Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy

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Poli A

2015-11-01

Full Text Available Anna Poli,1 Sergio Di Matteo,2 Giacomo M Bruno,2 Enrica Fornai,1 Maria Chiara Valentino,2 Giorgio L Colombo2,31Vigilanza e Controllo Infezioni Correlate all'Assistenza, Ospedale Piero Palagi, Azienda Sanitaria di Firenze, Firenze, Italy; 2SAVE Studi – Health Economics and Outcomes Research, Milan, Italy; 3Department of Drug Sciences, University of Pavia, Pavia, ItalyIntroduction: Despite the awareness about the increasing rates of Clostridium difficile infection (CDI and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation, few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication.Methods: We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI.Results: We enrolled 69 patients (19 males and 50 females, with a mean age of 82.16 years (minimum 46 to maximum 98. The total number of hospitalization days observed was 886 (12.8 per patient on average. The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature.Conclusion: The economic impact of CDI is most

Renovating Charity Hospital or building a new hospital in post-Katrina New Orleans: economic rationale versus political will.

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Leleu, Hervé; Moises, James; Valdmanis, Vivian Grace

2013-02-01

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

Treatment, monitoring, and economic outcomes of venous thromboembolism among hospitalized patients in China.

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Wu, Eric Q; Xie, Jipan; Wu, Chun; Du, Ella Xiaoyan; Li, Nanxin; Tan, Ruoding; Liu, Yuanli

2014-03-01

The prevalence of venous thromboembolism (VTE) has been increasing in China. However, the treatment pattern and economic burden of these patients have not been well-understood. The objective of this study was to examine the patient characteristics, treatment pattern, anticoagulant monitoring, and economic burden of VTE among hospitalized patients in China. Hospitalizations with a diagnosis of VTE [including deep vein thrombosis (DVT) or pulmonary embolism (PE)] between 1 January 2010 and 30 June 2013 were included. Descriptive analysis was conducted for patients' characteristics, anticoagulant treatment, international normalized ratio (INR) monitoring, and hospitalization cost [in 2013 Chinese yuan (Y) and US dollars (US$)]. Multivariate regressions were performed to assess factors associated with oral anticoagulant use and total costs of inpatient care. A total of 1,047 VTE-related hospitalizations were selected. The sample had a mean age of 62.4 years, with 45.9 % female. About 46.3 % of hospitalizations used heparin only, 35.0 % used warfarin, 0.8 % used rivaroxaban, and 18.0 % did not use anticoagulants. Among hospitalizations where warfarin was used, 90.8 % received at least one INR test and only 30 % had the last INR within the target therapeutic range (2-3) before discharge. The mean (standard deviation) total cost per hospitalization was Y29,114 (43,772) [US$4,757 (7,152)]. PE, VTE as primary diagnosis, female, insurance coverage, anticoagulant treatment, co-morbidities, admission condition, and surgical procedure were significantly associated with inpatient costs. Conventional anticoagulants were most commonly used in the study sample. Under-monitoring and suboptimal care may be an issue for patients treated with warfarin. The average total inpatient cost of VTE-related hospitalizations is high.

The effects of ownership and system affiliation on the economic performance of hospitals.

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Renn, S C; Schramm, C J; Watt, J M; Derzon, R A

1985-01-01

We investigated differences among five types of hospitals, defined by ownership (investor-owned or not-for-profit), system affiliation (system-affiliated or freestanding), and government sponsorship on 24 measures of economic performance. Using multivariate analysis of 1980 Medicare cost report and other data from a national sample of 561 hospitals, we found that investor-owned chain hospitals charged significantly more, and were more profitable, than all other types of hospitals except freestanding for-profits; there were no differences in productive efficiency that could be attributed to ownership or affiliation; the investor-owned hospitals had higher debt-to-asset ratios, less-capital-intensive plants, and greater capital costs as a percentage of operating costs than the not-for-profits; and there were no consistent case-mix differences among the hospitals.

[Medico-economic analysis of a neurosurgery department at a university hospital].

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Lemaire, J-J; Delom, C; Coste, A; Khalil, T; Jourdy, J-C; Pontier, B; Gabrillargues, J; Sinardet, D; Chabanne, A; Achim, V; Sakka, L; Coste, J; Chazal, J; Salagnac, A; Coll, G; Irthum, B

2015-02-01

Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Estimating the Direct Medical Economic Burden of Health Care-Associated Infections in Public Tertiary Hospitals in Hubei Province, China.

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Li, Hao; Liu, Xinliang; Cui, Dan; Wang, Quan; Mao, Zongfu; Fang, Liang; Zhang, Furong; Yang, Ping; Wu, Huiling; Ren, Nili; He, Jianyun; Sun, Jing

2017-07-01

This study estimated the attributable direct medical economic burden of health care-associated infections (HAIs) in China. Data were extracted from hospitals' information systems. Inpatient cases with HAIs and non-HAIs were grouped by the propensity score matching (PSM) method. Attributable hospitalization expenditures and length of hospital stay were measured to estimate the direct medical economic burden of HAIs. STATA 12.0 was used to conduct descriptive analysis, bivariate χ 2 test, paired Z test, PSM ( r = 0.25σ, nearest neighbor 1:1 matching), and logistic regress analysis. The statistically significant level was set at .05. The HAIs group had statistically significant higher expenditures and longer hospitalization stay than the non-HAIs group during 2013 to 2015 ( P economic burden of HAIs calls for more effective HAI surveillance and better control with appropriate incentives.

Economic burden of hospitalizations of Medicare beneficiaries with heart failure

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Kilgore M

2017-05-01

Full Text Available Meredith Kilgore,1 Harshali K Patel,2 Adrian Kielhorn,2 Juan F Maya,2 Pradeep Sharma1 1Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 2Amgen, Inc., Thousand Oaks, CA, USA Objective: The objective of this study was to assess the costs associated with the hospitalization and the cumulative 30-, 60-, and 90-day readmission rates in a cohort of Medicare beneficiaries with heart failure (HF.Methods: This was a retrospective, observational study based on data from the national 5% sample of Medicare beneficiaries. Inpatient data were gathered for Medicare beneficiaries with at least one HF-related hospitalization between July 1, 2005, and December 31, 2011. The primary end point was the average per-patient cost of hospitalization for individuals with HF. Secondary end points included the cumulative rate of hospitalization, the average length of hospital stay, and the cumulative 30-, 60-, and 90-day readmission rates.Results: Data from 63,678 patients with a mean age of 81.8 years were included in the analysis. All costs were inflated to $2,015 based on the medical care component of the Consumer Price Index. The mean per-patient cost of an HF-related hospitalization was $14,631. The mean per-patient cost of a cardiovascular (CV-related or all-cause hospitalization was $16,000 and $15,924, respectively. The cumulative rate of all-cause hospitalization was 218.8 admissions per 100 person-years, and the median length of stay for HF-related, CV-related, and all-cause hospitalizations was 5 days. Also, 22.3% of patients were readmitted within 30 days, 33.3% were readmitted within 60 days, and 40.2% were readmitted within 90 days.Conclusion: The costs associated with hospitalization for Medicare beneficiaries with HF are substantial and are compounded by a high rate of readmission. Keywords: heart failure, Medicare, health economics, hospitalization, costs

Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis.

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May, Peter; Normand, Charles; Cassel, J Brian; Del Fabbro, Egidio; Fine, Robert L; Menz, Reagan; Morrison, Corey A; Penrod, Joan D; Robinson, Chessie; Morrison, R Sean

2018-06-01

Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017. Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. Total direct hospital costs. This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged

Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study.

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López-Ortega, Mariana; García-Peña, Carmen; Granados-García, Víctor; García-González, José Juan; Pérez-Zepeda, Mario Ulises

2013-02-08

The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to

Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective.

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Sarker, Abdur Razzaque; Sultana, Marufa; Mahumud, Rashidul Alam; Ali, Nausad; Huda, Tanvir M; Salim Uzzaman, M; Haider, Sabbir; Rahman, Hafizur; Islam, Ziaul; Khan, Jahangir A M; Van Der Meer, Robert; Morton, Alec

2018-01-01

Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence

Socio-economic impact of improper hospital waste management on waste disposal employees

International Nuclear Information System (INIS)

Khan, M.R.; Raza, Z. L.

2011-01-01

Background: Improper disposal of hospital waste results in spread of disease to the community and its handlers. Objectives: To study the socio-economic impact of inappropriate disposal of hospital waste on the health of the waste disposal staff. Materials and Methods: Interviews were conducted from 50 hospital waste collectors of Lahore and using a pre-structured questionnaire, the information was filled. The data were statistically analyzed for frequencies, and cross tabulation. Results: The improper disposal of hospital waste lead to disease in 45 hospital waste collectors. Eighteen waste collectors were infected with respiratory diseases,14 with skin infection, 7 with tuberculosis and 6 with hepatitis. Only 8 workers were provided with special clothes by the hospital management. The chances of getting infection was high in those who were not provided with special clothes like, gowns, gloves and shoes as compared to those who were provided with these.The total cost of recovery for these diseases also varied with an amount of Rs. 68,340 for the treatment of hepatitis, Rs. 3,150 for tuberculosis, Rs. 1,500 for respiratory diseases and Rs. 1,000 for skin infection. Only 12 workers were given a small remuneration ranging from Rs.100-400 per month as compensation from the hospital administration. Conclusions: Use of protective clothing by the hospital waste disposal collectors can significantly reduce their exposure to the diseases. Policy message: Provision of clothing and gloves to the waste disposal collectors, would help significantly in reducing diseases like tuberculosis, hepatitis, respiratory diseases and skin infection. (author)

[Medico-economic assessment of the Pontoise Hospital stroke unit].

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Yekhlef, F; Decup, D; Niclot, P; Servan, J; Descombes, S; Richecoeur, J; Ollivier, A

2010-11-01

Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

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Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-12-01

The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes. We classified the reasons for readmissions as either procedure- or medical-related. Cost-to-charge ratios supplied with the Nationwide Readmissions Database were used to compute the individual per-patient cost of 90-day readmissions as a continuous variable in separate general linear models for THA and TKA. Payer, patient, clinical, and hospital factors were treated as covariates. We estimated the national burden of readmissions by payer and by the reason for readmission. The national rates of 30- and 90-day readmissions after THA were 4% (95% confidence interval [CI], 4.2%-4.5%) and 8% (95% CI, 7.5%-8.1%), respectively. The national rates of 30- and 90-day readmissions after primary TKA were 4% (95% CI, 3.8%-4.0%) and 7% (95% CI, 6.8%-7.2%), respectively. The five most important variables responsible for the cost of 90-day THA readmissions (in rank order, based

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia.

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Ismail, Aniza; Suddin, Leny Suzana; Sulong, Saperi; Ahmed, Zafar; Kamaruddin, Nor Azmi; Sukor, Norlela

2017-01-01

Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting. Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Greek economic crisis and impaired perinatal parameters: experience from a public maternity hospital.

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Sdona, E; Papamichail, D; Ragkou, E; Briana, D D; Malamitsi-Puchner, A; Panagiotopoulos, T

2017-07-04

Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.

The comparative economic performance of investor-owned chain and not-for-profit hospitals.

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Watt, J M; Derzon, R A; Renn, S C; Schramm, C J; Hahn, J S; Pillari, G D

1986-01-09

We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

Science.gov (United States)

2014-01-01

Background Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. Results The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. Conclusions This study shows that initiatives aimed at strengthening physicians’ positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians. PMID:24884491

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness.

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Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven

2014-05-21

Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

An economic evaluation of Clostridium difficile infection management in an Italian hospital environment.

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Magalini, S; Pepe, G; Panunzi, S; Spada, P L; De Gaetano, A; Gui, D

2012-12-01

Clostridium difficile infection (CDI) accounts for the majority of nosocomial cases of diarrhea, and with recent upsurge of multidrug-resistant strains, morbidity and mortality have increased. Data on clinical impact of CDI come mostly from Anglo-Saxon countries, while in Italy only two studies address the issue and no economic data exist on costs of CDI in the in hospital setting. A retrospective cross-sectional study with pharmacoeconomic analysis was performed on the CDI series of the Policlinico Gemelli of Rome, a major 1400 bed Hospital. The clinical charts of 133 patients in a 26 month period were reviewed. All costs of the involved resources were calculated and statistical analysis was carried out with means and standard deviations, and categorical variables as number and percentages. The results show the significant sanitary costs of CDI in an Italian hospital setting. The cost analysis of the various elements (exams, imaging studies, therapies, etc.) shows that none independently influences the high cost burden of CDI, but that it is the simple length of hospital stay that represents the most important factor. Prevention of CDI is the most cost-effective approach. The major break-through in cost reduction of CDI would be a therapeutical intervention or procedure that shortens hospital length of stay.

Demographic and socio-economic patterns of hospitalization for infectious diseases in Israel.

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Ellencweig, A Y; Slater, P E

1986-06-01

Hospitalization rates in Israel for five common enteric communicable diseases were computed according to age, sex, religion, origin and place of residence. Higher rates were found for non-Jews of both sexes and males of all origins. Higher rates were also found for settlements inhabited by new immigrants of low socio-economic classes. These findings suggest that more emphasis should be placed upon sanitary improvements and education for better health, rather than on merely improving the health delivery system.

Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study.

Science.gov (United States)

Eichler, Klaus; Hess, Sascha; Chmiel, Corinne; Bögli, Karin; Sidler, Patrick; Senn, Oliver; Rosemann, Thomas; Brügger, Urs

2014-10-01

Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year. The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers. From the health-economic point of view, our new service model shows 'dominance' over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Economic Standpoint of Referral System at Using Tertiary Hospital Services in Iran

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Samad Rouhani

2017-03-01

Full Text Available Background and purpose: Although, economically, referral systems make utilization of health facilities at different levels sound, in many countries caretakers often bypass primary care facilities that are regularly costlier for caretakers and health care systems. The main objective of the current study was to assess the utilization of hospital services with more emphasis on economic point of view.  Materials and methods: The present study was a facility-based cross-sectional study. A researcher developed questionnaire was used to collect the data. The samples were randomly selected and interviewed on their consent. SPSS Software was also used to analyze the collected data through Chi-2, correlation, and t-test. Results: Just 29.4 percent of the attendees to the hospital were carrying out a referral slip from their family medicine. Five variables including type of care, type of attending, appointment arrangement, satisfaction with family medicine, and vising family medicine were statistically analyzed and found significantly related to carrying referral slip. Conclusion: Because of dysfunction of referral system, Iran’s health care system was found to be far from achieving economic advantages of a referral based DHS. It is actually an inappropriate use of limited health resources in a country like Iran that seriously suffers from shortage of financial and health system resources. This is likely due to deficiencies in the components of its referral system, therefore, a full revision of current reforms and appropriate remedies for deficiencies in the components of referral system was found to be in top priority in Iran.

Investment in radiotherapy infrastructure positively affected the economic status of an oncology hospital.

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Smigielska, Mirella; Milecki, Piotr

2012-01-01

Radiotherapy is among the most efficient treatment methods of cancer. However, a radiotherapy base needs a substantial financial investment, especially before the beginning of its operation, and in some cases, in developing countries such a huge investment may cause some financial disturbances for a hospital concerned. To assess the influence of investments modernizing the radiotherapy base in the period between 2000 and 2007 on the financial condition of the oncology hospital in the region with population of about 3 million. Financial reports and medical statistics for the period between 2000 and 2007 from the studied oncology hospital and a recognized staffing model, as well as data on epidemiological situation of the region have been used to calculate the economic effects of financial investment in the radiotherapy base. The growth of RT therapeutic potential has been driven by two cost-effective investment programmes. The total amount invested in both programmes was PLN 127,191,000. The number of radiotherapy patients treated in the hospital increased from 2301 in 2000 to 4799 in 2007 with a the same number of five therapeutic machines, although all five of them were replaced over that period. Investments modernizing the radiotherapy base lead to a significant increase in depreciation and operating costs, which adversely affects financial results of the hospital. Long term trends showed that investments had positive influence on hospital performance shown both in increased income and larger number of patients treated.

Socio-economic deprivation associated with acute rheumatic fever. A hospital-based case-control study in Bangladesh.

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Zaman, M M; Yoshiike, N; Chowdhury, A H; Jalil, M Q; Mahmud, R S; Faruque, G M; Rouf, M A; Haque, K M; Tanaka, H

1997-07-01

There are few studies on the relationship between socio-economic factors and rheumatic fever (RF) in the populations where the burden of both socio-economic deprivation and RF is still very high. The aim of this study is to assess the association between some socio-economic factors and RF by examining data available from a RF hospital in Bangladesh. We have reviewed the medical records of patients presenting with manifestations suggestive of RF during a 1-year period. From the patients who showed group A beta-haemolytic streptococcal upper respiratory infection (ABHS infection), 44 RF cases defined by the Jones criteria and 86 control subjects, who did not satisfy the criteria, were identified for analysis. The median age was 12 years and 60% were female. RF was significantly associated with low income (odds ratio [OR] 2.37; P = 0.04); poor living conditions: substandard (kacha) house (OR 2.93, P = 0.02); and poor nutritional status: low height for age (OR 2.68, P = 0.02). Multiple logistic regression analysis revealed an increased OR for kacha house (OR 3.18, P = 0.02) but the same estimate for low height for age (OR 2.68; P = 0.04). Our analysis shows that, among the patients presenting to the RF hospital with proven ABHS infection, acute RF is associated with socio-economic deprivation.

In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013.

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Rana Maroun

Full Text Available The aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC, to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs.We performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10 codes for renal cell carcinoma (C64 and codes for metastases (C77 to C79. Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals.A total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18-102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906 in 2008 to 10,216€ (SD: €10,527 in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs.This study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs.

[Estimation of economic costs for the care of patients with nosocomial pneumonia in a regional peruvian hospital, 2009-2011].

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Dámaso-Mata, Bernardo; Chirinos-Cáceres, Jesús; Menacho-Villafuerte, Luz

2016-06-01

To estimate and compare the economic costs for the care of patients with and without nosocomial pneumonia at Hospital II Huánuco EsSalud during 2009-2011, in Peru. This was a partial economic evaluation of paired cases and controls. A collection sheet was used. nosocomial pneumonia. direct health costs, direct non-health costs, indirect costs, occupation, age, comorbidities, sex, origin, and education level. A bivariate analysis was performed. Forty pairs of cases and controls were identified. These patients were hospitalized for >2 weeks and prescribed more than two antibiotics. The associated direct health costs included those for hospitalization, antibiotics, auxiliary examinations, specialized assessments, and other medications. The direct non-health costs and associated indirect costs included those for transportation, food, housing, foregone payroll revenue, foregone professional fee revenue, extra-institutional expenses, and payment to caregivers during hospitalization and by telephone. The direct health costs for nosocomial pneumonia patients were more than three times and the indirect costs were more than two times higher than those for the controls. Variables with the greatest impact on costs were identified.

Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study.

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Shah, D N; Aitken, S L; Barragan, L F; Bozorgui, S; Goddu, S; Navarro, M E; Xie, Y; DuPont, H L; Garey, K W

2016-07-01

Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI). To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI. This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode. In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (Pcosts increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (Pcost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013). This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences.

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Adhikari, Shiva R; Maskay, Nephil M; Sharma, Bishnu P

2009-03-01

Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50% of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17% of annual household income. This expenditure causes more than 20% of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90%. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.

Economic evaluation of occupational safety preventive measures in a hospital.

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Ramos, Delfina G; Arezes, Pedro M; Afonso, Paulo

2015-01-01

When an organization performs an integrated analysis of risks through its Occupational Health and Safety Management System, several steps are suggested to address the implications of the identified risks. Namely, the organization should make a detailed analysis of the monetary impact for the organization of each of the preventive measures considered. However, it is also important to perform an analysis of the impact of each measure on society (externalities). The aim of this paper is to present a case study related to the application of the proposed economic evaluation methodology. An analysis of the work accidents in a hospital has been made. Three of the major types of accidents have been selected: needle stings, falls and excessive strain. Following the risk assessment, some preventive measures have been designed. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organization's perspective) and in economic terms (including the benefits for the worker and for the Society). While the financial ratio is only advantageous in some cases, when the externalities are taken into account, the B/C ratio increases significantly. It is important to consider external benefits to make decisions concerning the implementation of preventive measures in Occupational Health and Safety projects.

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

OpenAIRE

Barbadoro, Pamela; Di Tondo, Elena; Menditto, Vincenzo Giannicola; Pennacchietti, Lucia; Regnicoli, Februa; Di Stanislao, Francesco; D?Errico, Marcello Mario; Prospero, Emilia

2015-01-01

Objective The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. Methods The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Results Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32?6.47) of re-admissions have be...

[Use of a Delphi survey to assess the hospital economic impact of innovative products: The example of idarucizumab a dabigatran-specific reversal agent].

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Jamet, N; Thivilliers, A P; Paubel, P; Chevalier, D; Bourguignon, S; Bézie, Y

2017-11-01

The economic impact of therapeutic innovations on the hospital patient management cannot be easily estimated. The objective of this study is to illustrate the use of a Delphi survey as a support tool to identify the changes following the use of idarucizumab in dabigatran-treated patients with uncontrolled/life-threatening bleeding or who required emergency surgery/urgent procedures. The Delphi questionnaires have been administrated to 8 emergency physicians or anesthetists from 6 different hospital centers. Following the answers, an economic valorization has been carried out on every parameter on which a consensus was reached (at least 4 answers showing an identical trend). A mean management cost for each etiology with and without the use of idarucizumab has thus been identified. For gastro-intestinal and other life-threatening bleedings (excepted intracranial bleedings), the total management cost of the hospital stay was respectively 6058 € (-35%) and 6219 € (-34%) following the use of the reversal agent. The hospital management cost for intracranial bleeding is slightly increasing to 9790 € (+3%). The cost of a stay for emergency surgery decreases to 6962€ (-2%). This study shows a positive economic impact following the use of the dabigatran-specific reversal agent for patients with uncontrolled/life-threatening bleeding excepted in the case of intracranial bleeding. Moreover, it points out that a Delphi survey is an easy way to predict the hospital economic impact of a therapeutic innovation when no other evaluation is possible. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

The consequences of hospital autonomization in Colombia: a transaction cost economics analysis.

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Castano, Ramon; Mills, Anne

2013-03-01

Granting autonomy to public hospitals in developing countries has been common over recent decades, and implies a shift from hierarchical to contract-based relationships with health authorities. Theory on transactions costs in contractual relationships suggests they stem from relationship-specific investments and contract incompleteness. Transaction cost economics argues that the parties involved in exchanges seek to reduce transaction costs. The objective of this research was to analyse the relationships observed between purchasers and the 22 public hospitals of the city of Bogota, Colombia, in order to understand the role of relationship-specific investments and contract incompleteness as sources of transaction costs, through a largely qualitative study. We found that contract-based relationships showed relevant transaction costs associated mainly with contract incompleteness, not with relationship-specific investments. Regarding relationships between insurers and local hospitals for primary care services, compulsory contracting regulations locked-in the parties to the contracts. For high-complexity services (e.g. inpatient care), no restrictions applied and relationships suggested transaction-cost minimizing behaviour. Contract incompleteness was found to be a source of transaction costs on its own. We conclude that transaction costs seemed to play a key role in contract-based relationships, and contract incompleteness by itself appeared to be a source of transaction costs. The same findings are likely in other contexts because of difficulties in defining, observing and verifying the contracted products and the underlying information asymmetries. The role of compulsory contracting might be context-specific, although it is likely to emerge in other settings due to the safety-net role of public hospitals.

Hospital waste sterilization: a technical and economic comparison between radiation and microwave treatments

International Nuclear Information System (INIS)

Tata, A.; Beone, F.

1995-01-01

Hospital waste (HW) disposal is becoming a problem of increasing importance in almost all industrially advanced countries. In Italy the yearly hospital waste production is about 250,000 tons and only 60,000 are treated by incineration at present time. As by a recent Italian law a meaningful percentage of HW (50 to 60%), corresponding to food residuals, plastic, paper, various organic materials, etc., could be landfilled as municipal refuses if preliminarily submitted to a suitable sterilization treatment. Under this perspective, sterilization/sanitation techniques represent now a technically and commercially viable alternative to HW thermal destruction that, besides more and more socially and politically less accepted. Electron Beam (EB) and Microwave (MW) treatments are two of the most interesting and emerging HW sterilization techniques, and, based on engineering real data, a technical and economic comparison is carried out, focusing vantages and limits of each process. (author)

The impact of economic crisis on the Greek hospitals' productivity.

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Mitropoulos, Panagiotis; Mitropoulos, Ioannis; Karanikas, Haralampos; Polyzos, Nikolaos

2018-01-01

During the recent economic crisis, Greece implemented a comprehensive reform in the health care system. The 2010 health reform occurred under the constraints imposed by the memorandum of understanding that the Greek Government signed with its EU/International Monetary Fund creditors to control its deficit. The objective of the study is to examine the impact of the reform on the efficiency and productivity of public hospitals in Greece. We use the Malmquist productivity index to comparatively examine the potential changes before and after the reform years. We compare productivity, efficiency, and technological changes using panel data of 111 public acute hospitals operating in Greece throughout the recession period of 2009 to 2012. Bootstrapping methods are applied to allow for uncertainty owing to sampling error and for statistical inference for the Malmquist productivity index and its decompositions. The analysis indicates that the productivity has been increased following the policy changes. It appears that the expected benefits from the reform in general have been achieved, at least in the short-term. This result is examined in the light of management and operations activities, which are related with the reform process. Therefore, at a second stage, the Malmquist index is regressed on variables that may potentially be statistically associated with productivity growth. Copyright © 2017 John Wiley & Sons, Ltd.

Clinical, Ergonomic, and Economic Outcomes With Multichamber Bags Compared With (Hospital) Pharmacy Compounded Bags and Multibottle Systems: A Systematic Literature Review.

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Alfonso, Jorge Emilio; Berlana, David; Ukleja, Andrew; Boullata, Joseph

2017-09-01

Multichamber bags (MCBs) may offer potential clinical, ergonomic, and economic advantages compared with (hospital) pharmacy compounded bags (COBs) and multibottle systems (MBSs). A systematic literature review was performed to identify and assess the available evidence regarding advantages of MCBs compared with COBs and MBSs. Medline, Embase, the Cochrane Databases, and EconLit were searched for articles reporting clinical, ergonomic, and economic outcomes for MCBs compared with COBs or MBSs. The search was limited to studies conducted in hospitalized patients >2 years of age that were published in English between January 1990 and November 2014. The Population Intervention Comparison Outcomes Study Design (PICOS) framework was used for the analysis. From 1307 unique citations, 74 potentially relevant publications were identified; review of references identified 2 additional publications. Among the 76 publications, 18 published studies met the inclusion criteria. Most were retrospective in design. Ten studies reported clinical outcomes, including 1 prospective randomized trial and multiple retrospective analyses that reported a lower risk of bloodstream infection for MCBs compared with other delivery systems. Sixteen studies reported ergonomic and/or economic outcomes; most reported a potential cost benefit for MCBs, with consistent reports of reduced time and labor compared with other systems. The largest cost benefit was observed in studies evaluating total hospitalization costs. The systematic literature review identified evidence of potential clinical, ergonomic, and economic benefits for MCBs compared with COBs and MBSs; however, methodological factors limited evidence quality. More prospective studies are required to corroborate existing evidence.

Economic analysis of an epilepsy outreach model of care in a university hospital setting.

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Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

2017-07-01

The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

A techno-economic assessment of grid connected photovoltaic system for hospital building in Malaysia

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Mat Isa, Normazlina; Tan, Chee Wei; Yatim, AHM

2017-07-01

Conventionally, electricity in hospital building are supplied by the utility grid which uses mix fuel including coal and gas. Due to enhancement in renewable technology, many building shall moving forward to install their own PV panel along with the grid to employ the advantages of the renewable energy. This paper present an analysis of grid connected photovoltaic (GCPV) system for hospital building in Malaysia. A discussion is emphasized on the economic analysis based on Levelized Cost of Energy (LCOE) and total Net Present Post (TNPC) in regards with the annual interest rate. The analysis is performed using Hybrid Optimization Model for Electric Renewables (HOMER) software which give optimization and sensitivity analysis result. An optimization result followed by the sensitivity analysis also being discuss in this article thus the impact of the grid connected PV system has be evaluated. In addition, the benefit from Net Metering (NeM) mechanism also discussed.

The Economic and Social Burden of Traumatic Injuries: Evidence from a Trauma Hospital in Port-au-Prince, Haiti.

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Zuraik, Christopher; Sampalis, John; Brierre, Alexa

2018-06-01

The cost of traumatic injury is unknown in Haiti. This study aims to examine the burden of traumatic injury of patients treated and evaluated at a trauma hospital in the capital city of Port-au-Prince. A retrospective cross-sectional chart review study was conducted at the Hospital Bernard Mevs Project Medishare for all patients evaluated for traumatic injury from December 2015 to January 2016, as described elsewhere (Zuraik and Sampalis in World J Surg, https://doi.org/10.1007/s00268-017-4088-2 , 2017). Direct medical costs were obtained from patient hospital bills. Indirect and intangible costs were calculated using the human capital approach. A total of 410 patients were evaluated for traumatic injury during the study period. Total costs for all patients were $501,706 with a mean cost of $1224. Indirect costs represented 63% of all costs, direct medical costs 19%, and intangible costs 18%. Surgical costs accounted for the majority of direct medical costs (29%). Patients involved in road traffic accidents accounted for the largest number of injuries (41%) and the largest percentage of total costs (51%). Patients with gunshot wounds had the highest total mean costs ($1566). Mean costs by injury severity ranged from $62 for minor injuries, $1269 for serious injuries, to $13,675 for critical injuries. Injuries lead to a significant economic burden for individuals treated at a semi-private trauma hospital in the capital city of Port-au-Prince, Haiti. Programs aimed at reducing injuries, particularly road traffic accidents, would likely reduce the economic burden to the nation.

Radiobioassay economics and laboratory management

International Nuclear Information System (INIS)

Gilchrist, J.

1983-01-01

The economic situation faced by laboratories in the US is less than ideal. Inflation/interest rates are in the area of 10 to 20% per year, reimbursement policies are putting pressures on the laboratories, hospitals are in a cost-containment mode in the best of cases, and in the worst, are closing for a lack of funds. In the past six years, there has been a national net loss of 186 hospitals, according to American Hospital Association figures. The pressure is acute on community hospitals; 135 have failed. Many hospitals (160) have applied for federal grants as financially distressed hospitals. Since the community hospitals account for 85% of all admissions in the US, it is obvious that the pressure has been greatest on the hospitals that account for the greatest number of admissions. To put the general economic scene in perspective, according to 1977 Medicare data, 24% of all community hospitals had total expenses that exceeded their total revenues. Many social and economic factors contribute to this picture, but the rapidly rising operating expenses due to inflation, new high cost medical technology, surplus of hospital beds, and inadequate planning, purchasing, accounting, and hiring practices play a noticeable part in contributing to this problem

[Controlling and operation management in hospitals].

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Vagts, Dierk A

2010-03-01

The economical pressure on the health system and especially on hospitals is growing rapidly. Hence, economical knowledge for people in medical executive positions becomes imperative. In advanced and forward-looking hospitals controlling is gaining more and more weight, because it takes over a coordinative responsibility. Ideally controlling is navigating the teamwork of managers (CEOs) and medical executives by weighing medical necessities and economical framework. Controlling is contributing to evaluate an optimal efficiency of a hospital in a highly competitive surrounding by providing medical and economical data on a regular basis. A close, open-minded and trusting cooperation between all people, who are involved, is imperative. Hence, controlling in the proper meaning of the word can not flourish in dominant and hierarchic hospital structures. Georg Thieme Verlag Stuttgart * New York.

Positioning matrix of economic efficiency and complexity: a case study in a university hospital.

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Ippolito, Adelaide; Viggiani, Vincenzo

2014-01-01

At the end of 2010, the Federico II University Hospital in Naples, Italy, initiated a series of discussions aimed at designing and applying a positioning matrix to its departments. This analysis was developed to create a tool able to extract meaningful information both to increase knowledge about individual departments and to inform the choices of general management during strategic planning. The name given to this tool was the positioning matrix of economic efficiency and complexity. In the matrix, the x-axis measures the ratio between revenues and costs, whereas the y-axis measures the index of complexity, thus showing "profitability" while bearing in mind the complexity of activities. By using the positioning matrix, it was possible to conduct a critical analysis of the characteristics of the Federico II University Hospital and to extract useful information for general management to use during strategic planning at the end of 2010 when defining medium-term objectives. Copyright © 2013 John Wiley & Sons, Ltd.

The Factors Influencing Economic Efficiency of the Hospital Bed Care in Terms of the Regional Allowance Organizations

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Vaňková Ivana

2014-09-01

Full Text Available This paper aims to provide an efficiency evaluation of selected hospital bed care providers during years 2010 -2012 with respect to selected factors: The size of the hospital establishment according to number of beds, number of hospitalized patients, the average length of stay per a patient in care, total staff cost calculated per bed, total revenues calculated per bed, and total costs calculated per bed. For this purpose, hospitals providing primarily acute bed care were chosen. From the legal point of view, they are allowance organizations of a particular region. The evaluation concerns both allocative efficiency and technical efficiency. The allocative efficiency is treated from the proper algorithm point of view and it compares total costs calculated per bed with total revenues calculated per bed. A method denominated Data Envelopment Analysis was applied for the calculation of the technical efficiency of units. To be more specific, it was input-oriented model with constant returns to scale (CCR. The input parameters involve the number of beds, the average length of stay and costs per day of stay. Output parameters were as follows: Bed occupancy in days and the number of hospitalized patients. The data published by the Institute of Health Information and Statistic of the Czech Republic and by ÚFIS system (the Data Base of Ministry of Finance of the Czech Republic were used as the source of data. The evaluation implies that only three hospitals were economically-effective: Silesian Hospital in Opava, Hospital Jihlava, and TGM Hospital Hodonín. The most significant factor influencing the efficiency was determined - the average length of stay.

[Economic impact of consultation-liaison psychiatry in a French University Hospital Centre].

Science.gov (United States)

Yrondi, A; Petiot, D; Arbus, C; Schmitt, L

2016-02-01

In times of fiscal restraint for health structures, apart from the clinical input, it seems important to discuss the economic impact of liaison psychiatry. There are only a few studies on the economic added value provided by a liaison psychiatry team. In addition to this, only a few psychiatric pathologies are coded as they should be, hence we make the assumption of an additional development provided by a specialised team. Over a short period of 4months, in three departments of the Toulouse University Hospital Centre, the added value to the general pricing system of liaison psychiatry was studied. The population was represented by all the consecutive requests for consultations from patients over 18years old, men and women, hospitalised at that time. These three departments frequently request consultations with the psychiatry liaison team. They set a diagnostic, and if this is associated with a higher Homogeneous Group of Patients (HGP), it provides added value. Fifty-two patients benefited from a psychiatric consultation over 4months. The results highlight a development of € 8630.43 for the traumatology department, € 3325.03 for the internal medicine department, and € 513.61 for the haematology department over the study period. The overall development over this period was € 12,469.07. To our knowledge, this approach is one of the first in France to highlight an economic impact of the intervention of liaison psychiatry in the claiming departments. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Are hospital staff aware of the economic benefits of employing people with disabilities?

Directory of Open Access Journals (Sweden)

Małgorzata M. Machaj

2015-10-01

Full Text Available Introduction : One of the regulations governing employment on the open labour market is the Act for vocational and social rehabilitation and employment of people with disabilities, which defines disability in the context that it impacts upon a person’s ability to work. Aim of the research : To evaluate the level of hospital staff awareness of the financial impacts of employing people with disabilities at the Central Clinical Hospital of the Ministry of the Interior in Warsaw. Material and methods: The sample and control groups consisted of people working at the hospital, comprising 247 individuals, including 194 women and 53 men, aged between 25 and 60 years. The sample group consisted of people with disabilities. The control group consisted of colleagues with disabilities, of both sexes, and of the same age range. There was also a separate sample group comprising 60 people from middle management and senior management. The sample and control groups were provided with a questionnaire about issues relating to the economic aspects of employing people with disabilities. The results were compared with data from the questionnaire for management and from hospital statistics. The methodology of mathematical statistics was used. Results : Discrepancies were found between sample and control groups, and hospital statistics pertaining to people with disabilities as employees in terms of the burden placed on the business, such as sick leave, breaks from work in the general sense, additional leave, accessing specialist tests during working hours, and earnings, in particular reimbursement of the cost of workplace equipment and funding for salaries. Conclusions: There is a significant degree of divergence between managers’ and employees’ notions of privileges for disabled workers and their actual scale. There is misunderstanding and lack of knowledge of the applicable provisions of the Act for the Vocational and Social Rehabilitation and Employment of

Vertical Integration of Hospitals and Physicians: Economic Theory and Empirical Evidence on Spending and Quality.

Science.gov (United States)

Post, Brady; Buchmueller, Tom; Ryan, Andrew M

2017-08-01

Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.

The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey.

