    Directory of Open Access Journals (Sweden)

    Ángela Hernández Martín

    2006-08-01

    Full Text Available Antecedentes: El cáncer cutáneo es la neoplasia maligna más frecuente en humanos. Su tratamiento puede ser efectuado con diversas técnicas y por diferentes especialistas, y la escisión quirúrgica es el método terapéutico con menor tasa de recidivas. Objetivos: Evaluar el coste por proceso del tratamiento quirúrgico del cáncer cutáneo no melanoma (CCNM cuando es realizado por un servicio de dermatología. Material y método: Definición del proceso asistencial como conjunto de actividades clínicas que conducen al tratamiento quirúrgico del CCNM por parte de un especialista en dermatología, y cálculo del coste por proceso empleando los datos económicos facilitados por la institución sanitaria pública en que se ha realizado el análisis. Resultados: El gasto por proceso varió entre 273,71 y 1.129,84 euros, dependiendo del procedimiento quirúrgico y de los recursos sanitarios empleados. Conclusiones: El cáncer cutáneo es una de las enfermedades dermatológicas cuyo aspecto clínico suele ser inequívoco para los dermatólogos, por lo que muchas veces ni siquiera se precisa una confirmación histológica para diagnosticarlo y decidir la pauta terapéutica correspondiente. Este hecho hace que los dermatólogos quirúrgicos sean muy eficientes, ya que el proceso se realiza con un mínimo de episodios asistencia-les y solamente en los pacientes adecuados. El coste del tratamiento varía sustancialmente en función de la complejidad de la intervención y el escenario quirúrgico donde se realiza.Background: Skin cancer is the most common form of malignancy in humans. It can be treated with various techniques and by different specialists. The procedure with the lowest failure rates is surgical excision. Objectives: To calculate the cost per episode of care in the surgical treatment of non-melanoma skin cancer (NMSC when performed by dermatologists. Material and method: An episode of NMSC surgical care was defined as the series of

  19. The costs and effectiveness of large Phase III pre-licensure vaccine clinical trials.

    Science.gov (United States)

    Black, Steven

    2015-01-01

    Prior to the 1980s, most vaccines were licensed based upon safety and effectiveness studies in several hundred individuals. Beginning with the evaluation of Haemophilus influenzae type b conjugate vaccines, much larger pre-licensure trials became common. The pre-licensure trial for Haemophilus influenzae oligosaccharide conjugate vaccine had more than 60,000 children and that of the seven-valent pneumococcal conjugate vaccine included almost 38,000 children. Although trial sizes for both of these studies were driven by the sample size required to demonstrate efficacy, the sample size requirements for safety evaluations of other vaccines have subsequently increased. With the demonstration of an increased risk of intussusception following the Rotashield brand rotavirus vaccine, this trend has continued. However, routinely requiring safety studies of 20,000-50,000 or more participants has two major downsides. First, the cost of performing large safety trials routinely prior to licensure of a vaccine is very large, with some estimates as high at US$200 million euros for one vaccine. This high financial cost engenders an opportunity cost whereby the number of vaccines that a company is willing or able to develop to meet public health needs becomes limited by this financial barrier. The second downside is that in the pre-licensure setting, such studies are very time consuming and delay the availability of a beneficial vaccine substantially. One might argue that in some situations, this financial commitment is warranted such as for evaluations of the risk of intussusception following newer rotavirus vaccines. However, it must be noted that while an increased risk of intussusception was not identified in large pre-licensure studies, in post marketing evaluations an increased risk of this outcome has been identified. Thus, even the extensive pre-licensure evaluations conducted did not identify an associated risk. The limitations of large Phase III trials have also been

  20. Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986-2010

    OpenAIRE

    Boer, Annette; Schepers, Tim; Panneman, Martien; Van Beeck, Ed; Lieshout, Esther

    2014-01-01

    textabstractBackground: Foot and ankle injuries account for a large proportion of Emergency Department attendance. The aim of this study was to assess population-based trends in attendances due to foot and ankle injuries in the Netherlands since 1986, and to provide a detailed analysis of health care costs in these patients. Methods. Age- and gender-standardized emergency attendance rates and incidence rates for hospital admission were calculated for each year of the study. Injury cases and h...

  1. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

    Science.gov (United States)

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

  2. A blended design in acute care training: similar learning results, less training costs compared with a traditional format.

    Science.gov (United States)

    Dankbaar, Mary E W; Storm, Diana J; Teeuwen, Irene C; Schuit, Stephanie C E

    2014-09-01

    Introduction There is a demand for more attractive and efficient training programmes in postgraduate health care training. This retrospective study aims to show the effectiveness of a blended versus traditional face-to-face training design. For nurses in postgraduate Acute and Intensive Care training, the effectiveness of a blended course design was compared with a traditional design. Methods In a first pilot study 57 students took a traditional course (2-h lecture and 2-h workshop) and 46 students took a blended course (2-h lecture and 2-h online self-study material). Test results were compared for both groups. After positive results in the pilot study, the design was replicated for the complete programme in Acute and Intensive Care. Now 16 students followed the traditional programme (11 days face-to-face education) and 31 students did the blended programme (7 days face-to-face and 40 h online self-study). An evaluation was done after the pilot and course costs were calculated. Results Results show that the traditional and blended groups were similar regarding the main characteristics and did not differ in learning results for both the pilot and the complete programme. Student evaluations of both designs were positive; however, the blended group were more confident that they had achieved the learning objectives. Training costs were reduced substantially. Conclusion The blended training design offers an effective and attractive training solution, leading to a significant reduction in costs.

  3. Care and Quality of Life in the Dying Phase: The contribution of the Liverpool Care Pathway for the Dying Patient

    NARCIS (Netherlands)

    L. Veerbeek (Laetitia)

    2008-01-01

    textabstractThis thesis concerns the professional care and the quality of life for dying patients and their relatives in the hospital, the nursing home and the primary care setting. The effect of introducing the Liverpool Care Pathway for the Dying Patient (LCP) on the content of care and the qualit

  4. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Sørensen, Jan; Vach, Werner;

    2016-01-01

    , non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single...

  5. Payment mechanisms and the composition of physician practices: balancing cost-containment, access, and quality of care.

    Science.gov (United States)

    Barham, Victoria; Milliken, Olga

    2015-07-01

    We take explicit account of the way in which the supply of physicians and patients in the economy affects the design of physician remuneration schemes, highlighting the three-way trade-off between quality of care, access, and cost. Both physicians and patients are heterogeneous. Physicians choose both the number of patients and the quality of care to provide to their patients. When determining physician payment rates, the principal must ensure access to care for all patients. When physicians can adjust the number of patients seen, there is no incentive to over-treat. In contrast, altruistic physicians always quality stint: they prefer to add an additional patient, rather than to increase the quality of service provided. A mixed payment mechanism does not increase the quality of service provided with respect to capitation. Offering a menu of compensation schemes may constitute a cost-effective strategy for inducing physicians to choose a given overall caseload but may also generate difficulties with access to care for frail patients. PMID:24990110

  6. The impact of activity based cost accounting on health care capital investment decisions.

    Science.gov (United States)

    Greene, J K; Metwalli, A

    2001-01-01

    For the future survival of the rural hospitals in the U.S., there is a need to make sound financial decisions. The Activity Based Cost Accounting (ABC) provides more accurate and detailed cost information to make an informed capital investment decision taking into consideration all the costs and revenue reimbursement from third party payors. The paper analyzes, evaluates and compares two scenarios of acquiring capital equipment and attempts to show the importance of utilizing the ABC method in making a sound financial decision as compared to the traditional cost method. PMID:11794757

  7. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

    Science.gov (United States)

    Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    Background With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. Methods We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. Results The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219

  8. Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer.

    Science.gov (United States)

    Beernaert, K; Pardon, K; Van den Block, L; Devroey, D; De Laat, M; Geboes, K; Surmont, V; Deliens, L; Cohen, J

    2016-07-01

    Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p care needs of patients from diagnosis onwards.

  9. Evaluation of an Urban Phase of the Specialized Care Program for Diabetes in Iran: Providers′ Perspectives

    Directory of Open Access Journals (Sweden)

    Hamid Ravaghi

    2014-01-01

    Full Text Available Background: To develop and implement more effective programs of health care delivery to prevent and control diabetes, Iran has developed and implemented the urban phase of the specialized care program for diabetic′s patients. Deeply understanding the views and experiences of various stakeholders in this program can assist policy makers to identify the program′s strengths and weaknesses and enable them to develop action plans. Hence, the present study aimed to evaluate the planning and establishing of this program from the perspective of providers. Methods: A qualitative study was applied using documents review and face-to-face semi-structured interviews with the program leads and relevant executive managers of the local medical universities. Thematic analysis was used to analyze the data. Results: Three main themes and nine subthemes were explored, including program planning (the content and the strengths, weaknesses, and corrective measures, implementation (executive mechanisms at the university level, establishment of referral system, collaboration between deputies of health and treatment, information dissemination mechanisms, satisfaction measurement and strengths, weaknesses and corrective measures, and result (implementation results. Conclusions: The urban phase of the specialized care program for diabetic′s patients has been a good base to improve continuity of care, which emphasizes on controlling and prevention of occurrence or progression of chronic complications of diabetes. This model can also be used for better management of other chronic disease. However, there are still issues that should be considered and improved such as allocation of guaranteed resources, more trained health professionals, and more evidence based guidelines and protocols, better collaboration among medical universities′ deputies, clearer payment system for program evaluation and better information management system.

  10. Estimating the Effects of Teaching on the Costs of Inpatient Care: The Case of Radiology Treatments.

    Science.gov (United States)

    Massell, Adele P.; Hosek, James R.

    The report investigates production and the cost effects of teaching within hospital departments. Models of primary production show that the cost effects of teaching are determined by the salaries paid to students (including residents, interns, medical students, and technical trainees) and physicians, by the levels of student inputs used in…

  11. Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mohammad Ashraf Wani

    2013-01-01

    Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96. This includes expenditure incurred both by the hospital and the patient (out of pocket. Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

  12. Preconception care: preliminary estimates of costs and effects of smoking cessation and folic acid supplementation.

    NARCIS (Netherlands)

    Weerd, S. de; Polder, J.J.; Cohen-Overbeek, T.E.; Zimmermann, L.J.; Steegers, E.A.P.