Science.gov (United States)

Yang, Juan; Jit, Mark; Leung, Kathy S; Zheng, Ya-Ming; Feng, Lu-Zhao; Wang, Li-Ping; Lau, Eric H Y; Wu, Joseph T; Yu, Hong-Jie

2015-10-06

The seasonal influenza vaccine coverage rate in China is only 1.9 %. There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level, even though this kind of information is important for informing national-level immunization policy decision-making. A retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective. Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013. Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients. The study enrolled 529 outpatients (median age: eight years; interquartile range [IQR]: five to 20 years) and 254 inpatients (median age: four years; IQR: two to seven years). Among the outpatients, 22.1 % (117/529) had underlying diseases and among the inpatients, 52.8 % (134/254) had underlying diseases. The average total costs related to influenza-associated outpatient visits and inpatient visits were US$ 155 (standard deviation, SD US$ 122) and US$ 1,511 (SD US$ 1,465), respectively. Direct medical costs accounted for 45 and 69 % of the total costs related to influenza-associated outpatient and inpatient visits, respectively. For influenza outpatients, the mean cost per episode in children aged below five years (US$ 196) was higher than that in other age groups (US$ 129-153). For influenza inpatients, the mean cost per episode in adults aged over 60 years (US$ 2,735) was much higher than that in those aged below 60 years (US$ 1,417-1,621). Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions (outpatients: US$ 186 vs. US$ 146; inpatients: US$ 1

Do Catalan private hospitals enjoy financial health?

Directory of Open Access Journals (Sweden)

Judit Creixans Tenas

2016-02-01

Full Text Available Purpose: The present study reflects the economic and financial analysis of  private hospitals with non-charitable character in Catalonia 2008-2013. The private health sector is considered to be a service activity that develops an important social role. The study positions these analysed centers in the Catalan and Spanish health sector and presents the main economic and financial indicators to diagnose the situation of these companies during the period indicated by analysing short and long-term results and analysis of changes in equity and cash flows of the wineries. Design/methodology/approach: The data used comes from the statements of the Catalan hospital centers in the period 2008-2013 and in particular, it contains a sample of 94 Catalan private hospitals, that mostly are considered large-level accounting (according to the General Accounting Plan. The economic and financial  analysis has carried out using descriptive statistics and analysis results and conclusions have been reached. Findings: The study noted that enables private hospitals in this period have a healthy economic and financial status, although it should improve the management of assets. Most sales are concentrated with a small number of hospitals and, regarding the evolution of the results, produces two distinct stages, the first period of decrease (2008-2010 and the second period of growth and recovery from 2011.. Research limitations/implications: It would be desirable to perform the same study by the Spanish private hospitals in order to compare the economic and financial analysis of the Catalan private sector with the Spanish private sector. Practical implications: It allows us to assess the projection of this sector in recent years in Catalonia in order to take the appropriate economic decisions in this regard. Social implications: The results show the changes that have occurred over the years in the economic crisis of the period analysed. Originality / value: For

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil

Directory of Open Access Journals (Sweden)

Michelle Quarti Machado Rosa

2018-02-01

Full Text Available Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS and National database of Hospitalizations (SIH. We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease, respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization, totaling (international dollar Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%, followed by microvascular complications (25.4% and DM per se (18.1%. Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies.

Ozonation of hospital raw wastewaters for cytostatic compounds removal. Kinetic modelling and economic assessment of the process

Energy Technology Data Exchange (ETDEWEB)

Ferre-Aracil, J. [Universitat Politècnica de València – EPSA, Department of Chemical and Nuclear Engineering. Institute for Industrial, Radiophysical and Environmental Safety (ISIRYM), Pl. Ferrandiz i Carbonell, 03801 Alcoi, Alicante (Spain); Valcárcel, Y. [Environmental Health and Ecotoxicology Research Group, Universidad Rey Juan Carlos, Avd. Atenas s/n, Móstoles, 28922 Alcorcón (Spain); Negreira, N.; López de Alda, M. [Water and Soil Quality Research Group, Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research (IDAEA-CSIC), C/ Jordi Girona 18-26, 08034 Barcelona (Spain); Barceló, D. [Water and Soil Quality Research Group, Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research (IDAEA-CSIC), C/ Jordi Girona 18-26, 08034 Barcelona (Spain); Catalan Institute for Water Research (ICRA), H2O Building, Scientific and Technological Park of the University of Girona, Emili Grahit 101, 17003 Girona (Spain); Cardona, S.C. [Universitat Politècnica de València – EPSA, Department of Chemical and Nuclear Engineering. Institute for Industrial, Radiophysical and Environmental Safety (ISIRYM), Pl. Ferrandiz i Carbonell, 03801 Alcoi, Alicante (Spain); Navarro-Laboulais, J., E-mail: jnavarla@iqn.upv.es [Universitat Politècnica de València – EPSA, Department of Chemical and Nuclear Engineering. Institute for Industrial, Radiophysical and Environmental Safety (ISIRYM), Pl. Ferrandiz i Carbonell, 03801 Alcoi, Alicante (Spain)

2016-06-15

The kinetics of the ozone consumption for the pretreatment of hospital wastewater has been analysed in order to determine the reaction rate coefficients between the ozone and the readily oxidisabled organic matter and cytostatic compounds. The wastewater from a medium size hospital was treated with ozone and peroxone methodologies, varying the ozone concentration, the reaction time and the hydrogen peroxide doses. The analysis shows that there are four cytostatic compounds, i.e. irinotecan, ifosfamide, cyclophosphamide and capecitabine, detected in the wastewaters and they are completely removed with reasonably short times after the ozone treatment. Considering the reactor geometry, the gas hydrodynamics, the mass transfer of ozone from gas to liquid and the reaction of all oxidisable compounds of the wastewater it is possible to determine the chemical ozone demand, COzD, of the sample as 256 mg O{sub 3} L{sup −1} and the kinetic rate coefficient with the dissolved organic matter as 8.4 M{sup −1} s{sup −1}. The kinetic rate coefficient between the ozone and the cyclophosphamide is in the order of 34.7 M{sup −1} s{sup −1} and higher for the other cytostatics. The direct economic cost of the treatment was evaluated considering this reaction kinetics and it is below 0.3 €/m{sup 3} under given circumstances. - Highlights: • 17 cytostatic compounds were analysed and 4 detected by SPE-LC/MS-MS. • The ozonation is 100% effective on the removal of the detected cytostatics. • The kinetics of cytostatic ozonation reaction is modeled by competitive kinetics. • The economic cost of the treatment of hospital wastewater was assessed.

Ozonation of hospital raw wastewaters for cytostatic compounds removal. Kinetic modelling and economic assessment of the process

International Nuclear Information System (INIS)

Ferre-Aracil, J.; Valcárcel, Y.; Negreira, N.; López de Alda, M.; Barceló, D.; Cardona, S.C.; Navarro-Laboulais, J.

2016-01-01

The kinetics of the ozone consumption for the pretreatment of hospital wastewater has been analysed in order to determine the reaction rate coefficients between the ozone and the readily oxidisabled organic matter and cytostatic compounds. The wastewater from a medium size hospital was treated with ozone and peroxone methodologies, varying the ozone concentration, the reaction time and the hydrogen peroxide doses. The analysis shows that there are four cytostatic compounds, i.e. irinotecan, ifosfamide, cyclophosphamide and capecitabine, detected in the wastewaters and they are completely removed with reasonably short times after the ozone treatment. Considering the reactor geometry, the gas hydrodynamics, the mass transfer of ozone from gas to liquid and the reaction of all oxidisable compounds of the wastewater it is possible to determine the chemical ozone demand, COzD, of the sample as 256 mg O 3 L −1 and the kinetic rate coefficient with the dissolved organic matter as 8.4 M −1 s −1 . The kinetic rate coefficient between the ozone and the cyclophosphamide is in the order of 34.7 M −1 s −1 and higher for the other cytostatics. The direct economic cost of the treatment was evaluated considering this reaction kinetics and it is below 0.3 €/m 3 under given circumstances. - Highlights: • 17 cytostatic compounds were analysed and 4 detected by SPE-LC/MS-MS. • The ozonation is 100% effective on the removal of the detected cytostatics. • The kinetics of cytostatic ozonation reaction is modeled by competitive kinetics. • The economic cost of the treatment of hospital wastewater was assessed.

ELEMENTAL FORMS OF HOSPITALITY

OpenAIRE

Maximiliano Emanuel Korstanje

2010-01-01

Modern studies emphasized on the needs of researching the hospitality as relevant aspects of tourism and hospitality fields. Anyway, these approaches are inextricably intertwined to the industry of tourism and do not take seriously the anthropological and sociological roots of hospitality. In fact, the hotel seems to be a partial sphere of hospitality at all. Under this context, the present paper explores the issue of hospitality enrooted in the political and economic indo-European principle ...

Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

Science.gov (United States)

Aguilar-Bernier, M; González-Carrascosa, M; Padilla-España, L; Rivas-Ruiz, F; Jiménez-Puente, A; de Troya-Martín, M

2014-03-01

The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury.

Science.gov (United States)

Squair, Jordan W; White, Barry A B; Bravo, Grace I; Martin Ginis, Kathleen A; Krassioukov, Andrei V

2016-08-01

We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.

All-Round Marketing Increases Hospital Popularity.

Science.gov (United States)

Ziqi, Tao

2015-06-01

Xuzhou Center Hospital is in a competing medical market in Xuzhou city. This hospital has been dedicating to improve the medical skills and provide professional and individualized service to the patients in order to improve the patient's experience and increase the patient's satisfaction. On the other side, this hospital has provided an all-round marketing campaign to build up the social influence and public reputation through public-praise marketing, web marketing, media marketing, and scholar marketing. Besides, this hospital has been cooperating with foreign medical institutions and inviting foreign medical specialists to academic communication. With the combined effects of improving medical service and all-round marketing, the hospital's economic performance has been enhanced significantly and laid a solid foundation for its ambition to become the first-class hospital in Huaihai Economic Zone.

An analysis of hospital capital planning and financing in three European countries: Using the principal-agent approach to identify the potential for economic problems.

Science.gov (United States)

Thompson, Ceri R; McKee, Martin

2011-02-01

To explore differences in national approaches to hospital capital planning and financing in three European countries and to understand the roles and positions of the actors involved. Case studies of major new hospital developments were undertaken in each of the study countries (France, Sweden and England), based on a review of documents related to each development and the national framework within which they took place, as well as interviews with key informants. The principal-agent model was used, focusing on identification of differing utilities and information asymmetries. There are substantial differences between countries, for example in relation to the role of the hospital in its own redevelopment, the organisational distance between actors, the institutional level at which decision rights for major investments are exercised, and how principals control the agents. These differences have implications for the processes involved and the nature of economic and health care problems that can arise. There is evidence of, and opportunity for economic problems in all systems but these seems to be greater in France and England where the hospital leads the process, where there is limited involvement by the regional bodies, and informational differences appear greater. We conclude that hospital planning processes should be informed by an explicit understanding of the powerful groups involved and their divergent preferences and utilities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Hospital costs for treatment of acute heart failure: economic analysis of the REVIVE II study.

Science.gov (United States)

de Lissovoy, Greg; Fraeman, Kathy; Teerlink, John R; Mullahy, John; Salon, Jeff; Sterz, Raimund; Durtschi, Amy; Padley, Robert J

2010-04-01

Acute heart failure (AHF) is the leading cause of hospital admission among older Americans. The Randomized EValuation of Intravenous Levosimendan Efficacy (REVIVE II) trial compared patients randomly assigned to a single infusion of levosimendan (levo) or placebo (SOC), each in addition to local standard treatments for AHF. We report an economic analysis of REVIVE II from the hospital perspective. REVIVE II enrolled patients (N = 600) hospitalized for treatment of acute decompensated heart failure (ADHF) who remained dyspneic at rest despite treatment with intravenous diuretics. Case report forms documented index hospital treatment (drug administration, procedures, days of treatment by care unit), as well as subsequent hospital and emergency department admissions during follow-up ending 90 days from date of randomization. These data were used to impute cost of admission based on an econometric cost function derived from >100,000 ADHF hospital billing records selected per REVIVE II inclusion criteria. Index admission mean length of stay (LOS) was shorter for the levo group compared with standard of care (SOC) (7.03 vs 8.96 days, P = 0.008) although intensive care unit (ICU)/cardiac care unit (CCU) days were similar (levo 2.88, SOC 3.22, P = 0.63). Excluding cost for levo, predicted mean (median) cost for the index admission was levo US $13,590 (9,458), SOC $19,021 (10,692) with a difference of $5,431 (1,234) favoring levo (P = 0.04). During follow-up through end of study day 90, no significant differences were observed in numbers of hospital admissions (P = 0.67), inpatient days (P = 0.81) or emergency department visits (P = 0.41). Cost-effectiveness was performed with a REVIVE-II sub-set conforming to current labeling, which excluded patients with low baseline blood pressure. Assuming an average price for levo in countries where currently approved, there was better than 50% likelihood that levo was both cost-saving and improved survival. Likelihood that levo would

Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials.

Science.gov (United States)

Shih, Sophy T F; Carter, Rob; Heward, Sue; Sinclair, Craig

2017-08-01

While skin cancer is still the most common cancer in Australia, important information gaps remain. This paper addresses two gaps: i) the cost impact on public hospitals; and ii) an up-to-date assessment of economic credentials for prevention. A prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using State service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Combining inpatient and outpatient costs, total annual costs for Victoria were $48 million to $56 million. The SunSmart program is estimated to have prevented more than 43,000 skin cancers between 1988 and 2010, a net cost saving of $92 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). At about $50 million per year for hospitals in Victoria alone, the cost burden of a largely preventable disease is substantial. Skin cancer prevention remains highly cost-effective, yet underfunded. Implications for public health: Increased funding for skin cancer prevention must be kept high on the public health agenda. Hospitals would also benefit from being able to redirect resources to non-preventable conditions. © 2017 The Authors.

[HERA-QUEST: HTA evaluation of generic pharmaceutical products to improve quality, economic efficiency, patient safety and transparency in drug product changes in hospitals].

Science.gov (United States)

Gyalrong-Steur, Miriam; Kellermann, Anita; Bernard, Rudolf; Berndt, Georg; Bindemann, Meike; Nusser-Rothermundt, Elfriede; Amann, Steffen; Brakebusch, Myga; Brüggmann, Jörg; Tydecks, Eva; Müller, Markus; Dörje, Frank; Kochs, Eberhard; Riedel, Rainer

2017-04-01

In view of the rising cost pressure and an increasing number of drug shortages, switches between generic drug preparations have become a daily routine in hospitals. To ensure consistently high treatment quality and best possible patient safety, the equivalence of the new and the previous drug preparation must be ensured before any change in the purchase of pharmaceutical products takes place. So far, no easily usable, transparent and standardized instrument for this kind of comparison between generic drug products has been available. A group of pharmaceutical experts has developed the drug HTA (health technology assessment) model "HERA" (HTA Evaluation of geneRic phArmaceutical products) through a multi-step process. The instrument is designed to perform both a qualitative and economic comparison of equivalent drug preparations ("aut idem" substitution) before switching products. The economic evaluation does not only consider unit prices and consumption quantity, but also the processing costs associated with a product change process. The qualitative comparison is based on the evaluation of 34 quality criteria belonging to six evaluation fields (e.g., approval status, practical handling, packaging design). The objective evaluation of the quality criteria is complemented by an assessment of special features of the individual hospital for complex drug switches, including the feedback of the physicians utilizing the drug preparation. Thus potentially problematic switches of pharmaceutical products can be avoided at the best possible rate, contributing to the improvement of patient safety. The novel drug HTA model HERA is a tool used in clinical practice that can add to an increase in quality, therapeutic safety and transparency of drug use while simultaneously contributing to the economic optimization of drug procurement in hospitals. Combining these two is essential for hospitals facing the tension between rising cost pressure and at the same time increasing demands

socio-economic population

African Journals Online (AJOL)

not ideal, underscores the peculiarities of experience in a general hospital in a low socio-economic setting. In conclusion, hernia surgery in a general hospital setting can be safely performed with the judicious use of intravenous Kctamine in children and emergency adult surgery as long as awareness of its side-effects and.

The economic burden of Clostridium difficile

Science.gov (United States)

McGlone, S. M.; Bailey, R. R.; Zimmer, S. M.; Popovich, M. J.; Tian, Y.; Ufberg, P.; Muder, R. R.; Lee, B. Y.

2013-01-01

Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient’s primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease. PMID:21668576

Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative Medicare population

Directory of Open Access Journals (Sweden)

Chen SY

2013-05-01

Full Text Available Shih-Yin Chen,1 Concetta Crivera,2 Michael Stokes,1 Luke Boulanger,1 Jeffrey Schein2 1United BioSource Corporation, Lexington, MA, USA; 2Janssen Scientific Affairs, LLC, Raritan, NJ, USA Objective: To evaluate the clinical and economic burden of acute coronary syndrome (ACS, a common cardiovascular illness, in the Medicare population. Methods: Data from the Medicare Current Beneficiary Survey were analyzed. Patients with incident hospitalization for ACS without similar events during the 6 months prior were included. Outcomes evaluated included inpatient mortality, 30-day mortality and readmission, subsequent hospitalization events, and total direct health care costs. Sample population weights were applied, accounting for multistage sampling design to obtain nationally representative estimates for the US Medicare population. Results: Between March 1, 2002 and December 31, 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male representing 2,542,211 Medicare beneficiaries. The inpatient mortality rate was 9.71% and the 30-day mortality ranged from 10.96% to 13.93%. The 30-day readmission rate for surviving patients was 18.56% for all causes and 17.90% for cardiovascular disease (CVD-related diagnoses. The incidence of death since admission was 309 cases per 1000 person–years. Among patients discharged alive, the incidence was 197 for death, 847 for CVD-related admission, and 906 for all-cause admission. During the year when the ACS event occurred, mean annual total direct health care costs per person were US$50,458, with more than half attributable to inpatient hospitalization ($27,609. Conclusion: In this national representative Medicare population, we found a substantial clinical and economic burden for ACS. These findings suggest a continuing unmet medical need for more effective management of patients with ACS. The continuous burden underscores the importance of development of new interventions and/or strategies to

The technical-economic potential of thermal energy saving in hospitals; El potencial tecnico-economico de ahorro de energia termica en hospitales

Energy Technology Data Exchange (ETDEWEB)

Herrera, A. [Universidad Nacional Autonoma de Mexico (Mexico); Islas, J [Universidad Nacional Autonoma de Mexico, Mexico, D.F. (Mexico); Arriola, A. [Instituto de Investigaciones Electricas, Cuernavaca, Morelos (Mexico)

2001-07-01

The hospitals are important consumers of energy. At the General Hospital of Zone (HGZ) N of the IMSS in Aguscalientes (HGZ N . IMSS Ags.), the diesel oil is the main fuel that is used to satisfy the requirements of thermal energy of the hospital. According to the data collected by this author, this fuel represented in 2001, 75% of its total energy consumption and the 67.9% of its total costs in energy that ascended to $396.131 (December 2001 Dollars) Since this last amount represents an important percentage of the total expenses of the hospital (29.367 million dollars) it is important to determine the technical-economic possibilities of thermal energy saving of the hospital. The HGZ N 1 IMSS Ags. is located in a ampler conglomerate where the IMSS units are located, such as, the regional laundry, the sport unit, the center of social security, the familiar medicine unit N 1 and the hospital. Nevertheless departing from the installation of the electrical systems and the provision of steam and hot water to the hospital, the electrical and thermal fluids of all this facilities are distributed. Due to this situation, in this work we will refer to the global consumption of the IMSS of Aguascalientes development where the hospital is the main consumer of thermal energy. In the present work we will calculate the technical-economic potential of thermal energy saving in the development of the IMSS through the thermodynamic technique of folding point or pinch technique. [Spanish] Los hospitales son importantes consumidores de energia. En el Hospital General de Zona N del IMSS en Aguscalientes (HGZ N - IMSS Ags.), el diesel es el principal combustible que se usa para satisfacer los requerimientos de energia termica del hospital. Segun los datos obtenidos por el autor anterior, este combustible represento en 2001 el 75% de su consumo total energetico y el 67.9% de sus costos totales en energeticos que ascendieron a $396,131 (dolares de diciembre de 2001). Dado que esta ultima

Global Dynamics in Travel, Tourism, and Hospitality

OpenAIRE

Pappas, Nikolaos; Bregoli, Ilenia

2016-01-01

Worldwide, tourism is the third largest economic activity in direct earnings after petroleum and automobile industries, and by far the largest one if indirect earnings are also taken into consideration. Taking into account the profound economic impact the tourism and hospitality industries can have on regions and cities around the world, further research in this area is critical.\\ud \\ud Global Dynamics in Travel, Tourism, and Hospitality takes a holistic approach to tourism and hospitality op...

Introduction: Special issue in hospitality

OpenAIRE

Ríos-Morales, Ruth; Jenkins, Ian

2012-01-01

In the era of globalization, the economic contribution of the tourism, hospitality and leisure industry to the world’s GDP is significant. Tourism represents one of the main sources of income for many countries; tourism creates jobs, enhances exports and contributes to the economic welfare of a host country. Although the contribution of tourism, hospitality and the leisure industry in the era of globalization has been broadly recognized, there are also numerous challenges that this industry f...

Introduction: Special Issue on Hospitality

OpenAIRE

Ruth Rios-Morales; Ian Jenkins

2012-01-01

In the era of globalization, the economic contribution of the tourism, hospitality and leisure industry to the world’s GDP is significant. Tourism represents one of the main sources of income for many countries; tourism creates jobs, enhances exports and contributes to the economic welfare of a host country. Although the contribution of tourism, hospitality and the leisure industry in the era of globalization has been broadly recognized, there are also numerous challenges that this industry f...

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

Science.gov (United States)

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

Science.gov (United States)

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Corporate governance in Czech hospitals after the transformation.

Science.gov (United States)

Pirozek, Petr; Komarkova, Lenka; Leseticky, Ondrej; Hajdikova, Tatana

2015-08-01

This contribution is a response to the current issue of corporate governance in hospitals in the Czech Republic, which draw a significant portion of funds from public health insurance. This not only has a significant impact on the economic efficiency of hospitals, but ultimately affects the whole system of healthcare provision in the Czech Republic. Therefore, the effectiveness of the corporate governance of hospitals might affect the fiscal stability of the health system and, indirectly, health policy for the whole country. The main objective of this paper is to evaluate the success of the transformation in connection with the performance of corporate governance in hospitals in the Czech Republic. Specifically, there was an examination of the management differences in various types of hospitals, which differed in their ownership structure and legal form. A sample of 100 hospitals was investigated in 2009, i.e., immediately after the transformation had been completed, and then three years later in 2012. With regard to the different public support of individual hospitals, the operating subsidies were removed from the economic results of the corporations in the sample. The adjusted economic results were first of all examined in relationship to the type of hospital (according to owner and legal form), and then in relation to its size, the size of the supervisory board and the education level of the senior hospital manager. A multiple median regression was used for the evaluation. One of the basic findings was the fact that the hospital's legal form had no influence on economic results. Successful management in the form of adjusted economic results is only associated with the private type of facility ownership. From the perspective of our concept of corporate governance other factors were under observation: the size of the hospital, the size of the supervisory board and the medical qualifications of the senior manager had no statistically verifiable influence on the

ELEMENTAL FORMS OF HOSPITALITY

Directory of Open Access Journals (Sweden)

Maximiliano Emanuel Korstanje

2010-11-01

Full Text Available Modern studies emphasized on the needs of researching the hospitality as relevant aspects of tourism and hospitality fields. Anyway, these approaches are inextricably intertwined to the industry of tourism and do not take seriously the anthropological and sociological roots of hospitality. In fact, the hotel seems to be a partial sphere of hospitality at all. Under this context, the present paper explores the issue of hospitality enrooted in the political and economic indo-European principle of free-transit which is associated to a much broader origin.  Starting from the premise etymologically hostel and hospital share similar origins, we follow the contributions of J Derrida to determine the elements that formed the hospitality up to date.

Research in Hospitality Management: Editorial Policies

African Journals Online (AJOL)

Research in Hospitality Management is a peer-reviewed journal publishing papers that ... financial management, marketing, strategic management, economics, ... Articles covering social theory and the history and politics of the hospitality ...

Hospitality Occupations. Curriculum Guide.

Science.gov (United States)

California State Dept. of Education, Sacramento. Bureau of Homemaking Education.

This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…

Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative Medicare population.

Science.gov (United States)

Chen, Shih-Yin; Crivera, Concetta; Stokes, Michael; Boulanger, Luke; Schein, Jeffrey

2013-01-01

To evaluate the clinical and economic burden of acute coronary syndrome (ACS), a common cardiovascular illness, in the Medicare population. Data from the Medicare Current Beneficiary Survey were analyzed. Patients with incident hospitalization for ACS without similar events during the 6 months prior were included. Outcomes evaluated included inpatient mortality, 30-day mortality and readmission, subsequent hospitalization events, and total direct health care costs. Sample population weights were applied, accounting for multistage sampling design to obtain nationally representative estimates for the US Medicare population. Between March 1, 2002 and December 31, 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male) representing 2,542,211 Medicare beneficiaries. The inpatient mortality rate was 9.71% and the 30-day mortality ranged from 10.96% to 13.93%. The 30-day readmission rate for surviving patients was 18.56% for all causes and 17.90% for cardiovascular disease (CVD)-related diagnoses. The incidence of death since admission was 309 cases per 1000 person-years. Among patients discharged alive, the incidence was 197 for death, 847 for CVD-related admission, and 906 for all-cause admission. During the year when the ACS event occurred, mean annual total direct health care costs per person were US$50,458, with more than half attributable to inpatient hospitalization ($27,609). In this national representative Medicare population, we found a substantial clinical and economic burden for ACS. These findings suggest a continuing unmet medical need for more effective management of patients with ACS. The continuous burden underscores the importance of development of new interventions and/or strategies to improve long-term outcomes.

Economics of childbirth.

Science.gov (United States)

Fahy, Michael; Doyle, Orla; Denny, Kevin; McAuliffe, Fionnuala M; Robson, Michael

2013-05-01

Increasing birth rates have raised questions for policy makers and hospital management about the economic costs of childbirth. The purpose of this article is to identify and review all existing scientific studies in relation to the economic costs of alternative modes of childbirth delivery and to highlight deficiencies in the existing scientific research. We searched Cochrane, Centre for Reviews and Dissemination, EconLit, the Excerpta Medica Database, the Health Economic Evaluations Database, MEDLINE and PubMed. Thirty articles are included in this review. The main findings suggest that there is no internationally acceptable childbirth cost and clinical outcome classification system that allows for comparisons across different delivery modes. This review demonstrates that a better understanding and classification of the costs and associated clinical outcomes of childbirth is required to allow for valid comparisons between maternity units, and to inform policy makers and hospital management. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Economic evaluation of laboratory testing strategies for hospital-associated Clostridium difficile infection.

Science.gov (United States)

Schroeder, Lee F; Robilotti, Elizabeth; Peterson, Lance R; Banaei, Niaz; Dowdy, David W

2014-02-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and 93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI.

Hospitality Services. Curriculum Guide.

Science.gov (United States)

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

Hospital 360°.

Science.gov (United States)

Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia

2015-01-01

There are forces that are greater than the individual performance of each hospital institution and of the health system structural of each country. The world is changing and to face up to the future in the best possible way, we need to understand how contexts and emerging trends link up and how they affect the hospital sector. The Columbian Association of Hospitals and Clinics, ACHC, has thus come up with the Hospital 360° concept which uses hospitals capable of anticipating changing contexts by means of the transition between present and future and takes on board the experience of global, socio-economic, demographic, political, environmental and technological fields as its model. Hospital 360° is an invitation to reinvent processes and institution themselves allowing them to adapt and incorporate a high degree of functional flexibility. Hospital 360° purses goals of efficiency, effectiveness and relevance, but also of impact and sustainability, and is coherent with the internal needs of hospital institutions and society for long-term benefits.

Economic aspects of radiation safety in hospitals

International Nuclear Information System (INIS)

Subrahmanian, G.; Venkataraman, G.

1977-01-01

Radiation protection procedures to be adhered to while using radiological equipment in hospitals both for the patients and the medical personnel are described in detail. The hazards resulting from careless handling of equipment and the need for adequately trained staff to handle the equipment is stressed. (A.K.)

[Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005-2006)].

Science.gov (United States)

Gómez, Joaquín; García-Vázquez, Elisa; Antonio Puertas, José; Ródenas, Julio; Herrero, José Antonio; Albaladejo, Carmen; Baños, Víctor; Canteras, Manuel; Alcaraz, Manolo

2009-02-01

Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (peconomic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.

Revisiting the relevance of economic theory to hotel revenue ...

African Journals Online (AJOL)

This paper explores the role of economics in hospitality education and industry practice, with a particular focus on revenue management, and puts forward an argument for a return to the inclusion of economic theory in UK hospitality education, not seen since the 1990s. Given the increasing amounts of pricing data available ...

Economic Evaluation of Laboratory Testing Strategies for Hospital-Associated Clostridium difficile Infection

Science.gov (United States)

Robilotti, Elizabeth; Peterson, Lance R.; Banaei, Niaz; Dowdy, David W.

2014-01-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and 93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI. PMID:24478478

Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence: A prospective hospital cohort study in Malawi.

Science.gov (United States)

Maheswaran, Hendramoorthy; Petrou, Stavros; Cohen, Danielle; MacPherson, Peter; Kumwenda, Felistas; Lalloo, David G; Corbett, Elizabeth L; Clarke, Aileen

2018-01-01

Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence. Sequential medical admissions to Queen Elizabeth Central Hospital, Malawi, between June-December 2014 were followed until discharge, with standardised classification of medical diagnosis and estimation of healthcare resources used. Primary costing studies estimated total health provider cost by medical diagnosis. Participants were interviewed to establish direct non-medical and indirect costs. Costs were adjusted to 2014 US$ and INT$. HRQoL was measured using the EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes. Of 892 eligible participants, 80.4% (647/892) were recruited and medical notes found. In total, 447/647 (69.1%) participants were HIV-positive, 339/447 (75.8%) were on ART prior to admission, and 134/647 (20.7%) died in hospital. Mean duration of admission for HIV-positive participants not on ART and HIV-positive participants on ART was 15.0 days (95%CI: 12.0-18.0) and 12.2 days (95%CI: 10.8-13.7) respectively, compared to 10.8 days (95%CI: 8.8-12.8) for HIV-negative participants. Mean total provider cost per hospital admission was US$74.78 (bootstrap 95%CI: US$25.41-US$124.15) higher for HIV-positive than HIV-negative participants. Amongst HIV-positive participants, the mean total provider cost was US$106.87 (bootstrap 95%CI: US$25.09-US$106.87) lower for those on ART than for those not on ART. The mean total direct non-medical and indirect cost per hospital admission was US$87.84. EQ-5D utility scores were lower

Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland.

Science.gov (United States)

Mehra, Tarun; Moos, Rudolf M; Seifert, Burkhardt; Bopp, Matthias; Senn, Oliver; Simmen, Hans-Peter; Neuhaus, Valentin; Ciritsis, Bernhard

2017-12-01

The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals

Influential variables in the profitability of hospital companies

Directory of Open Access Journals (Sweden)

Judit Creixans

2018-02-01

Full Text Available Purpose: This study attempts to evidence the economic and financial health of Spanish hospital companies in the period 2008-2015 and discover the variables that explain their profitability for survival and the opportune performance of their assets during a period of technological revolution and austerity. Design/methodology: The study methodology consists of the short and long-term financial analysis of the companies in the study sample during the period 2008-2015, together with analysis is of their economic state, equity and treasury. To add value to the research, the profitability of the hospital companies has been explained in terms of the following independent variables: short-term solvency, debt, business size, legal form, GDP per capita, population density of and indicators of Corporate Social Responsibility. Findings: In the analyzed period, the economic and financial health of hospital companies is characterized by acceptable liquidity and indebtedness that significantly influence its profitability; this is accompanied by good financial and expenditure management, though it is necessary to improve the management of assets. Research limitations/implications: It was not possible to obtain data for 2016, as it was not available in the database used (SABI. These data would have been useful to evaluate the changes in trends that are taking place in the health sector due to the technological revolution and economic policies affecting it. Practical implications: The health sector is one of the pillars on which society is based, and therefore knowing detailed economic and financial information allows us to make appropriate decisions, both on the hospital level and in terms of the economic policies of governments. Social implications: This study provides evidence of the financially relevant indicators that healthcare companies must control for their survival and to provide proper service to society in general. The research also identifies non

Economic impact of surgery cancellation in a general hospital, Iran

African Journals Online (AJOL)

unhcc

cause of inefficient use of operating room (OR) time and a drain on finite .... of total hospitalizations. In this hospital (270 beds ... Preoperative instructions not followed or patient not instructed. Change in .... concrete possibilities of reducing the level of surgical cancellations by .... room case-mix problem under uncertainty and.

How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2014-07-01

Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual

The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda.

Science.gov (United States)

Ngabo, Fidele; Mvundura, Mercy; Gazley, Lauren; Gatera, Maurice; Rugambwa, Celse; Kayonga, Eugene; Tuyishime, Yvette; Niyibaho, Jeanne; Mwenda, Jason M; Donnen, Philippe; Lepage, Philippe; Binagwaho, Agnes; Atherly, Deborah

2016-01-01

Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child's caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction. Households often bear the largest share of the economic burden attributable to

The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda.

Directory of Open Access Journals (Sweden)

Fidele Ngabo

Full Text Available Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction.This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child's caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$.Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction.Households often bear the largest share of the economic burden

Hospital Medicine Resident Training Tracks: Developing the Hospital Medicine Pipeline.

Science.gov (United States)

Sweigart, Joseph R; Tad-Y, Darlene; Kneeland, Patrick; Williams, Mark V; Glasheen, Jeffrey J

2017-03-01

Hospital medicine (HM) is rapidly evolving into new clinical and nonclinical roles. Traditional internal medicine (IM) residency training likely does not optimally prepare residents for success in HM. Hospital medicine residency training tracks may offer a preferred method for specialized HM education. Internet searches and professional networks were used to identify HM training tracks. Information was gathered from program websites and discussions with track directors. The 11 HM tracks at academic medical centers across the United States focus mostly on senior residents. Track structure and curricular content are determined largely by the structure and curricula of the IM residency programs in which they exist. Almost all tracks feature experiential quality improvement projects. Content on healthcare economics and value is common, and numerous track leaders report this content is expanding from HM tracks into entire residency programs. Tracks also provide opportunities for scholarship and professional development, such as workshops on abstract creation and job procurement skills. Almost all tracks include HM preceptorships as well as rotations within various disciplines of HM. HM residency training tracks focus largely on quality improvement, health care economics, and professional development. The structures and curricula of these tracks are tightly linked to opportunities within IM residency programs. As HM continues to evolve, these tracks likely will expand to bridge clinical and extra-clinical gaps between traditional IM training and contemporary HM practice. Journal of Hospital Medicine 2017;12:173-176. © 2017 Society of Hospital Medicine

Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg.

Science.gov (United States)

Engdahl, J; Abrahamsson, P; Bång, A; Lindqvist, J; Karlsson, T; Herlitz, J

2000-02-01

To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. Municipality of Göteborg, Sweden. All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

[Macro-economic calculation of spending versus micro-economic follow-up of costs of breast cancer].

Science.gov (United States)

Borella, L; Paraponaris, A

2002-12-01

In the healthcare field, the ability to make economic forecasts requires knowledge of the costs of caring for major diseases. In the case of a semi-chronic condition like cancer, this cost covers all the episodes of care associated with a patient. An evaluation of a macro-economic method of calculating costs for treating non-metastatic cancer, covering all hospital episodes, is proposed. This method is based entirely on the use of annual hospital activity databases, linked to data concerning the incidence of cancer. It allows us to obtain the global cost of care for a neoplasm of a particular site, without the need to reconstruct the whole care pathway of the patients. The model was assessed by comparing it's own results, in the particular case of breast cancer to those issuing from a micro-economic follow-up of 115 patients. Data for macro-economic calculation are extracted from the national French hospital database for the year 1999 and from cancer incidence data. The prospective study was done in 1995, in a comprehensive cancer centre. Macro-economic calculation leads to a cost of 14,555 Euro, for primary breast cancer. Prospective follow-up showed a cost of 14,350 Euro (data corrected, 1999 value). With a difference of 1%, there was a clear cohesion of the two results, while a higher level of divergence was noticed (from 1 to 15%) in the comparison between therapeutic techniques. Accuracy and reliability of results were evaluated. This method may be extended to all types of neoplasms. This method cannot be used instead of follow-up studies, for cost-efficacy or cost-severity analysis, but may be interesting beyond economic forecasts, in the field of payment per pathology.

Critical Access Hospitals (CAH)

Science.gov (United States)

... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...

Enhancing hospital productivity

NARCIS (Netherlands)

van Hulst, B.L.

2016-01-01

Healthcare expenditure in Western countries is substantial and outpaces economic growth, therefore cost containment in healthcare is high on the political agenda. One option is to increase productivity in healthcare, do more with less. This thesis uses the Dutch hospitals as a case-study and

The economic cost of hospital malnutrition in Europe; a narrative review.