    2004-01-01

    OBJECTIVE: To assess costs and effectiveness of preconception counseling for all women planning pregnancy in The Netherlands with regard to folic acid supplementation and smoking cessation counseling. STUDY DESIGN: Costs and effects were estimated based on 200,000 women approached yearly and uptake

  13. Identifying potentially cost effective chronic care programs for people with COPD

    NARCIS (Netherlands)

    L.M.G. Steuten (Lotte); K.M.M. Lemmens (Karin); A.P. Nieboer (Anna); H.J.M. Vrijhoef

    2009-01-01

    textabstractObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified. Methods: Systematic search of Medline and Cochrane databases for evaluations of multicomponent disease ma

  14. Identifying potentially cost effective chronic care programs for people with COPD

    NARCIS (Netherlands)

    Steuten, L.M.G.; Lemmens, K.M.M.; Nieboer, A.P.; Vrijhoef, H.J.M.

    2009-01-01

    Objective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified. Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management o

  15. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

    Science.gov (United States)

    Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J

    2016-03-09

    Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p nutritional parameters were improved at one year (albumin: +10.6%, p nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.

  16. Mount Sinai leverages smartphone technology, aiming to boost care, coordination of ED patients while also trimming costs.

    Science.gov (United States)

    2015-05-01

    Mount Sinai Hospital in New York, NY, is using smartphone technology to enhance follow-up calls to senior patients who have visited the ED, and to help provide acute-level care to select patients in their own homes. Investigators are hoping to show that these approaches can improve care and coordination while trimming costs, and they expect that patients will approve of these new approaches as well. While senior patients are still in the ED, nurse coordinators will work with them to load a HIPAA-compliant application to their smartphones so they can conduct face-to-face follow-up calls that meet HIPAA standards. Nurses say the face-to-face communications enhance their ability to assess how patients are doing following their ED visit. The hospital is also testing a program that enables some ED patients who meet inpatient criteria to receive this care in the home setting through the use of a mobile acute care team (MACT). In the case of emergencies, the MACT team relies on community paramedics who will visit the patients' homes and provide care under the direction of MACT physicians who are linked in to these visits via smartphone technology. PMID:25932496

  17. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Andreas Kuznik

    2013-11-01

    Full Text Available BACKGROUND: Untreated syphilis in pregnancy is associated with adverse clinical outcomes for the infant. Most syphilis infections occur in sub-Saharan Africa (SSA, where coverage of antenatal screening for syphilis is inadequate. Recently introduced point-of-care syphilis tests have high accuracy and demonstrate potential to increase coverage of antenatal screening. However, country-specific cost-effectiveness data for these tests are limited. The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs averted. METHODS AND FINDINGS: The decision analytic model reflected the perspective of the national health care system and was based on the sensitivity (86% and specificity (99% reported for the immunochromatographic strip (ICS test. Clinical outcomes of infants born to syphilis-infected mothers on the end points of stillbirth, neonatal death, and congenital syphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specific inputs included the antenatal prevalence of syphilis, annual number of live births, proportion of women with at least one antenatal care visit, per capita gross national income, and estimated hourly nurse wages. In all 43 sub-Saharan African countries analyzed, syphilis screening is highly cost-effective, with an average cost/DALY averted of US$11 (range: US$2-US$48. Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0% to 0.038% (range: 0.002%-0.113%. Universal antenatal screening of pregnant women in clinics may reduce the annual number of stillbirths by up to 64,000, neonatal deaths by up to 25,000, and annual incidence of congenital syphilis by up to 32

  18. Safety evaluations under the proposed US Safe Cosmetics and Personal Care Products Act of 2013: animal use and cost estimates.

    Science.gov (United States)

    Knight, Jean; Rovida, Costanca

    2014-01-01

    The proposed Safe Cosmetics and Personal Care Products Act of 2013 calls for a new evaluation program for cosmetic ingredients in the US, with the new assessments initially dependent on expanded animal testing. This paper considers possible testing scenarios under the proposed Act and estimates the number of test animals and cost under each scenario. It focuses on the impact for the first 10 years of testing, the period of greatest impact on animals and costs. The analysis suggests the first 10 years of testing under the Act could evaluate, at most, about 50% of ingredients used in cosmetics. Testing during this period would cost about $ 1.7-$ 9 billion and 1-11.5 million animals. By test year 10, alternative, high-throughput test methods under development are expected to be available, replacing animal testing and allowing rapid evaluation of all ingredients. Given the high cost in dollars and animal lives of the first 10 years for only about half of ingredients, a better choice may be to accelerate development of high-throughput methods. This would allow evaluation of 100% of cosmetic ingredients before year 10 at lower cost and without animal testing. PMID:24468774

  19. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

    LENUS (Irish Health Repository)

    Pope, George

    2012-01-31

    OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

  20. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

    Directory of Open Access Journals (Sweden)

    Nikhilesh Anand

    2016-01-01

    Full Text Available Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs in an Intensive Care Unit (ICU increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77% was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%, metronidazole (12%, amoxicillin/clavulanic acid (6.44%, and azithromycin (4.34%. Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR. Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.