Science.gov (United States)

Khalatbari-Soltani, Saman; Marques-Vidal, Pedro

2015-06-01

Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. To review the impact of malnutrition on hospital LOS and costs in Europe. PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional individual cost ranging between 1640 € and 5829 €. At the national level, the costs of malnutrition ranged between 32.8 million € and 1.2 billion €. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the individual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries. Copyright © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

The Economic Burden Attributable to a Child’s Inpatient Admission for Diarrheal Disease in Rwanda

Science.gov (United States)

Ngabo, Fidele; Mvundura, Mercy; Gazley, Lauren; Gatera, Maurice; Rugambwa, Celse; Kayonga, Eugene; Tuyishime, Yvette; Niyibaho, Jeanne; Mwenda, Jason M.; Donnen, Philippe; Lepage, Philippe; Binagwaho, Agnes; Atherly, Deborah

2016-01-01

Background Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. Methods This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child’s caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Results Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction. Conclusion Households often bear the largest share

Outsourcing and benchmarking in a rural public hospital: does economic theory provide the complete answer?

Science.gov (United States)

Young, S H

2003-01-01

The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. Case study research operates within the interpretivism paradigm and is used in this research to uncover why the outsourcing decision was made. Such research aims to study real-life experiences by examining the way people think and act and, in contrast to positivism, allows the interviewer to participate to better understand the details and features of the experiences. In the present research, individual interviews were conducted with managers of the hospital and owners and staff of the vendor organisations using semi- and unstructured questions to ascertain the extent of, and processes used in, outsourcing specific functional areas, and areas that were not outsourced. Pathology, radiology, dental technician services and lawn

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry.

Science.gov (United States)

Scollo, M; Lal, A; Hyland, A; Glantz, S

2003-03-01

To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.

Medical store management: an integrated economic analysis of a tertiary care hospital in central India.

Science.gov (United States)

Mahatme, Ms; Dakhale, Gn; Hiware, Sk; Shinde, At; Salve, Am

2012-04-01

Economic analysis plays a pivotal role in the management of medical store. The main objectives of this study were to consider always better control-vital, essential and desirable (ABC-VED) analysis with economic order quantity (EOQ), comparison of indexed cost and the actual cost, and to assess the expenditure for the forthcoming years. Based on cost and criticality, a matrix of nine groups by combining ABC and VED analysis was formulated. Drug categories were narrowed down for prioritization to direct supervisory monitoring. The subgroups AE and AV of the categories category I and II should be ordered based on EOQ. The difference between the actual annual drug expenditure (ADE) and the derived indexed cost using the cost inflation index (CII) was calculated. Linear regression was used to assess the expenditure for the forth coming years. The total ADE for the financial year of 2010-2011 was Rs. 1,91,44,253 which was only 7.68% of annual hospital expenditure. Using the inflation index, the indexed cost of acquisition of ADE for year 2010-2011 was Rs. 1,95,10,387. The difference between the two was estimated to be 2.11%. Thus, the CII justifies the demand of increased budget for next year and prompts us for cautious use of drugs. By taking into consideration the ADE of last 10 years, we have forecasted the budget for forthcoming years which will help significantly for making policies according to the available budget.

Addressing the risk of bacterial contamination in platelets: a hospital economic perspective.

Science.gov (United States)

Li, Justin W; Brecher, Mark E; Jacobson, Jessica L; Harm, Sarah K; Chen, Dorothy; El-Gamil, Audrey; Dobson, Al; Mintz, Paul D

2017-10-01

Bacterially contaminated platelets (PLTs) remain a serious risk. The Food and Drug Administration has issued draft guidance recommending hospitals implement secondary testing or transfuse PLTs that have been treated with pathogen reduction technology (PRT). The cost implications of these approaches are not well understood. We modeled incurred costs when hospitals acquire, process, and transfuse PLTs that are PRT treated with INTERCEPT (Cerus Corp.) or secondary tested with the PLT PGD Test (Verax Biomedical). Hospitals will spend $221.27 (30.0%) more per PRT-treated apheresis PLT unit administered compared to a Zika-tested apheresis PLT unit that is irradiated and PGD tested in hospital. This difference is reflected in PRT PLT units having: 1) a higher hospital purchase price ($100.00 additional charge compared to an untreated PLT); 2) lower therapeutic effectiveness than untreated PLTs among hematologic-oncologic patients, which contributes to additional transfusions ($96.05); or 3) fewer PLT storage days, which contributes to higher outdating cost from expired PLTs ($67.87). Only a small portion of the incremental costs for PRT-treated PLTs are offset by costs that may be avoided, including primary bacterial culture, secondary bacterial testing ($26.65), hospital irradiation ($8.50), Zika testing ($4.47), and other costs ($3.03). The significantly higher cost of PRT-treated PLTs over PGD-tested PLTs should interest stakeholders. For hospitals that outdate PLTs, savings associated with expiration extension to 7 days by adding PGD testing will likely be substantially greater than the cost of implementing PGD-testing. Our findings might usefully inform a hospital's decision to select a particular blood safety approach. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

QUALITY ASSURANCE IN THE HOSPITALITY INDUSTRY: QUALITATIVE ASSESMENT OF NIGERIA

Directory of Open Access Journals (Sweden)

OFOBRUKU SYLVESTER ABOMEH

2013-06-01

Full Text Available Hospitality is currently the fasted growing economic activity in Abuja-Nigeria. It has also been instrumental in creating jobs and has significant impact on other sectors of economic growth. Based on the above factors much attention need to be placed on the quality of the hospitality industry in Abuja-Nigeria in other to systematic compete with other destinations. Quality assurance is becoming an increasing integral component of the service industry. However, despite some indication that quality assurances are receiving attention in the hospitality industry, its adoption continues to be very slow. This paper examine the usefulness of quality assurance in hospitality operations and how to encourage it’s observances in the industry.

How do nonprofit hospitals manage earnings?

Science.gov (United States)

Leone, Andrew J; Van Horn, R Lawrence

2005-07-01

We hypothesize that, unlike for-profit firms, nonprofit hospitals have incentives to manage earnings to a range just above zero. We consider two ways managers can achieve this. They can adjust discretionary spending [Hoerger, T.J., 1991. 'Profit' variability in for-profit and not-for-profit hospitals. Journal of Health Economics 10, 259-289.] and/or they can adjust accounting accruals using the flexibility inherent in Generally Accepted Accounting Principles (GAAP). To test our hypothesis we use regressions as well as tests of the distribution of earnings by Burgstahler and Dichev [Burgstahler, D., Dichev, I., 1997. Earnings management to avoid earnings decreases and losses. Journal of Accounting and Economics 24, 99-126.] on a sample of 1,204 hospitals and 8,179 hospital-year observations. Our tests support the use of discretionary spending and accounting accrual management. Like Hoerger (1991), we find evidence that nonprofit hospitals adjust discretionary spending to manage earnings. However, we also find significant use of discretionary accruals (e.g., adjustments to the third-party-allowance, and allowance for doubtful accounts) to meet earnings objectives. These findings have two important implications. First, the previous evidence by Hoerger that nonprofit hospitals show less variation in income may at least partly be explained by an accounting phenomenon. Second, our findings provide guidance to users of these financial statements in predicting the direction of likely bias in reported earnings.

The hospital meal - Feeding or treating the elderly

DEFF Research Database (Denmark)

Røjel, Terkel

Geriatric malnutrition is a significant problem for hospital patients in affluent countries, and is associated with severe personal consequences and economic bearing. We need to facilitate interventions focused on the multisensory and psychosocial quality of the hospital meals along with enhanced...

Economic aspects of hospital treated pneumococcal pneumonia and the results of Pneumo 23 vaccine use in Serbia

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Adžić Tatjana

2008-01-01

Full Text Available INTRODUCTION In Serbia, there is a significant number of persons suffering of pneumococcal pneumonia. Persons aged 65 years or older, immunocompromised patients, patients with co-morbidities, such as chronic obstructive lung disease and congestive heart failure, are at the highest risk for developing pneumococcal pneumonia. Most of the patients are treated empirically, although it is often overlooked that Streptococcus pneumoniae can be resistant to the used antibiotics. The treatment costs of such inpatients and outpatients are very high. In Serbia, immunization of persons at risk to develop the diseases caused by Streptococcus pneumoniae is carried out using pneumococcus polysaccharide vaccine according to clinical indications. The exact number of immunized persons and the total number of registered patients are still unknown, but it is certain of being unjustifiably low. OBJECTIVE The goal of the study was to investigate, during a one-year period, the number and basic characteristics of persons hospitably treated for pneumonia, the type of cause of the infection, applied antibiotic medications, duration and costs of hospital treatment at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade. METHOD We retrospectively analyzed the medical records of patients with pneumonia treated at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade during 2006. RESULTS During the observed one-year period, 290 patients underwent hospital treatment, of whom the cause of the infection was confirmed in 116 (40%. The average duration of hospitalization was 12 days, with treatment cost of 32,031.74 RSD (402.42 EUR per patient. The treatment cost per patient including general and intensive care was 18,290.01 RSD (229.78 EUR. The distribution cost of Pneumo 23 vaccine in Serbia, without purchase tax, was 746.90 RSD (9.38 EUR. CONCLUSION Pneumococcal pneumonia is a significant medical

Training Hospital Managers as to Fire Management

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Roya Khalili

2015-01-01

Full Text Available Fire is one of the most dangerous phenomena in the world which yields main damages, healthy and economical, and is thus a major threat to hospitals. Since, most of the residents in hospitals are the individuals who cannot rescue themselves in such situations, fire in hospitals is more hazardous than any other public place; hence, it can endanger several sophisticated medical equipment. Therefore, security against fire plays a very vital role in hospitals and has to be taken into account by authorities. Among the personnel, hospital manager and the security guard supervisor are much more responsible. One of their responsibilities includes planning fire security scheme in hospitals to reduce the death rate caused by fire so that there is less threat to the building of hospital admits content. Due to the significance of this issue in hospitals, it seems necessary for the personnel to be aware of security measures against fire. Therefore, a study was carried out in Isfahan University of Medical Sciences teaching hospitals on all managers, their awareness about this issue was measured through a questionnaire. The results indicated that of a total of 60, the obtained average was (37.63+7.36 in the medium level. Also, most of the managers believed that proper and updated training by skillful trainers regarding hospital security measures and its application can be truly effective on their productivity. Thus, it is concluded that practical training the mentioned target group (hospital personnel especially clerks and the managers about the security plans can be effective in the control of fire and security measures, resulting in reduction of accidents and human and economic loss in the future.

Hospital board structure: changing form and changing issues.

Science.gov (United States)

Tregoning, S

2000-01-01

Economic and social pressures are compelling many hospitals to consider their current board structure in an effort to position their hospital to meet changing demands. A national profile of the structures of hospital boards has been compiled from a questionnaire completed by hospital board representatives from both government and non-government sectors. Results show that hospital board structures are a hybrid of both philanthropic and corporate models. New structures may be required to meet future challenges. In developing new structures, consideration should be given to identifying the skills and processes required to undertake board business.

A booming economy means a bursting trauma system: association between hospital admission for major injury and indicators of economic activity in a large Canadian health region.

Science.gov (United States)

Roberts, Derek J; Das, Debanjana; Mercado, Michelle; Vis, Christine; Kortbeek, John B; Kirkpatrick, Andrew W; Ball, Chad G

2014-05-01

Injury epidemiology fluctuates with economic activity in many countries. These relationships remain unclear in Canada. The annual risk of admission for major injury (Injury Severity Score ≥12) to a high-volume, level-1 Canadian trauma center was compared with indicators of economic activity over a 16-year period using linear regression. An increased risk of injured patient admissions was associated with rising mean gross domestic product (GDP [millions of chained 2002 dollars]) (.36 person increase per 100,000 population/$1,000 increase in GDP; P = .001) and annual gasoline prices (.47 person increase per 100,000 population/cent increase in gasoline price; P = .001). Recreation-related vehicle injuries were also associated with economic affluence. The risk of trauma patient mortality with increasing mean annual GDP (P = .72) and gasoline prices (P = .32) remained unchanged. Hospital admissions for major injury, but not trauma patient mortality, were associated with economic activity in a large Canadian health care region. Copyright © 2014 Elsevier Inc. All rights reserved.

Hospitals : a design manual

NARCIS (Netherlands)

Wagenaar, C.; Mens, N.

Hospitals as a building type have undergone a substantial evolution in the past years. Changes in healthcare, the impact of evidence-based medicine and aspects of healthcare economics (such as the clustering of diagnostic procedures in specialized clinics) pose new and different challenges for the

Segmentation in local hospital markets.

Science.gov (United States)

Dranove, D; White, W D; Wu, L

1993-01-01

This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

Data on motivational factors of the medical and nursing staff of a Greek Public Regional General Hospital during the economic crisis.

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Charalambous, Marianna; Konstantinos, Mitosis; Talias, Michael A

2017-04-01

In this article, we present the data related to motivational factors given by the medical (n=118) and nursing (n=217) staff, of a Greek Public General Hospital during a period of financial austerity. The data collection has been based on a structured self-administrable questionnaire which was used in a previous survey in Cyprus (Chatzicharalambous, 2015) [1]. The incentives-rewards included amount in a total to 11 (both financial and non-financial). The data contains 4 parts: (1) demographics, (2) assessment of the degree to which this hospital provided such incentives-rewards, (3) personal assessment of the participants about the significance of these incentive-rewards and (4) to what extent these incentives-rewards have increased or decreased over the last five years due to the economic crisis. The sample was analyzed as a whole on demographics and by a professional subgroup (doctors and nurses) for the other three parts. The data include quantitative tables for all parts. Finally include three tables contain multilevel models.

The new wave of hospital consolidation.

Science.gov (United States)

Goldstein, Lisa

2012-04-01

Reimbursement challenges, spiraling healthcare costs, and a slow economic recovery are driving the latest wave of hospital consolidation. Health insurance companies and provider systems are forming partnerships in the consolidation field with the goal of reducing healthcare costs and improving quality. The "cost" of the acquisition may include debt and other obligations of the acquired hospital, such as pension liabilities, along with a multiyear capital commitment.

Factors driving physician-hospital alignment in orthopaedic surgery.

Science.gov (United States)

Page, Alexandra E; Butler, Craig A; Bozic, Kevin J

2013-06-01

The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico

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Rachana Bhattarai

2018-05-01

Full Text Available ABSTRACT The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329 and US$ 2,576 (95% CI: 2,244 – 2,908, respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527, US$ 228 (95% CI: 167 – 288, US$ 157 (95% CI: 111 – 202, US$ 150 (95% CI: 106 – 204, and US$ 91 (95% CI: 27 – 154, respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Hospitality, Tourism, and Politics

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Stephen W. Litvin

2012-09-01

Full Text Available Government policy has a significant impact on the hospitality and tourism industry, but it is unclear if political leaders fully understand this economic sector when crafting policies. This article offers new research about the direct involvement of industry practitioners in the political process, by analyzing the backgrounds of legislators in the six New England states. The data indicate that only 3% of these legislators have current or former careers related to hospitality and tourism. The author suggests that practitioners should seek election to political office, to better influence government policy.

New tax law hobbles tax-exempt hospitals.

Science.gov (United States)

Goldblatt, S J

1982-03-01

The Economic Recovery Tax Act of 1981 left tax-exempt hospitals at a significant disadvantage in the competition for capital. Although the new law's accelerated depreciation schedules and liberalized investment tax credits contain some marginal benefits for tax-exempt hospitals, these benefits are probably more than offset by the impact of the law on charitable giving.

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.

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Pamela Barbadoro

Full Text Available The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED for non-urgent visits.The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47 of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57. The regression model has shown the significant role played by age, type of structure (geriatric acute care, and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27 of the total number of respondents to the questionnaire (N = 504. The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3-7.8 p = 0.008, while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30-0.90.In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.

QUALITY ASSURANCE IN THE HOSPITALITY INDUSTRY: QUALITATIVE ASSESMENT OF NIGERIA

OpenAIRE

OFOBRUKU SYLVESTER ABOMEH; Amagbakhan Omoghan Roland

2013-01-01

Hospitality is currently the fasted growing economic activity in Abuja-Nigeria. It has also been instrumental in creating jobs and has significant impact on other sectors of economic growth. Based on the above factors much attention need to be placed on the quality of the hospitality industry in Abuja-Nigeria in other to systematic compete with other destinations. Quality assurance is becoming an increasing integral component of the service industry. However, despite some indication that qual...

Home-based intermediate care program vs hospitalization

Science.gov (United States)

Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

2008-01-01

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

Orthopedic specialty hospitals: centers of excellence or greed machines?

Science.gov (United States)

Badlani, Neil; Boden, Scott; Phillips, Frank

2012-03-07

Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.

Science.gov (United States)

Morales, Eva; Cots, Francesc; Sala, Maria; Comas, Mercè; Belvis, Francesc; Riu, Marta; Salvadó, Margarita; Grau, Santiago; Horcajada, Juan P; Montero, Maria Milagro; Castells, Xavier

2012-05-23

We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively). P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting.

Science.gov (United States)

Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J

2015-01-01

To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.

The economics of cardiac biomarker testing in suspected myocardial infarction.

Science.gov (United States)

Goodacre, Steve; Thokala, Praveen

2015-03-01

Suspected myocardial infarction (MI) is a common reason for emergency hospital attendance and admission. Cardiac biomarker measurement is an essential element of diagnostic assessment of suspected MI. Although the cost of a routinely available biomarker may be small, the large patient population and consequences in terms of hospital admission and investigation mean that the economic impact of cardiac biomarker testing is substantial. Economic evaluation involves comparing the estimated costs and effectiveness (outcomes) of two or more interventions or care alternatives. This process creates some difficulties with respect to cardiac biomarkers. Estimating the effectiveness of cardiac biomarkers involves identifying how they help to improve health and how we can measure this improvement. Comparison to an appropriate alternative is also problematic. New biomarkers may be promoted on the basis of reducing hospital admission or length of stay, but hospital admission for low risk patients may incur significant costs while providing very little benefit, making it an inappropriate comparator. Finally, economic evaluation may conclude that a more sensitive biomarker strategy is more effective but, by detecting and treating more cases, is also more expensive. In these circumstances it is unclear whether we should use the more effective or the cheaper option. This article provides an introduction to health economics and addresses the specific issues relevant to cardiac biomarkers. It describes the key concepts relevant to economic evaluation of cardiac biomarkers in suspected MI and highlights key areas of uncertainty and controversy. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Economic impact of enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke: a hospital perspective of the PREVAIL trial.