  1. The Effects Of Customer Satisfaction and Switching Costs On Customer Lo yalty In Health Care

    Directory of Open Access Journals (Sweden)

    Abidin Pişgin

    2015-12-01

    Full Text Available In recent years, the increasing number of private hospitals and the change in service quality and service requirements offered to patients in our country has led to an increase in competition for patients. Becauseof higher competition in healtcare sector, hospitals change their approach and focus more first on retention and then new patient acquisition. As a result, the relationship between satisfaction, trust, loyalty and switching costs as well as factors that affect these variables gain stratejik importance for hospital managements. Therefore, in this study, the relationship between satisfaction, loyalty and switching costs are investigated for university hospitals. Results show that satisfaction and direct effect of switching costs are important for loyalty. However, moderating effects of switching costs are not too strong.

  2. Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Wu J

    2015-04-01

    Full Text Available Jing Wu,1 Xiaoning He,1 Li Liu,2 Wenyu Ye,2 William Montgomery,3 Haibo Xue,2 Jeffery S McCombs41School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China; 2Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, People’s Republic of China; 3Eli Lilly and Company, Sydney, Australia; 4Departments of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USAObjective: Information concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China.Methods: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated.Results: A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median length of stay of 112.1 (71 days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median number of visits of 6.2 (4 and a mean cost of $42 per visit during the 12-month follow-up period. Non

  3. Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

    OpenAIRE

    Baji, Petra; Boncz, Imre; Jenei, György; Gulácsi, László

    2012-01-01

    The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pock...

  4. Costs and Benefits of Competitive Traits in Females: Aggression, Maternal Care and Reproductive Success

    OpenAIRE

    Cain, Kristal E.; Ellen D Ketterson

    2013-01-01

    Recent research has shown that female expression of competitive traits can be advantageous, providing greater access to limited reproductive resources. In males increased competitive trait expression often comes at a cost, e.g. trading off with parental effort. However, it is currently unclear whether, and to what extent, females also face such tradeoffs, whether the costs associated with that tradeoff overwhelm the potential benefits of resource acquisition, and how environmental factors mig...

  5. Costs and Benefits of In-Kind Transfers: The Case of Medicaid Home Care Benefits

    OpenAIRE

    Ethan M.J. Lieber; Lee M. Lockwood

    2013-01-01

    Many large government programs provide benefits in kind as opposed to in cash. Providing benefits in kind potentially distorts decisions and leads to a deadweight loss if recipients value the benefits less than a cost-equivalent cash transfer. Yet providing benefits in kind may have some offsetting benefits, especially in terms of improving the targeting of benefits to desired beneficiaries. We complete what is to our knowledge one of the first empirical studies of the costs and benefits of p...

  6. Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

    Directory of Open Access Journals (Sweden)

    Alessandra A Vieira Machado

    2014-09-01

    Full Text Available Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed.To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002 in the group that received blood products (US $1,622.40 compared with the group that did not receive blood products (US $550.20.The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

  7. Association between refill compliance to oral bisphosphonate treatment, incident fractures, and health care costs--an analysis using national health databases

    DEFF Research Database (Denmark)

    Olsen, K R; Hansen, C; Abrahamsen, Bo

    2013-01-01

    The study estimates the cost of poor and suboptimal refill compliance by estimating fracture costs and assessing the association between refill compliance with oral bisphosphonates and incident fractures using Danish health registers. Patients with poor and suboptimal refill compliance had more...... major osteoporotic fractures, and the direct costs related to hospital care, primary care, and pharmaceutical treatment for these excess fractures reached almost 14 M DKK (2.5 M USD) for the study population which compares to a national annual excess cost of around 17 M DKK (3.1 M USD) using 2011...

  8. A Fire Safety Certification System for Board and Care Operators and Staff. SBIR Phase II: Final Report.

    Science.gov (United States)

    Walker, Bonnie L.

    This report describes Phase II of a project which developed a system for delivering fire safety training to board and care providers who serve adults with developmental disabilities. Phase II focused on developing and pilot testing a "train the trainers" workshop for instructors and field testing the provider's workshop. Evaluation of the 2-day…

  9. Phase 1 of the automated array assembly task of the low cost silicon solar array project

    Science.gov (United States)

    Pryor, R. A.; Grenon, L. A.; Coleman, M. G.

    1978-01-01

    The results of a study of process variables and solar cell variables are presented. Interactions between variables and their effects upon control ranges of the variables are identified. The results of a cost analysis for manufacturing solar cells are discussed. The cost analysis includes a sensitivity analysis of a number of cost factors.

  10. DEMONSTRATION OF FUEL CELLS TO RECOVER ENERGY FROM ANAEROBIC DIGESTER GAS - PHASE I. CONCEPTUAL DESIGN, PRELIMINARY COST, AND EVALUATION STUDY

    Science.gov (United States)

    The report discusses Phase I (a conceptual design, preliminary cost, and evaluation study) of a program to demonstrate the recovery of energy from waste methane produced by anaerobic digestion of waste water treatment sludge. The fuel cell is being used for this application becau...

  11. A decade of health care cost growth has wiped out real income gains for an average US family.

    Science.gov (United States)

    Auerbach, David I; Kellermann, Arthur L

    2011-09-01

    Although a median-income US family of four with employer-based health insurance saw its gross annual income increase from $76,000 in 1999 to $99,000 in 2009 (in current dollars), this gain was largely offset by increased spending to pay for health care. Monthly spending increases occurred in the family's health insurance premiums (from $490 to $1,115), out-of-pocket health spending (from $135 to $235), and taxes devoted to health care (from $345 to $440). After accounting for price increases in other goods and services, the family had $95 more in monthly income to devote to nonhealth spending in 2009 than in 1999. By contrast, had the rate of health care cost growth not exceeded general inflation, the family would have had $545 more per month instead of $95-a difference of nearly $5,400 per year. Even the $95 gain was artificial, because tax collections in 2009 were insufficient to cover actual increases in federal health spending. As a result, we argue, the burdens imposed on all payers by steadily rising health care spending can no longer be ignored. PMID:21900652

  12. The Negative Impact of Stark Law Exemptions on Graduate Medical Education and Health Care Costs: The Example of Radiation Oncology

    International Nuclear Information System (INIS)

    Purpose: To survey radiation oncology training programs to determine the impact of ownership of radiation oncology facilities by non-radiation oncologists on these training programs and to place these findings in a health policy context based on data from the literature. Methods and Materials: A survey was designed and e-mailed to directors of all 81 U.S. radiation oncology training programs in this country. Also, the medical and health economic literature was reviewed to determine the impact that ownership of radiation oncology facilities by non-radiation oncologists may have on patient care and health care costs. Prostate cancer treatment is used to illustrate the primary findings. Results: Seventy-three percent of the surveyed programs responded. Ownership of radiation oncology facilities by non-radiation oncologists is a widespread phenomenon. More than 50% of survey respondents reported the existence of these arrangements in their communities, with a resultant reduction in patient volumes 87% of the time. Twenty-seven percent of programs in communities with these business arrangements reported a negative impact on residency training as a result of decreased referrals to their centers. Furthermore, the literature suggests that ownership of radiation oncology facilities by non-radiation oncologists is associated with both increased utilization and increased costs but is not associated with increased access to services in traditionally underserved areas. Conclusions: Ownership of radiation oncology facilities by non-radiation oncologists appears to have a negative impact on residency training by shifting patients away from training programs and into community practices. In addition, the literature supports the conclusion that self-referral results in overutilization of expensive services without benefit to patients. As a result of these findings, recommendations are made to study further how physician ownership of radiation oncology facilities influence graduate

  13. Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe;

    2014-01-01

    to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore, interviews with nursing home and home-care management, nursing staff and nutrition coordinators......BACKGROUND: Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss......-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. METHODS: An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care...

  14. COSTS AND BENEFITS OF DAY TREATMENT WITH COMMUNITY CARE FOR SCHIZOPHRENIC-PATIENTS

    NARCIS (Netherlands)

    WIERSMA, D; KLUITER, H; NIENHUIS, FJ; RUPHAN, M; GIEL, R

    1991-01-01

    The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new appro

  15. COSTS AND BENEFITS OF HOSPITAL AND DAY TREATMENT WITH COMMUNITY CARE OF AFFECTIVE AND SCHIZOPHRENIC DISORDERS

    NARCIS (Netherlands)

    WIERSMA, D; KLUITER, H; NIENHUIS, FJ; RUPHAN, M; GIEL, R

    1995-01-01

    Background. A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a p

  16. Developing a cost-effective home care management support system for small nursing homes in Taiwan.

    Science.gov (United States)

    Tu, Ming-Hsiang; Chang, Polun

    2009-01-01

    Home care is important in Taiwan but most of the institutes are small and cannot afford computerization. We develop a support system based on InterRAI case management system using Excel VBA which is the most "free" application in institutes. The prototype system shows promising. PMID:19592932

  17. Financial Pressures Prompt Teaching Hospitals to Cut Costs, Raising Fears about Medical Education and Patient Care.

    Science.gov (United States)

    Grassmuck, Karen

    1991-01-01

    Financial pressures are forcing the closure of some teaching hospitals and retrenchment using such strategies as development of ambulatory care and satellite facilities, merging with or acquiring other hospitals, and shortening patient hospital stays. A table lists revenues and profit margins for the 20 largest university-owned teaching hospitals.…

  18. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

    Directory of Open Access Journals (Sweden)

    Kostrowski Shannon

    2011-10-01

    Full Text Available Abstract Background A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs. Methods Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach. Results Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3% had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient. Conclusions A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated. Trial registration

  19. Household cost of antenatal care and delivery services in a rural community of Kaduna state, northwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Mohd Nasiq Sambo