Science.gov (United States)

Pineo, Graham; Lin, Jay; Stern, Lee; Subrahmanian, Tarun; Annemans, Lieven

2012-03-01

The PREVAIL (Prevention of VTE [venous thromboembolism] after acute ischemic stroke with LMWH [low-molecular-weight heparin] and UFH [unfractionated heparin]) study demonstrated a 43% VTE risk reduction with enoxaparin versus UFH in patients with acute ischemic stroke (AIS). A 1% rate of symptomatic intracranial and major extracranial hemorrhage was observed in both groups. To determine the economic impact, from a hospital perspective, of enoxaparin versus UFH for VTE prophylaxis after AIS. A decision-analytic model was constructed and hospital-based costs analyzed using clinical information from PREVAIL. Total hospital costs were calculated based on mean costs in the Premier™ database and from wholesalers acquisition data. Costs were also compared in patients with severe stroke (National Institutes of Health Stroke Scale [NIHSS] score ≥14) and less severe stroke (NIHSS score <14). The average cost per patient due to VTE or bleeding events was lower with enoxaparin versus UFH ($422 vs $662, respectively; net savings $240). The average anticoagulant cost, including drug-administration cost per patient, was lower with UFH versus enoxaparin ($259 vs $360, respectively; net savings $101). However, when both clinical events and drug-acquisition costs were considered, the total hospital cost was lower with enoxaparin versus UFH ($782 vs $922, respectively; savings $140). Hospital cost-savings were greatest ($287) in patients with NIHSS scores ≥14. The higher drug cost of enoxaparin was offset by the reduction in clinical events as compared to the use of UFH for VTE prophylaxis after an AIS, particularly in patients with severe stroke. Copyright © 2011 Society of Hospital Medicine.

[Economic aspects of anesthesia. I. Health care reform in the German Republic].

Science.gov (United States)

Bach, A; Bauer, M

1998-03-01

Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

CLUSTERIZATION – A FACTOR OF EFFICIENCY IN SMALL AND MEDIUM HOSPITALITY ENTERPRISES

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Zorica Krželj-Čolović

2016-12-01

Full Text Available In the modern global economy that is constantly changing and causing constant threats and challenges, various forms of association and networking enterprises are of growing importance. Considering that small and medium enterprises are drivers of economic growth and employment, they should be the most dynamic and most efficient segment of the economy. The same is true for the hospitality industry, where small and medium hospitality enterprises are the main providers of the tourism offer. The lack of networks in clusters of small and medium hospitality enterprises in Croatia is the cause of the unsatisfactory level of competitiveness and quality of hotel facilities with negative implications for economic and social development. The beginning of clustering in Croatia could be a good way to increase the economic efficiency of Croatian small and medium hospitality enterprises. The aim of this paper is to present clustering as a factor that affects the quality of small and medium hospitality enterprises by increasing their competitiveness in the tourism market which is becoming an important element for their business efficiency. For the purposes of the research, a survey was carried out on a sample of 72 small and medium hospitality enterprises in the period from June to September 2012. The survey results have shown that clusterization is a factor of efficiency in small and medium hospitality enterprises.

A systematic review of the direct economic burden of type 2 diabetes in china.

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Hu, Huimei; Sawhney, Monika; Shi, Lizheng; Duan, Shengnan; Yu, Yunxian; Wu, Zhihong; Qiu, Guixing; Dong, Hengjin

2015-03-01

Type 2 diabetes is associated with acute and chronic complications and poses a large economic, social, and medical burden on patients and their families as well as society. This study aims to evaluate the direct economic burden of type 2 diabetes in China. systematic review on cost of illness, health care costs, direct service costs, drug costs, and health expenditures in relation to type 2 diabetes was conducted up to 2014 using databases such as Pubmed; EBSCO; Elsevier ScienceDirect, Web of Science; and a series of Chinese databases, including Wanfang Data, China National Knowledge Infrastructure (CNKI), and the China Science and Technology Journal Database. Factors influencing hospitalization and drug fees were also identified. (1) estimation of the direct economic burden including hospitalization and outpatient cost of type 2 diabetes patients in China; (2) evaluation of the factors influencing the direct economic burden. Articles only focusing on the cost-effectiveness analysis of diabetes drugs were excluded. The direct economic burden of type 2 diabetes has increased over time in China, and in 2008, the direct medical cost reached $9.1 billion, Both outpatient and inpatient costs have increased. Income level, type of medical insurance, the level of hospital care, and type and number of complications are primary factors influencing diabetes related hospitalization costs. Compared to urban areas, the direct non-medical cost of type 2 diabetes in rural areas is significantly greater. The direct economic burden of type 2 diabetes poses a significant challenge to China. To address the economic burden associated with type 2 diabetes, measures need to be taken to reduce prevalence rate and severity of diabetes and hospitalization cost.

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States.

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Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C

2018-05-03

 The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization.  We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs.  Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM.  The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surveillance of multidrug resistant suppurative infection causing bacteria in hospitalized patients in an Indian tertiary care hospital

OpenAIRE

Nabakishore Nayak; Rajesh K. Lenka; Rabindra N. Padhy

2014-01-01

Objective: To examine antibiograms of a cohort of suppurative bacteria isolated from wound-swabs from hospitalized patients of all economic groups of a typical Indian teaching hospital. Methods: In surveillance, antibiotic resistance patterns of 10 species of suppurative bacteria isolated from wound-swabs over a period of 24 months were recorded. Those were subjected to antibiotic sensitivity test, using 16 prescribed antibiotics of 5 different groups (3 aminoglycosides, 4 beta-lactams, 3 ...

Data on motivational factors of the medical and nursing staff of a Greek Public Regional General Hospital during the economic crisis

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Marianna Charalambous

2017-04-01

Full Text Available In this article, we present the data related to motivational factors given by the medical (n=118 and nursing (n=217 staff, of a Greek Public General Hospital during a period of financial austerity. The data collection has been based on a structured self-administrable questionnaire which was used in a previous survey in Cyprus (Chatzicharalambous, 2015 [1]. The incentives-rewards included amount in a total to 11 (both financial and non-financial. The data contains 4 parts: (1 demographics, (2 assessment of the degree to which this hospital provided such incentives-rewards, (3 personal assessment of the participants about the significance of these incentive-rewards and (4 to what extent these incentives-rewards have increased or decreased over the last five years due to the economic crisis. The sample was analyzed as a whole on demographics and by a professional subgroup (doctors and nurses for the other three parts. The data include quantitative tables for all parts. Finally include three tables contain multilevel models.

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

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Morales Eva

2012-05-01

Full Text Available Abstract Background We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. Methods A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain. All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Results Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros. In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively. Conclusions P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

The ties that bind: an integrative framework of physician-hospital alignment

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Gemmel Paul

2011-02-01

Full Text Available Abstract Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

The ties that bind: an integrative framework of physician-hospital alignment.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2011-02-15

Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

Economic analysis of basiliximab in renal transplantation.

Science.gov (United States)

Keown, P A; Balshaw, R; Krueger, H; Baladi, J F

2001-06-15

Basiliximab is a chimeric monoclonal directed against the alpha-chain of the interleukin-2 receptor. International studies have shown that it is highly effective in preventing acute rejection in patients receiving Neoral, and causes no measurable incremental toxicity, but its economic value remains unknown. This study employed an economic model to examine the potential economic benefit of basiliximab. Parameter estimates were derived from a randomized, prospective, double-blind study conducted in 21 renal transplant centers in seven countries in which 380 adult primary allograft recipients were randomized within center to receive basiliximab (20 mg i.v.) on days 0 and 4 or placebo in addition to dual immunosuppression with Neoral and steroids. Key clinical events included primary hospitalization, immunosuppressive drug use, patient and graft survival, graft rejection, treatment of rejection, dialysis, and repeat hospitalization. Health resources were valued via a comprehensive electronic cost dictionary, based upon a detailed economic evaluation of renal transplantation in Canada. Medication costs were calculated from hospital pharmacy acquisition costs; basiliximab was assessed a zero cost. The average estimated cost per patient for the first year after transplant was $55,393 (Canadian dollars) for placebo and $50,839 for basiliximab, rising to $141,690 and $130,592, respectively, after 5 years. A principal component of the cost in both groups was accrued during the initial transplant hospitalization ($14,663 for standard therapy and $14,099 for basiliximab). An additional $15,852 and $14,130 was attributable to continued care, graft loss, and dialysis in the two groups, whereas follow-up hospitalization consumed an additional $15,538 for placebo and $13,916 for basiliximab. The mean incremental cost of dialysis was $5,397 for placebo compared with $3,821 for basiliximab, whereas incremental costs of graft loss were $2,548 compared with $2,295 in the two treatment

Linking Hospital and Tax data to support research on the economic impacts of hospitalization

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Claudia Sanmartin

2017-04-01

This project has created a unique linked database that will support research on the economic consequences of ‘health shocks’ for individuals and their families, and the implications for income, labour and health policies. This database represents a new and unique resource that will fill an important national data gap, and enable a wide range of relevant research.

Chronic suppurative otitis media: Socio-economic implications in a ...

African Journals Online (AJOL)

Chronic suppurative otitis media: Socio-economic implications in a tertiary hospital in Northern Nigeria. ... This paper highlights the socio-economic burden of chronic suppurative otitis media on a ... minimum wage for individuals in our environment where the cost of health care is the sole responsibility of the patient.

To make or buy patient safety solutions: a resource dependence and transaction cost economics perspective.

Science.gov (United States)

Fareed, Naleef; Mick, Stephen S

2011-01-01

For almost a decade, public and private organizations have pressured hospitals to improve their patient safety records. Since 2008, the Centers for Medicare & Medicaid Services has no longer been reimbursing hospitals for secondary diagnoses not reported during the point of admission. This ruling has motivated some hospitals to engage in safety-oriented programs to decrease adverse events. This study examined which hospitals may engage in patient safety solutions and whether they create these patient safety solutions within their structures or use suppliers in the market. We used a theoretical model that incorporates the key constructs of resource dependence theory and transaction cost economics theory to predict a hospital's reaction to Centers for Medicare & Medicaid Services "never event" regulations. We present propositions that speculate on how forces conceptualized from the resource dependence theory may affect adoption of patient safety innovations and, when they do, whether the adopting hospitals will do so internally or externally according to the transaction cost economics theory. On the basis of forces identified by the resource dependence theory, we predict that larger, teaching, safety net, horizontally integrated, highly interdependent, and public hospitals in concentrated, high public payer presence, competitive, and resource-rich environments will be more likely to engage in patient safety innovations. Following the logic of the transaction cost economics theory, we predict that of the hospitals that react positively to the never event regulation, most will internalize their innovations in patient safety solutions rather than approach the market, a choice that helps hospitals economize on transaction costs. This study helps hospital managers in their strategic thinking and planning in relation to current and future regulations related to patient safety. For researchers and policy analysts, our propositions provide the basis for empirical testing.

Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público Epidemiology, treatment and economical aspects of multiple trauma in children and adolescents in a public hospital

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Carlos Eduardo da Silveira Franciozi

2008-01-01

Full Text Available INTRODUÇÃO: A realização deste trabalho foi motivada pela escassez de artigos encontrados na literatura que estudam o politrauma na infância e na adolescência.. O objetivo é descrever o perfil epidemiológico das lesões traumáticas na infância tratadas num centro de trauma, avaliar os aspectos econômicos relacionados com o gasto hospitalar e o tempo de internação de acordo com o tratamento realizado. MATERIAIS E MÉTODOS: analisamos todos os prontuários do hospital Geral de Pirajussara no período de dezembro de 2005 a dezembro de 2006. Obtivemos 182 pacientes, sendo 71% do sexo masculino e 29% do feminino; 48% brancos e 52% não brancos. RESULTADOS: houve predominância dos indivíduos do sexo masculino com 71% dos pacientes. O mecanismo de trauma mais freqüente foi a queda (36%. A média de dias de internação foi 4,1 dias, com gasto estimado de R$ 649,50 para cada paciente. A taxa de mortalidade foi de 2,74%, sendo o traumatismo crânio-encefálico responsável por 80% da mortalidade e os maus tratos presentes em 40% dos óbitos. CONCLUSÃO: a população pediátrica tem particularidades que a tornam distinta da população adulta em relação à epidemiologia e manejo das lesões.INTRODUCTION: the motivation to conduct this study was the reduced number of articles in literature correlating multiple trauma in childhood and infancy. The objective here was to describe the epidemiological profile of traumatic injuries treated in a trauma center, evaluating the economic aspects associated with hospitalized patients' costs and the period of hospital stay according to the treatment provided. MATERIAL AND METHODS: we assessed all Pirajussara Hospital patients' files in the period of December of 2005 to December 2006. We selected 182 patients, 129 (71% males and 53 (29% females; 88 (48% Caucasian and 94 (52% non-Caucasian children. RESULTS: male patients were prevalent, with 129 (71% cases. The most frequent trauma mechanism was fall

[Philanthropic hospitals and the operation of provider-owned health plans in Brazil].

Science.gov (United States)

Lima, Sheyla Maria Lemos; Portela, Margareth C; Ugá, Maria Alicia Dominguez; Barbosa, Pedro Ribeiro; Gerschman, Silvia; Vasconcellos, Miguel Murat

2007-02-01

To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

Correlation between relative rates of hospital treatment or death due to ischaemic heart disease (IHD) and of IHD-related medication among socio-occupational and economic activities groups in Denmark, 1996-2005

DEFF Research Database (Denmark)

Hannerz, Harald; Dalhoff, Kim; Burr, Hermann

2014-01-01

Standardised Hazard Ratios (SHR) for hospital treatment or death due to IHD and SHR for purchase of prescriptions for medicine that may prevent IHD from (re)occurring, among socio-occupational and economic activities groups in Denmark. The SHR were based on a 10-year prospective follow-up of 2 million people.......74 for the economic activities groups). We observed, however, one markedly contradictive result; the industrial group entitled 'general practitioner, dentists etc.' was associated both with significantly high rates of medicine usage (SHR = 1.15, 95% CI: 1.12-1.19) and significantly low rates of hospital treatment...... or death due to IHD (SHR = 0.80, 95% CI: 0.71-0.91). CONCLUSION: Apart from a few caveats, the strong correlations obtained in the present study signify that purchase of a prescription for IHD-related medication is a usable risk indicator for IHD in the working population of Denmark. The usage of medicine...

EARNINGS MANAGEMENT IN U.S. HOSPITALS.

Science.gov (United States)

Dong, Gang Nathan

2016-01-01

This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

OpenAIRE

Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven

2014-01-01

Background: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using valida...

Clinical and economic outcomes of Acinetobacter vis a vis non-Acinetobacter infections in an Indian teaching hospital

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Priyendu Asim

2016-01-01

Full Text Available Context: Acinetobacter infections are a major nosocomial infection causing epidemics of infection in the Intensive Care Units (ICU. Aims: This study estimates the clinical and economic outcomes of Acinetobacter infections and compares them with those of non-Acinetobacter bacterial infections. Settings and Design: Prospective cross-sectional observational study carried out for 6 months in the medicine ICU of a tertiary care hospital. Materials and Methods: Patients were divided in two groups, one group with Acinetobacter infections and the other with non-Acinetobacter infections. The data was collected for infection, length of stay (LOS, mortality and cost along with patient demographics from the hospital records for analysis. Statistical Analysis Used: The data was analyzed using Statistical Package for the Social Sciences Version 15.0. The LOS and cost of treatment (COT for the two groups were compared using the nonparametric Mann–Whitney U-test. Results: A total of 220 patients were studied out of which 91 had Acinetobacter infections. The median LOS was 20 days in Group-A and 12 days in Group-B (P < 0.0001. The median COT was INR 125,862 in Group-A and INR 68,228 in the Group-B (P < 0.0001. Mortality in Group-A and Group-B was 32.97 and 32.56 (P = 0.949 respectively. Conclusion: The burden of Acinetobacter infections in ICUs is increasing with the increase in LOS and COT for the patients. The infection control team has to play a major role in reducing the rate of nosocomial infections.

Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China.

Science.gov (United States)

Zhang, S; Ma, Q; Liang, S; Xiao, H; Zhuang, G; Zou, Y; Tan, H; Liu, J; Zhang, Y; Zhang, L; Feng, X; Xue, L; Hu, D; Cui, F; Liang, X

2016-03-01

A nationwide survey of hepatitis B virus (HBV)-associated economic burden has not previously been performed in China. The purpose of this study was to examine the direct, indirect, and intangible costs of HBV-related diseases within the span of one year. A random sample was taken from specialty and general hospitals across 12 cities in six provinces of China. Intangible costs were estimated based on willingness to pay or open-ended answers provided by patients. The results showed that 27 hospitals were enrolled, with a sample population of 4726 patients (77.7% response rate). The average annual costs were $4454.0 (direct), $924.3 (indirect), and $6611.10 (intangible), corresponding to 37.3%, 7.7%, and 55.1% of the total costs, respectively. The direct medical fees were substantially greater than the non-medical fees. Annual indirect costs were divided into outpatient ($112.9) and inpatient ($811.40) loss of income. The intangible costs of chronic HBV were notably higher than either the direct or indirect costs, consistent with the social stigma in China. The comparison amongst individual cities for the average ratio of direct to indirect costs revealed that the sizes of ratios were negatively correlated with the socioeconomic status of the regions. This study suggested that as a whole in China, the HBV-related diseases caused a heavy financial burden which was positively associated with disease severity. Although the intangible costs coincided with a high prevalence of discrimination against CHB patients in Chinese society, our study may serve as future reference for detailed exploration. © 2015 John Wiley & Sons Ltd.

Economic burden and its associated factors of hospitalized patients infected with A (H7N9) virus: a retrospective study in Eastern China, 2013-2014.

Science.gov (United States)

Huo, Xiang; Chen, Li-Ling; Hong, Lei; Xiang, Lun-Hui; Tang, Fen-Yang; Chen, Shan-Hui; Gao, Qiang; Chen, Cong; Dai, Qi-Gang; Sun, Chuan-Wu; Xu, Ke; Dai, Wen-Jun; Qi, Xian; Li, Chang-Cheng; Yu, Hui-Yan; Zhou, Yin; Huang, Hao-Di; Pan, Xing-Yang; Xu, Chang-Sha; Zhou, Ming-Hao; Bao, Chang-Jun

2016-09-01

H7N9 continues to cause human infections and remains a pandemic concern. Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation, including infectious disease prevention and control investment. However, there are limited data on such impacts. Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed. Patients' direct medical costs of hospitalization were derived from their hospital bills. A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics. The mean direct cost of hospitalization for H7N9 was estimated to be ¥ 71 060 (95 % CI, 48 180-104 820), i.e., US$ 10 996 (95 % CI, 7 455-16 220), and was ¥12 060 (US$ 1 861), ¥136 120 (US$ 21 001) and ¥218 610 (US$ 33 728) for those who had mild or severe symptoms or who died, respectively. The principal components of the total fees differed among patients with different disease severity, although medication fees were always the largest contributors. Disease severity, proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient's direct medical cost of hospitalization. The direct medical costs of hospitalized patients with H7N9 are significant, and far surpass the annual per capita income of Jiangsu Province, China. The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation. Not applicable. This is a survey study with no health care intervention implemented on human participants.

Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series.

Science.gov (United States)

Rodriguez-Jimenez, Roberto; Bagney, Alexandra; Torio, Iosune; Caballero, Montserrat; Ruiz, Pedro; Rivas, Francisco de Paula Jose; Jimenez-Arriero, Miguel Angel

2015-01-01

Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables. A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality. After inclusion in the program, 50.0% of patients reported feeling « much better » and 37.5% « moderately better » in the Clinical Global Impression-Improvement Scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy program, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with Emergency Department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of patients assessed the care and treatment received as being « very satisfactory », and 12.5% as « satisfactory ». This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights

Can Economic Performance Predict Pediatric Surgical Capacity in Sub-Saharan Africa?

Science.gov (United States)

Okoye, Mekam T; Nguyen, Evelyn T; Kushner, Adam L; Ameh, Emmanuel A; Nwomeh, Benedict C

2016-06-01

The relationship between economic status and pediatric surgical capacity in low- and middle-income countries (LMICs) is poorly understood. In sub-Saharan Africa (SSA), Nigeria accounts for 20 % of the population and has the highest Gross Domestic Product (GDP), but whether this economic advantage translates to increased pediatric surgical capacity is unknown. This study compares the pediatric surgical capacity between Nigeria and other countries within the region. The Pediatric Personnel, Infrastructure, Procedures, Equipment and Supplies (PediPIPES) survey, a recent tool that is useful in assessing and comparing the capacity of health facilities to deliver essential and emergency surgical care (EESC) to children in LMICs, was used for this evaluation. Data from hospitals in Nigeria (n = 24) and hospitals in 17 other sub-Saharan African countries (n = 25) were compared. The GDP of Nigeria was approximately twenty-five times the average GDP of the 17 other countries represented in our survey. Running water was unavailable in 58 % of the hospitals in Nigeria compared to 20 % of the hospitals in the other countries. Most hospitals in Nigeria and in the other countries did not have a CT scan (67 and 60 %, respectively). Endoscopes were unavailable in 58 % of the hospitals in Nigeria and 44 % of the hospitals in the other countries. Despite better economic indicators in Nigeria, there were no distinct advantages over the other countries in the ability to deliver EESC to children. Our findings highlighted the urgent need for specific allocation of more resources to pediatric surgical capacity building efforts across the entire region.

The improving efficiency frontier of religious not-for-profit hospitals.

Science.gov (United States)

Harrison, Jeffrey P; Sexton, Christopher

2006-01-01

By using data-envelopment analysis (DEA), this study evaluates the efficiency of religious not-for-profit hospitals. Hospital executives, healthcare policy makers, taxpayers, and other stakeholders benefit from studies that improve hospital efficiency. Results indicate that overall efficiency in religious hospitals improved from 72% in 1998 to 74% in 2001. What is more important is that the number of religious hospitals operating on the efficiency frontier increased from 40 in 1998 to 47 in 2001. This clearly documents that religious hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the healthcare industry.

Private finance initiative hospital architecture: towards a political economy of the Royal Liverpool University Hospital.

Science.gov (United States)

Jones, Paul

2018-02-01

Sociological analysis has done much to illuminate the architectural contexts in which social life takes place. Research on care environments suggests that the built environment should not be understood as a passive backdrop to healthcare, but rather that care is conditioned by the architecture in which it happens. This article argues for the importance of going beyond the hospital walls to include the politics that underwrite the design and construction of hospital buildings. The article assesses the case of the yet-to-be-realised Liverpool Royal University Hospital, and the private finance initiative (PFI) funding that underpins the scheme, which is suggested as a salient 'external' context for understanding architecture's role in the provision of healthcare of many kinds for many years to come. PFI has major implications for democratic accountability and local economy, as well as for the architecture of the hospital as a site of care. Critical studies can illuminate these paradoxically visible-but-opaque hospital spaces by going beyond that which is immediately empirically evident, so as to reveal the ways in which hospital architecture is conditioned by political and economic forces. © 2018 Foundation for the Sociology of Health & Illness.

Psychiatric referrals in two general hospitals.

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Doongaji D

1989-07-01

Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.

Organization structure and the performance of hospital emergency services.

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Georgopoulos, B S

1985-07-01

A comparative study of 30 hospital emergency departments (EDs) and nearly 1,500 individuals associated with them was conducted. Data were obtained from institutional records, physicians, patients, and other sources. The object was to investigate the relationship between the organization and performance of these health service systems. The study assessed the quality of medical care, the quality of nursing care, and the economic efficiency of hospital EDs. The results show substantial interinstitutional differences in these criteria. They also show a significant relationship between medical and nursing care, but not between the quality of care and economic efficiency. Differences in ED performance are related to medical staffing patterns, medical teaching affiliation, personnel training, scope of emergency services, number of patient visits processed, and hospital size and complexity. Not all of these variables, however, correlate positively with all three criteria of performance, nor are they equally important to each.

[Morbidity and mortality associated to influenza A (H1N1) 2009 admissions in two hospitals of the Metropolitan area and analysis of its economic impact].

Science.gov (United States)

Armstrong, Macarena; Fica, Alberto; Dabanch, Jeannette; Olivares, Felipe; Fasce, Rodrigo; Triantafilo, Vjera

2012-12-01

Influenza A (H1N1) 2009 infection was an important cause of morbidity and mortality in Chile. To characterize the clinical pattern of hospitalized patients, identify risk factors associated with ICU admission or death, and evaluate its economic impact. Twenty five adult patients admitted to 2 hospitals in the Metropolitan Area from May 2009 to December 2010 with PCR confirmed H1N1 infection were analyzed. Total hospital charges were obtained and, using data of registered cases, expenses for the whole country during the first epidemic wave were estimated. Aill cases presented a risk factor: age over 60 years old (n = 13, 52%), co-morbid conditions (n = 24, 96%) or pregnancy (n = 1, 4%). Pneumonia was present in 64% (n = 16) and 16% (n = 4) had hypotension. Only 6 patients (24%) had a CURB-65 score ≥ 2 and 36% (n = 9) requiring ICU admission. Case fatality rate was 16% (n = 4). By multivariate analysis, diabetes mellitus type 2 was independently associated with ICU admission or death (OR 8.12; IC95 1.11-59.2, p Chile during the first wave. The CURB-65 score was inappropriate to recognize patients at risk of hospitalization or ICU admission.

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study.

Science.gov (United States)

Planas Vila, M; Álvarez Hernández, J; García de Lorenzo, A; Celaya Pérez, S; León Sanz, M; García-Lorda, P; Brosa, M

2010-01-01

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

Cost variation in diabetes care delivered in English hospitals

DEFF Research Database (Denmark)

Kristensen, Troels

2009-01-01

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......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...

Audit of antibiotic prescribing in two governmental teaching hospitals in Indonesia.

NARCIS (Netherlands)

Hadi, U.; Duerink, D.O.; Lestari, E.S.; Nagelkerke, N.J.; Keuter, M.; Huis in 't Veld, D.; Suwandojo, E.; Rahardjo, E.; Broek, P. van den; Gyssens, I.C.J.

2008-01-01

This article estimates the magnitude and quality of antibiotic prescribing in Indonesian hospitals and aims to identify demographic, socio-economic, disease-related and healthcare-related determinants of use. An audit on antibiotic use of patients hospitalized for 5 days or more was conducted in two

[Outlier cases in surgical disciplines. Micro-economic and macro-economic problems].

Science.gov (United States)

Tecklenburg, A; Liebeneiner, J; Schaefer, O

2009-09-01

Postoperative complications will always occur and the negative impact puts strain on patients, relatives and the attending physicians. The conversion to a remuneration system based on flat rates (diagnosis-related groups) presents additional economic problems for hospitals in some resource-intensive treatments. This particularly pertains to extremely cost-intensive cases in which costs succeed revenue by the factor of 2 and are often surgical procedures. Here the economic risk increases with the number of interventions performed. Despite improvements in the remuneration system this problem persists. An improved payment for these treatments is desirable. To achieve this it is necessary to systematically analyze the extremely cost-intensive cases by experts of different medical disciplines to create a data basis for a proposal of a cost-covering payment.

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China

Directory of Open Access Journals (Sweden)

Lu Jingjing

2013-01-01

Full Text Available Abstract Background Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease. Methods From April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China. Results Our data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China.

Science.gov (United States)

Lu, Jingjing; Xu, Aiqiang; Wang, Jian; Zhang, Li; Song, Lizhi; Li, Renpeng; Zhang, Shunxiang; Zhuang, Guihua; Lu, Mingshan

2013-01-31

Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease. From April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China. Our data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute

Marketing to Develop the Premier Medical Brand in the Huaihai Economic Zone.

Science.gov (United States)

Zhang, Peiying; Meng, Qingchao

2015-06-01

Based on the practices at Xuzhou Central Hospital, the authors analyzed the improvements in the healthcare quality and economic efficiency after implementing a brand marketing strategy. Using methods including questionnaires and business controlling means, we summarized that the improvements to the healthcare quality and economic efficiency after strategies were implemented in the areas of network, reputation, academic research, and public welfare. After the implementation of a brand marketing campaign, the medical service quality and brand reputation have been greatly improved. Meanwhile, a central hospital group was formed and gradually became the central healthcare provider in the Huaihai Economic Zone. The new marketing facilitated the drastic increase of medical service and brand reputation.

Optimized biofilm-based systems for removal of pharmaceuticals from hospital waste water

DEFF Research Database (Denmark)

Andersen, Henrik R; Chhetri, Ravi; Hansen, Kamilla

Discharge of hospital wastewater is of increasing concern, as hospitals are identified as chemical pollution source due to pharmaceutical content. This project seeks to develop the most efficient and economically feasible technology to remove pharmaceuticals from wastewater, regardless of the poi...

Hospital infection prevention and control issues relevant to extensive floods.

Science.gov (United States)

Apisarnthanarak, Anucha; Mundy, Linda M; Khawcharoenporn, Thana; Glen Mayhall, C

2013-02-01

The devastating clinical and economic implications of floods exemplify the need for effective global infection prevention and control (IPC) strategies for natural disasters. Reopening of hospitals after excessive flooding requires a balance between meeting the medical needs of the surrounding communities and restoration of a safe hospital environment. Postflood hospital preparedness plans are a key issue for infection control epidemiologists, healthcare providers, patients, and hospital administrators. We provide recent IPC experiences related to reopening of a hospital after extensive black-water floods necessitated hospital closures in Thailand and the United States. These experiences provide a foundation for the future design, execution, and analysis of black-water flood preparedness plans by IPC stakeholders.

Economic and clinical value of levofloxacin

Directory of Open Access Journals (Sweden)

Mario Eandi

2006-12-01

Full Text Available Levofloxacin is a newer fluoroquinolone, with broad spectrum of antibacterial activity and good tolerability. This drug has a pharmacokinetic and pharmacodynamic profile that allows a once-a-day administration and offers the potential for intravenous-to-oral switch therapy. Due to these characteristics, the principal guidelines recommend it, as an option for the empirical therapy of patients with mild or more severe community acquired pneumonia (CAP, acute exacerbation of chronic bronchitis (AECB, complicated urinary tract infection (cUTI and skin and soft tissue infection (SSTI. These pathologies are common causes of morbidity and mortality and place a large burden on medical and economic resources, specially if hospitalization is required. The implementation of a critical pathway, based on levofloxacin use and on a risk prediction rule to establish the need for hospitalization, has the potential to decrease healthcare resource consumption without impairment of clinical outcomes, with respect to conventional management. The possibility of switch therapy allows to reduce length of hospital stay, with a saving in both direct and indirect costs, and an increase in patient satisfaction. In summary, when used according to appropriateness criteria and for approved indications, levofloxacin offers favorable economic features for the healthcare provider, whilst guaranteeing a positive impact on patient functioning and quality of life.

Inpatient Profile of Patients with Major Depression in Portuguese National Health System Hospitals, in 2008 and 2013: Variation in a Time of Economic Crisis.

Science.gov (United States)

Rodrigues, Daniel Francisco Santos; Nunes, Carla

2018-02-01

The economic crisis has placed Portugal in a situation of budgetary constraints with repercussions on mental health, since 2009. This study analyses the association between economic crisis and the inpatient profile of major depression in the working-age population in Portuguese National Health System hospitals. This was an observational, descriptive and cross-sectional study. An individual analysis of hospitalisation and an ecological analysis at district level, were performed before 2008 and during the crisis (2013). Data on the hospitalisation episodes, working-age population and psychiatric inpatient beds were analysed. An increase in hospitalisation rates for major depression were observed, and across country, high spatial variations were perceived: districts with lower rates of urbanisation and population density had higher hospitalisation rates for major depression. Hospitalisation rates were positively influenced by the available inpatient beds. The results for 2013 were more critical (higher hospitalisation rates, less beds). Further research is needed to understand all patterns, considering other individual and contextual information.

GLOBAL CRISIS’ IMPACT UPON THE EMPLOYED NUMBER IN HOSPITALITY INDUSTRY

OpenAIRE

MARIAN ZAHARIA; ANIELA BALACESCU; RODICA MANUELA GOGONEA

2014-01-01

TThe globalization, complex interconnection process of the economies of states, is a reality of the XXI century. However, at the end of the first decade of this century, besides the positive effects of this process, due to the economic interconnections created, it has favored also a rapid propagation of a negative economic phenomenon: the global economic crisis. Its impact significantly influenced the hospitality industry, important component of modern economies. This paper examines over a pe...

The efficiency and budgeting of public hospitals: case study of iran.

Science.gov (United States)

Yusefzadeh, Hasan; Ghaderi, Hossein; Bagherzade, Rafat; Barouni, Mohsen

2013-05-01

Hospitals are the most costly and important components of any health care system, so it is important to know their economic values, pay attention to their efficiency and consider factors affecting them. The aim of this study was to assess the technical scale and economic efficiency of hospitals in the West Azerbaijan province of Iran, for which Data Envelopment Analysis (DEA) was used to propose a model for operational budgeting. This study was a descriptive-analysis that was conducted in 2009 and had three inputs and two outputs. Deap2, 1 software was used for data analysis. Slack and radial movements and surplus of inputs were calculated for selected hospitals. Finally, a model was proposed for performance-based budgeting of hospitals and health sectors using the DEA technique. The average scores of technical efficiency, pure technical efficiency (managerial efficiency) and scale efficiency of hospitals were 0.584, 0.782 and 0.771, respectively. In other words the capacity of efficiency promotion in hospitals without any increase in costs and with the same amount of inputs was about 41.5%. Only four hospitals among all hospitals had the maximum level of technical efficiency. Moreover, surplus production factors were evident in these hospitals. Reduction of surplus production factors through comprehensive planning based on the results of the Data Envelopment Analysis can play a major role in cost reduction of hospitals and health sectors. In hospitals with a technical efficiency score of less than one, the original and projected values of inputs were different; resulting in a surplus. Hence, these hospitals should reduce their values of inputs to achieve maximum efficiency and optimal performance. The results of this method was applied to hospitals a benchmark for making decisions about resource allocation; linking budgets to performance results; and controlling and improving hospitals performance.

Bed, Breakfast and Friendship: Intimacy and Distance in Small-Scale Hospitality Businesses

Directory of Open Access Journals (Sweden)

Johan Hultman

2010-09-01

Full Text Available Through an analysis of the narrative of a Bed and Breakfast (B & B and art gal-lery owner, the emergence of intimacy as a commercial value in the hospitality industry is illustrated. This is a formation of economic value where economic ra-tionality as a motive for commercial activity is rejected. Simultaneously though, a different set of market attitudes are performed by hospitality practitioners in the course of everyday interactions with customers, and a tension between emotional, spatial and temporal intimacy and distance is uncovered and discussed. It is con-cluded that commercial friendship is a more complex issue than what has been acknowledged so far in the hospitality literature. A continued discussion of inti-macy in hospitality will therefore affect the cultural understanding of emotions, identity and lifestyle values on the one hand, and business strategy, value creation and markets on the other.

Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

Directory of Open Access Journals (Sweden)

Baddley John W

2013-01-01

Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

Links between economic and financial theory in graduate health administration education.

Science.gov (United States)

Pink, G H; Coyte, P C

1989-01-01

The curricula of graduate health administration programs have, historically, not articulated the theoretical links between health economics and health finance, although an understanding of these links could enhance comprehension of both disciplines. We provide a pedagogical approach that can be used to clarify these interconnections. It compares the standard neoclassical microeconomic concept of the hospital with the financial concept of the hospital, for the purpose of relating the optimal output decision in microeconomic theory to the optimal investment decision in financial theory. This approach can be taught in an advanced course in either economics or finance.

OCCUPATIONAL ROLE AFTER PSYCHIATRIC HOSPITALIZATION

Directory of Open Access Journals (Sweden)

GH.R GHASSEMI

2003-03-01

Full Text Available Introduction: Severe Psychiatricillness is accompanied by gross disturbances in patient's occupational role. This study presents a comparative picture of work performance before and after psychiatric hospitalization. Method: Subjects comprised 440 psychiatric admitters from Noor Medical center - Isfahan - Iran, who were followed from November 1999 to November 2000. Their work adjustment was measured by means of Weiss man's index. Data were computer analyzed using SPSS by running paired t- student and ANOVA. Results: Majority of the patients (53 % were without permanent sources of income before psychiatric hospitalization, about 12 percent of those who were working prior to hospitalization lost their job after being discharged from hospital. Better work adjustment before hospitalization was positively correlated with better work adjustment after discharge for working patients (r =0/66. Working ability of the patients after discharge was lesser than before the attack f9r patients with regular and irregular job (P < 001. Discussion: Job loss or poor working ability after psychiatric admission reported by several researchers and has bean confirmed in this study as well. These observatoins have been discussed in view of the current socio economic problems in the society and nature of psychiatric disturbances.

Performance Measurement in Belgian Hospitals : a state-of-the-art

OpenAIRE

Van Caillie, Didier; Rouhana, Rima; Santin, Sarah

2007-01-01

This communication proposes a global state-of-the-art around the central question : "How is performance measured and controlled in Belgian hospitals. As a first step in a global research project dedicated to the use of Balanced ScoreCard in publics hospitals around the world, it is essentially focused on global economic aspects and on major macroeconomic statistics.

Critical Access Hospitals and Retail Activity: An Empirical Analysis in Oklahoma

Science.gov (United States)

Brooks, Lara; Whitacre, Brian E.

2011-01-01

Purpose: This paper takes an empirical approach to determining the effect that a critical access hospital (CAH) has on local retail activity. Previous research on the relationship between hospitals and economic development has primarily focused on single-case, multiplier-oriented analysis. However, as the efficacy of federal and state-level rural…

Significant Trends Are Now Reshaping the Industry Training for Foodservice and Hospitality.