    2013-01-01

    Full Text Available Background: Maternal mortality remains a leading cause of death among women of reproductive age. While Nigeria has only two percent of the global population, it contributes 10% to the global maternal mortality burden. Antenatal care (ANC reduces the incidence of maternal mortality. However, financial capability affects access to antenatal care. Thus, the rural poor are at a higher risk of maternal mortality. Materials and Methods: A cross-sectional descriptive study involving 135 women (pregnant women and those who are 6 weeks postpartum. Structured interviewer-administered questionnaires were used for data collection. Data analysis was carried out using statistical package for social sciences software (version 17. Results: The average amount spent on booking and initial laboratory investigations were N77 (half a dollar and N316 ($2, respectively. Per ANC visit, average amount spent on drugs and transportation were N229 ($1.5 and N139 ($0.9 respectively. For delivery, the average amount spent was N1500 ($9.6. On an average, ANC plus delivery cost about N3,365.00 ($22. There was a statistically significant association between husband′s income and ANC attendance (X 2 = 2.451, df = 2, P = 0.048. Conclusion: Cost of Antenatal care and delivery services were not catastrophic but were a barrier to accessing antenatal care and facility-based delivery services in the study area. ANC attendance was associated with the income of household heads. Pro-poor policies and actions are needed to address this problem, as it will go a long way in reducing maternal mortality in this part of the country.

  20. Incorporating ulipristal acetate in the care of symptomatic uterine fibroids: a Canadian cost-utility analysis of pharmacotherapy management

    Directory of Open Access Journals (Sweden)

    Tsoi B

    2015-04-01

    Full Text Available Bernice Tsoi,1,2 Gord Blackhouse,1,2 Simon Ferrazzi,3 Clare J Reade,4 Innie Chen,5,6 Ron Goeree1,2,7 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 2Programs for Assessment of Technology in Health (PATH Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; 3Independent Consultant, Oakville, ON, Canada; 4Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; 5Department of Obstetrics and Gynaecology, University of Ottawa, 6Ottawa Hospital Research Institute, Ottawa, ON, Canada; 7Centre for Evaluation of Medicines (CEM, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada Objective: To present a Canadian economic evaluation on the cost-utility of ulipristal acetate (5 mg orally daily compared to leuprolide acetate (3.75 mg intramuscular monthly in the treatment of moderate-to-severe symptoms of uterine fibroids in women eligible for surgery. Methods: A probabilistic decision tree was constructed to model the pre-operative pharmacological management of uterine fibroids under the primary perspective of the Ontario public payer. The model parameterized data from clinical trials, observational studies, and public costing databases. The outcome measure was the incremental cost-utility ratio. Uncertainty in the model was explored through sensitivity and scenario analyses. Results: Ulipristal was associated with faster control of excessive menstrual bleeding, fewer symptoms of hot flashes and lower health care resource consumption. The ulipristal strategy dominated leuprolide as it provided patients with more quality-adjusted life years (0.177 versus 0.165 at a lower cost ($1,273 versus $1,366. Across a range of sensitivity analyses, the results remained robust except to the dose of the comparator drug. If leuprolide was administered at 11.25 mg, once every 3 months, the expected cost for the leuprolide strategy would decline and the associated incremental

  1. Cost Effectiveness, Quality-Adjusted Life-Years and Supportive Care: Recombinant Human Erythropoietin as a Treatment of Cancer-Associated Anaemia

    OpenAIRE

    Pierre-Yves Cremieux; Stan N. Finkelstein; Berndt, Ernst R.; Jeffrey Crawford; Mitchell B. Slavin

    1999-01-01

    Objective: To measure the cost effectiveness of a supportive care intervention when the no-treatment option is unrealistic in an analysis of recombinant human erythropoietin (epoetin) treatment for anaemic patients with cancer undergoing chemotherapy. Further, to assess whether quality-adjusted life-years (QALYs) can provide the basis for an appropriate measure of the value of supportive care interventions. Design: A modelling study drawing cost and effectiveness assumptions from a literature...

  2. Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey

    OpenAIRE

    Wagner, Ryan G.; Bertram, Melanie Y; Gómez-Olivé, F. Xavier; Tollman, Stephen M; Lindholm, Lars; Charles R. Newton; Hofman, Karen J.

    2016-01-01

    Background Epilepsy is a common neurological disorder, with over 80 % of cases found in low- and middle-income countries (LMICs). Studies from high-income countries find a significant economic burden associated with epilepsy, yet few studies from LMICs, where out-of-pocket costs for general healthcare can be substantial, have assessed out-of-pocket costs and health care utilization for outpatient epilepsy care. Methods Within an established health and socio-demographic surveillance system in ...

  3. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds. PMID:26563760

  4. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.

  5. Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

    Directory of Open Access Journals (Sweden)

    Kirubi Beatrice

    2011-01-01

    Full Text Available Abstract Background The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya. Methods The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions. Results A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8 and indirect (opportunity; USD 294.2 costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach. Conclusions The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and

  6. Cost-Effectiveness of Escitalopram in Major Depressive Disorder in the Dutch Health Care Setting

    NARCIS (Netherlands)

    Nuijten, Mark J. C.; Brignone, Melanie; Marteau, Florence; den Boer, Johan A.; Hoencamp, Erik

    2012-01-01

    Objective: This study assessed the cost-effectiveness of escitalopram for the treatment of depression in the Netherlands from a societal perspective. Methods: A decision tree model was constructed using decision analytical techniques. Data sources included published literature, clinical trials, offi

  7. Predictors of direct cost of diabetes care in pediatric patients with type 1 diabetes

    Science.gov (United States)

    This study examines factors that predict elevated direct costs of pediatric patients with type 1 diabetes. Methods: A cohort of 784 children with type 1 diabetes at least 6 months postdiagnosis and managed by pediatric endocrinologists at Texas Children's Hospital were included in this study. Actual...

  8. Contrasting RCC, RVU, and ABC for managed care decisions. A case study compares three widely used costing methods and finds one superior.

    Science.gov (United States)

    West, T D; Balas, E A; West, D A

    1996-08-01

    To obtain cost data needed to improve managed care decisions and negotiate profitable capitation contracts, most healthcare provider organizations use one of three costing methods: the ratio-of-costs-to-charges method, the relative value unit method, or the activity-based costing method. Although the ratio-of-costs to charges is used by a majority of provider organizations, a case study that applied these three methods in a renal dialysis clinic found that the activity-based costing method provided the most accurate cost data. By using this costing method, healthcare financial managers can obtain the data needed to make optimal decisions regarding resource allocation and cost containment, thus assuring the longterm financial viability of their organizations. PMID:10158925

  9. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis

    NARCIS (Netherlands)

    Norheim, O.F.; Baltussen, R.M.; Johri, M.; Chisholm, D.; Nord, E.; Brock, D.; Carlsson, P.; Cookson, R.; Daniels, N.; Danis, M.; Fleurbaey, M.; Johansson, K.A.; Kapiriri, L.; Littlejohns, P.; Mbeeli, T.; Rao, K.D.; Edejer, T.T.; Wikler, D.

    2014-01-01

    This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form o

  10. Health care use and costs for children with attention-deficit/hyperactivity disorder - National estimates front the Medical Expenditure Panel Survey

    NARCIS (Netherlands)

    Chan, E; Zhan, CL; Homer, CJ

    2002-01-01

    Context: Although attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent chronic condition of childhood, little is known about patterns of health care use and associated expenditures. Objective: To compare health care use and costs among children with ADHD, children with asthma, and t

  11. Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model.

    Directory of Open Access Journals (Sweden)

    R Scott Braithwaite

    2010-02-01

    Full Text Available BACKGROUND: Evidence suggests that cost sharing (i.e.,copayments and deductibles decreases health expenditures but also reduces essential care. Value-based insurance design (VBID has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. METHODS AND FINDINGS: We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1 applying VBID solely to pharmacy benefits and (2 applying VBID to both pharmacy benefits and other health care services (e.g., devices. We assumed that cost sharing would be eliminated for high-value services ($300,000 per life-year. All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80% of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. CONCLUSION: Broader diffusion of VBID may amplify benefits from

  12. Cost-effectiveness analysis of health care waste treatment facilities in iran hospitals; a provider perspective.

    Directory of Open Access Journals (Sweden)

    Arash Rashidian

    2015-03-01

    Full Text Available Our aim was to make right and informative decision about choosing the most cost-effectiveness heterogeneous infectious waste treatment methods and devices.In this descriptive study, decision tree analysis, with 10-yr time horizon in bottom-up approach was used to estimate the costs and effectiveness criteria of the employed devices at provider perspective in Iranian hospitals. We used the one-way and scenario sensitivity analysis to measure the effects of variables with uncertainty. The resources of data were national Environmental and Occupational Health Center Survey (EOHCS in 2012, field observation and completing questionnaire by relevant authorities in mentioned centers.Devices called Saray 2, Autoclave based, and Newster 10, Hydroclave based, with 92032.4 (±12005 and 6786322.9 (±826453 Dollars had the lowest and highest costs respectively in studied time period and given the 5-10% discount rate. Depending on effectiveness factor type, Newster 10 with Ecodas products and Saray products respectively had the highest and lowest effectiveness. In most considered scenarios, Caspian-Alborz device was the most cost-effectiveness alternative, so for the treatment of each adjusted unit of volume and weight of infectious waste in a 10 year period and in different conditions, between 39.4 (±5.1 to 915 (±111.4 dollars must be spent.The findings indicate the inefficiency and waste of resources, so in order to efficient resource allocation and to encourage further cost containment in infectious waste management we introduce policy recommendation that be taken in three levels.

  13. Cost of ambulatory care by mobile health clinic run by a Medical College in India for the year 2008-09

    Directory of Open Access Journals (Sweden)

    Aslesh Prabhakaran

    2014-01-01

    Full Text Available Background: The feasibility of using mobile health clinics (MHCs to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

  14. The Costs of Addressing Age Discrimination in Social Care (PSSRU Discussion Paper 2538)

    OpenAIRE

    Forder, Julien E.

    2008-01-01

    Historically PSS expenditure per head on older people using social care services has been lower than for other adult client groups. Along with a number of investigations, this difference is taken as a possible indicator of age discrimination in the deployment of services. The UK government is proceeding with the introduction of a Single Equality Bill during this Parliament. One of the proposals is to outlaw age discrimination in the provision of public services. This report seeks to gauge the...

  15. Intoxicated children at an intensive care unit: popular medicine risks, complications and costs.

    OpenAIRE

    Consuelo de Rovetto; Sandra Concha

    2009-01-01

    Introduction: The Hospital Universitario del Valle (HUV) at the Pediatrics Intensive Care Unit (PICU) admits intoxicated patients, erroneously medicated by «teguas» or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case series Objective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers (...

  16. The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

    OpenAIRE

    Fiona Yan-Yee Ho; Wing-Fai Yeung; Tommy Ho-Yee Ng; Chan, Christian S.

    2016-01-01

    Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trial...

  17. Clinical outcomes and health care costs combining metformin with sitagliptin or sulphonylureas or thiazolidinediones in uncontrolled type 2 diabetes patients

    Directory of Open Access Journals (Sweden)

    Degli Esposti L

    2014-10-01

    Full Text Available Luca Degli Esposti, Stefania Saragoni, Stefano Buda, Ezio Degli Esposti Health, Economics and Outcome Research, Clicon Srl, Ravenna, ItalyObjectives: To compare clinical outcomes and health care costs across three cohorts of uncontrolled diabetic patients who initiated treatment with one of the following: sulphonylureas (SU, thiazolidinediones (TZD or sitagliptin (SITA.Materials and methods: We performed a retrospective study based on a linkage between administrative and laboratory databases maintained by three Italian local health units. The index period ranged from July 2008–June 2010. Patients were treatment-naïve to either SU, TZD, or SITA, but they were already treated with other oral hypoglycemic agents. Demographics and clinical characteristics were assessed at baseline. Adherence was measured by the medication possession ratio and adherent was defined a patient with a medication possession ratio of 80% or greater. We used a Poisson regression model to estimate the risk ratios for disease-related hospitalizations that occurred during the 18-month follow-up period. The total annual costs included all the pharmacological treatments and the direct costs due to hospitalizations and outpatient services.Results: We identified 928 patients treated with SU, 330 patients treated with TZD, and 83 patients treated with SITA. SITA patients were significantly younger and with fewer previous hospital discharges. The baseline mean glycated hemoglobin level was 8.1% for SU, 8.0% for TZD, and 8.3% for SITA patients. SITA-naïve patients resulted more adherent than the SU- and TZD-naïve patients (79.5% versus 53.2% and 62.8%, respectively; P<0.001. The SU and TZD group showed a significant increased risk of disease-related hospitalizations compared with the SITA group (the unadjusted rate was 10.42 and 7.16 per 100 person-years versus 1.64 per 100 person-years, P=0.003; compared with SU, the adjusted incidence rate ratio for SITA was 0.21, P=0.030. The

  18. Development of a Cost-Effective Database Software for Psychiatric Research: A Study From Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Sabu Karakkamandapam

    2010-10-01

    Full Text Available Background: Technological progression made drastic changes in health care. Still there is a growing concern about proper utilization of health information within hospitals for various research activities. Huge volumes of such health information in majority of hospitals are redundant due to lack of appropriate and cost-effective technological tools for retrieving relevant health information for research purpose. Objective: To develop a cost-effective and user-friendly computerized medical record database for psychiatry using available technology with the department. Methodology: Study performed at a tertiary care teaching hospital in Udupi district of South India. Various datasets from psychiatry medical records were utilized for the design and creation of database. A computerized database called PsyCase was developed with the help of technology available within the department. A 4612 patient’s data were entered into the PsyCase and subjected to various analyses. Results: Applications of PsyCase in various epidemiological studies were explored through performing numerous analyses with actual data. PsyCase was found effective in supporting psychiatric research as well as routine clinical and administrative activities. Conclusion: This study emphasizes need of appropriate use of technology available within a healthcare system to facilitate medical research in psychiatry and role of health information professional in such initiatives. Healthcare organization must focus on collective utilization of resources within the system to improve the utilization of health information for medical research.

  19. Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

    Directory of Open Access Journals (Sweden)

    Walter Leutz

    2005-10-01

    Full Text Available Purpose: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB care at Kaiser Permanente Northwest (KPNW, serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC. Methods: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180 and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day

  20. An institutional sociology perspective of the implementation of activity based costing by Spanish health care institutions

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    Eriksen, Scott D.; Urrutia, Ignacio

    2005-01-01

    According to institutional sociology, hospitals will respond to external environmental pressures and adopt Activity-Based-Costing (ABC). This theory overemphasizes conformity and fails to consider the advantages of organizational non-conformance. A conflict of interests between physicians and management leads to physician resistance to accepting ABC. This paper investigates the Spanish government's response to this resistance by creating new public foundation hospitals, and involves a case st...