Science.gov (United States)

Reiman, Tyrus

1984-01-01

The hospitality industry is one that is not adversely affected by the information revolution. As tourism is stimulated by government economic development efforts, opportunities in the food service and hospitality occupations are increasing, both for the young and for the unemployed who need retraining. (SK)

Economic impact of medication error: a systematic review.

Science.gov (United States)

Walsh, Elaine K; Hansen, Christina Raae; Sahm, Laura J; Kearney, Patricia M; Doherty, Edel; Bradley, Colin P

2017-05-01

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Hospitalizations and Deaths Caused by Methicillin-Resistant Staphylococcus aureus, United States, 1999?2005

OpenAIRE

Klein, Eili; Smith, David L.; Laxminarayan, Ramanan

2007-01-01

Hospital-acquired infections with Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA) infections, are a major cause of illness and death and impose serious economic costs on patients and hospitals. However, the recent magnitude and trend of these infections have not been reported. We used national hospitalization and resistance data to estimate the annual number of hospitalizations and deaths associated with S. aureus and MRSA from 1999 through 2005. During this period, t...

[Hospital care expenses caused by acute fascioliasis, cystic echinococcosis, and neurocysticercosis in Santiago, Chile].

Science.gov (United States)

Fica, Alberto; Weitzel, Thomas

2014-08-01

Acute fascioliasis (FA), cystic echinococcosis (CE) and neurocysticercosis (NCC) are three endemic parasitic diseases in Chile for whom there is scarce information about the economic impact they represent during management at the hospital. To quantify and compare hospital care expenses caused by these three endemic helminth infections in a Chilean hospital. Retrospective analysis of hospital costs at a referral hospital in Santiago between 2006 and 2010. Hospital databases were used to identify patients with the corresponding infections, and those with sufficient data on hospital costs were included. A total of 16 patients representing 21 cases were identified and analyzed: four with AF, eleven with CE, and six with NCC. Median hospital expenses for cases with AF were US$ 1799 and mainly caused by bed-day costs. Median hospital costs for cases of CE were US$ 4707 and the most important costs components were medications, bed-day costs and consumables. NCC patients had median costs of US$ 1293, which were mainly due to bed-day costs. Non-parenchymatous or mixed forms of NCC showed a trend toward higher hospital costs compared with parenchymatous forms. Although helminth infections in Chile, an upper middle income country, are declining and considered rare in routine clinical practice, hospital care expenses caused by patients with AF, CE, and NCC are high and might still present an important economic burden to the Chilean healthcare system.

A news media analysis of the economic and reputational penalties of the hospital readmissions reduction program.

Science.gov (United States)

Winborn, Melissa S; Alencherril, Joyce; Pagán, José A

2014-01-01

Section 3025 of the Affordable Care Act (ACA) of 2010 established the Hospital Readmissions Reduction Program (HRRP), an initiative designed to penalize hospitals with excess 30-day readmissions. This study investigates whether readmission penalties under HRRP impose significant reputational effects on hospitals. Data extracted from 2012 to 2013 news stories suggest that the higher the actual penalty, the higher the perceived cost of the penalty, the more likely it is that hospitals will state they have no control over the low-income patients they serve or that they will describe themselves as safety net providers. The downside of being singled out as a low-quality hospital deserving a relatively high penalty seems to be larger than the upside of being singled out as a high-quality hospital facing a relatively low penalty. Although the financial burden of the penalties seems to be low, hospitals may be reacting to the fact that information about excess readmissions and readmission penalties is being released widely and is scrutinized by the news media and the general public. © The Author(s) 2014.

The impact of the 2008 economic crisis on the increasing number of young psychiatric inpatients.

Science.gov (United States)

Medel-Herrero, Alvaro; Gomez-Beneyto, Manuel

2017-11-21

Little is published about the impact of the 2008 economic crisis on mental health services in Spain. An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

[The influence of socio-economic conditions in renal posttransplant infection].

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Ianhez, L E; Sampaio, M; Chocair, P R; Fonseca, J A; Sabbaga, E

1993-01-01

Two hundred and four patients who underwent renal transplantation were followed up as outpatients with a minimum of four years. They were divided into two socio-economic levels: group I - 104 patients who underwent transplantation in a private hospital and 120 patients (group II) with a lower socio-economic standard, treated in a public hospital. In both groups urinary infections and hepatitis were excluded. The incidence of infection in group I was 24% and in group II, 50% (p = 0.0002). There was no difference in relation to viral infection in either groups. However, bacterial infection and infection by opportunistic agents were significantly higher in group II (p = 0.0001 and p = 0.0282). The number of hospitalizations and the number of infections of patients were higher in group II. There was a tendency for an increase in mortality owing to infection in group II. There was no difference in the two groups as the parameters of: age, sex, type of donor, primary disease, number of rejections crises, level of serum creatinine and number of patients with ciclosporine. On the other hand, the dose of azathioprine and prednisone was mildly higher in those patients of group II. Low level of socio-economic conditions is a risk factor in renal transplant patients.

Revisiting the relevance of economic theory to hotel revenue ...

African Journals Online (AJOL)

Keywords: economic theory, hotels, revenue management, Big Data, hospitality education ... and the ease and quality in which pricing information is delivered to ...... Cornell Hotel and Restaurant Administration Quarterly, 25(2), 27–40.

Exposure measurement in the neighboring hospital beds during an x-ray procedure in hospitalization unit

Energy Technology Data Exchange (ETDEWEB)

Goto, Rafael E.; Capeleti, Felipe F.; Cabete, Henrique V., E-mail: rafael.goto@fcmsantacasasp.edu.br, E-mail: felipe.capeleti@fcmsantacasasp.edu.br, E-mail: henrique@gmpbrasil.com.br [Faculdade de Ciencias Medicas da Santa Casa Sao Paulo, SP (Brazil); GMP Consultoria em Radioprotecao e Fisica Medica e Assessoria LTDA, Sao Paulo, SP (Brazil)

2017-11-01

There are lots of discussion about the exposure in hospitalization units in Brazil, especially around labor legislation and economic advantages of unhealthiness. With the attention focused on hospitalized patients, there were measured the exposure in neighboring beds of the patient submitted to an X-ray procedure with a mobile X-ray system that could be used to illustrate the discussion with consistent values. The most common X-ray procedure made in hospitalization units are chests images with techniques between 70 to 120 kV and 5 to 20 mAs. The measurement was made during routine exposure and simulations using a scattering phantom with Radcal AccuPro electrometer and 1800cc ionization chamber in a private hospital and a philanthropic hospital, both in Sao Paulo, Brazil. The ionization chambers are placed at 2 meters distance of the patient exposed of both sides during the routine procedure. During the simulation, a nylon phantom of 20 centimeters thick and 30 x 30 cm² size was placed on the bed, a typical exposure technique was used and the exposure was measured surrounding the phantom at 0.6, 1.0 and 2.0 meters distance for scattered radiation characterization. Initial results showed that the neighboring exposure at about 2 meters distance from the exposed patient bed have low values, even when exposure is integrated during the length of hospital stay. Therefore, the exposure in hospitalization units are very low compared to the exams doses. (author). (author)

Six hospitals describe decentralization, cost containment, and downsizing.

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Lineweaver, L A; Battle, C E; Schilling, R M; Nall, C M

1999-01-01

Decentralization, cost containment, and downsizing continue in full force as healthcare organizations continue to adapt to constant economic change. Hospitals are forced to take a second and third look at how health care is managed in order to survive. Six Northwest Florida hospitals were surveyed in an effort to explore current changes within the healthcare delivery system. This article provides both managers and staff with an overview of recent healthcare changes in an area of the country with implications for staff development.

[Risk management of hospital infections as a supporting tool for the improvement of hospital quality - some European examples].

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Sitek, Mateusz; Witczak, Izabela; Kiedik, Dorota

Prevention and control of nosocomial infections is one of the main pillars of security in each medical facility. This affects the quality of services and helps to minimize the economic losses incurred as a result of such infections. (Prolonged hospitalization, expensive antibiotic therapies, court costs of damages). Nosocomial infections occur in every medical facility in the hospitals in terms of risk of infection compared to other medicinal entities are at greater risk of environmental (number of hospitalizations for one bed, the amount of disinfectants, etc.). The number and diverse category of employment of medical and auxiliary, which should meet certain standards for the prevention of hospital infections, has an impact on the incidence of infection. It is impossible to eliminate hospital-acquired infections, but can be limited by appropriate measures, ranging from monitoring through the use of risk management methods, which are one of the elements supporting the improvement of the quality of medical entities. Hospital infection is a threat not only for patients but also for workers exposed to the risk of so-called occupational exposure. A comprehensive approach including elements of active surveillance and effective monitoring can help to minimize the risk of nosocomial infections.

Revisiting the relevance of economic theory to hotel revenue management education and practice in the era of Big Data

OpenAIRE

Haynes, Natalie; Egan, David

2017-01-01

Abstract\\ud This paper explores the role of economics in hospitality education and industry practice, with a particular focus on revenue management, and puts forward an argument for a return to the inclusion of economic theory in UK hospitality education, not seen since the 1990s. Given the increasing amounts of pricing data available to both managers and customers and the consequent market complexities now seen, developing economic literacy is demonstrated to be a crucial skill required for ...

Humans, 'things' and space: costing hospital infection control interventions.

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Page, K; Graves, N; Halton, K; Barnett, A G

2013-07-01

Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. Previous literature and techniques in both health economics and psychology are reviewed and synthesized. This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The Hidden Face of Hospital Economy. The Hospital of Sant’Andrea of Vercelli in 14th and 15th century

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Antonio Olivieri

2016-05-01

Full Text Available The study of four fourteenth- and fifteenth-century registers of hospital of San Andrea of Vercelli allows to shine a light on some aspects of property management and hospital economy. On one hand, it is possible to see a technical evolution of the recordings of rents payment; on the other hand one can understand the nature of economic connection between the hospital and his tenants. It changed depending on the location of property together with the origin of the tenants, urban (above all craftsmen or rural. The careful accounting of the actual payment of rents ‒ with accounts of delays, of debts accumulation charging on tenants, of replacements of kind or money rents with manufactured goods or (in the case of peasants labour services ‒ enlightens the specific features of the hospital economy, aimed to product wealth in view of the nurture of the hospital life in its whole.

The changing role of the hospital chief financial officer.

Science.gov (United States)

Freitag, T R; Freitag, W

1980-01-01

Things are changing. That statement is obviously true of things political, economic and scientific. Not surprisingly, therefore, the statement applies to the activities, responsibilities, qualifications and, ultimately, status of the hospital chief financial officer (CFO).

The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.

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Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2016-01-01

Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships. The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes. Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed. Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes. Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.

Socio-economic disadvantage, quality of medical care and admission for acute severe asthma.

Science.gov (United States)

Kolbe, J; Vamos, M; Fergusson, W

1997-06-01

In asthma, socio-economic and health care factors may operate by a number of mechanisms to influence asthma morbidity and mortality. To determine the quality of medical care including the patient perception of the doctor-patient relationship, and the level of socio-economic disadvantage in patients admitted to hospital with acute severe asthma. One hundred and thirty-eight patients (15-50 years) admitted to hospital (general ward or intensive care unit) with acute asthma were prospectively assessed using a number of previously validated instruments. The initial subjects had severe asthma on admission (pH = 7.3 +/- 0.2, PaCO2 = 7.1 +/- 5.0 kPa, n = 90) but short hospital stay (3.7 +/- 2.6 days). Although having high morbidity (40% had hospital admission in the last year and 60% had moderate/severe interference with sleep and/or ability to exercise), they had indicators of good ongoing medical care (96% had a regular GP, 80% were prescribed inhaled steroids, 84% had a peak flow meter, GP measured peak flow routinely in 80%, 52% had a written crisis plan and 44% had a supply of steroids at home). However, they were severely economically disadvantaged (53% had experienced financial difficulties in the last year, and for 35% of households the only income was a social security benefit). In the last year 39% had delayed or put off GP visit because of cost. Management of the index attack was compromised by concern about medical costs in 16% and time off work in 20%. Patients admitted to hospital with acute asthma have evidence of good quality on-going medical care, but are economically disadvantaged. If issues such as financial barriers to health care are not acknowledged and addressed, the health care services for asthmatics will not be effectively utilised and the current reductions in morbidity and mortality may not be maintained.

The future of hospital laboratories. Position statement from the Royal Belgian Society of Clinical Chemistry (RBSCC).

Science.gov (United States)

Langlois, Michel R; Wallemacq, Pierre

2009-01-01

To face the economic pressures arising from the current socio-economic conjuncture, hospital laboratories are endangered by an increasing trend towards the outsourcing of clinical laboratory tests to external (mega-) laboratories. This should allow hospitals to meet their economic requirements, but with an increased risk of loss of medical quality and, mid- to long-term, loss of cost effectiveness of healthcare at the national level. To anticipate current developments (economical and technological) that inevitably will affect the future of laboratory medicine, hospital laboratories should be proactive and enhance efficiency, reduce costs by consolidation, integrate into regional networks, and form alliances or partnerships. To create additional value, the core competency of laboratory professionals must be refocused to provide medical knowledge services (consultative support to clinicians) related to in vitro diagnostic testing. To integrate cost-efficiency with medical quality, implementation of a matricial organization - operational vs. biomedical level - could be an interesting approach. This integrated structure should create total quality of laboratory testing, managing the entire medical diagnostic cycle from the pre-preanalytical to post-postanalytical phase.

Direct medical cost of influenza-related hospitalizations among severe acute respiratory infections cases in three provinces in China.

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Lei Zhou

Full Text Available BACKGROUND: Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. METHODS: Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital's Hospital Information System (HIS and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range and median (interquartile range [IQR] costs were calculated and compared among children (≤15 years, adults (16-64 years and elderly (≥65 years groups. Factors influencing cost were analyzed. RESULTS: A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range direct medical cost was $1,797 ($80-$27,545 for all hospitalizations, and the median (IQR direct medical cost was $231 ($164, $854 ($890, and $2,263 ($7,803 for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. CONCLUSION: Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

Performance Analysis of Hospital Information System of the National Health Insurance Corporation Ilsan Hospital

Science.gov (United States)

Han, Jung Mi; Boo, Eun Hee; Kim, Jung A; Yoon, Soo Jin; Kim, Seong Woo

2012-01-01

Objectives This study evaluated the qualitative and quantitative performances of the newly developed information system which was implemented on November 4, 2011 at the National Health Insurance Corporation Ilsan Hospital. Methods Registration waiting time and changes in the satisfaction scores for the key performance indicators (KPI) before and after the introduction of the system were compared; and the economic effects of the system were analyzed by using the information economics approach. Results After the introduction of the system, the waiting time for registration was reduced by 20%, and the waiting time at the internal medicine department was reduced by 15%. The benefit-to-cost ratio was increased to 1.34 when all intangible benefits were included in the economic analysis. Conclusions The economic impact and target satisfaction rates increased due to the introduction of the new system. The results were proven by the quantitative and qualitative analyses carried out in this study. This study was conducted only seven months after the introduction of the system. As such, a follow-up study should be carried out in the future when the system stabilizes. PMID:23115744

[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products].

Science.gov (United States)

Berreur, B; Guerin, F; Christophe, B; Limido, G; Paubel, P

2018-01-01

To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products. Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H 1 ); all initiations under biosimilars and continuation therapy with the princeps (H 2 ) or all patients are treated with biosimilars (H 3 ). The annual savings are estimated at 237,000 € with the H 1 hypothesis. In the case of H 2 , the expected savings would be 376,200 € per year. In the case of H 3 , savings for the community could reach almost 1,282,800 € per year. The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H 1 and H 2 hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample.

Science.gov (United States)

Akinyemiju, Tomi; Meng, Qingrui; Vin-Raviv, Neomi

2016-09-05

The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery. We conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay. A total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and

HOSPITALITY TODAY AND TOMORROW

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Ray F. IUNIUS

2017-08-01

Full Text Available As a wise man once said, “Don’t worry about what you don’t know. Be worried about what you think you know, but don’t.” Regarding different ways “hospitality” is understood, the root of the problem lies in part in the different interpretations that hospitality has in different cultures and languages. In American English, for example, when we speak about “hospitality” we first think of it as an industry and only secondarily as an attribute of an individual or community. In other cultures, the primary meaning of hospitality is more a characteristic of people, or of a country or city, etc., and encompasses such ideas as welcome, reception, amiability, generosity, etc. – not an industry! Even in American English, other words are sometimes used to describe the same economic activity: lodging, accommodation, etc.

The Future Hospital: A Business Architecture View.

Science.gov (United States)

Mokhtar, Ariffin Marzuki

2017-10-01

The future hospital is a resilient, physical learning facility featuring digital enhancement and leveraging an ecosystem of platforms for the Internet of Things (IoT) and analytics, achieving patient-centric care delivery via multidisciplinary healthcare provider teams coordinated to meet patients' medical, psychological, social and economic needs. It exists in a just ecosystem that assimilates the care spectrum from healthy living, the prevention of disease to acute care and the rehabilitation of patients recuperating from illnesses. It will take some time for these future hospitals to be built or for current hospitals to evolve and/or transform, but efforts to spread wisdom among the stakeholders, healthcare providers and patients must start now. The development of the digital components can also begin today, as can competency building for the healthcare providers who will be staffing these future hospitals, ensuring that they are equipped with competent staff employing patient-centric care processes that cater to patients' current and future needs.

The effect of chain membership on hospital costs.

Science.gov (United States)

Menke, T J

1997-06-01

To compare the cost structures of hospitals in multihospital systems and independently owned hospitals. The American Hospital Association's Annual Survey from 1990 for data on hospital costs and attributes. Area characteristics came from the Area Resource File, and the Medicare case-mix index came from the Health Care Financing Administration. Data on wages are from the Bureau of the Census' State and Metropolitan Area Data Book. The Guide to Hospital Performance from HCIA, Inc. provided data on quality of care. Separate cost functions were estimated for chain and independent hospitals. Hybrid translog cost functions included measures of outputs, input prices, and hospital and area characteristics. The estimation method accounted for the simultaneous determination of costs and chain membership, and for any nonrandom selection of hospitals into chains. Several economic cost measures were calculated to compare the cost structures of the two types of hospitals. Data from all sources were merged at the hospital level to form the study sample. Hospitals in multihospital systems were less costly than independently owned hospitals. Among independent hospitals, for-profits had the highest costs. There were no statistically significant differences in costs by ownership among chain members. Economies of scale were enjoyed in both types of hospitals only at high volumes of output, while economies of scope occurred at all volumes for chain hospitals, but only at low and medium volumes for independent hospitals. This study provides support for the idea that growth of the multihospital system sector can provide a market solution to the problem of constraining costs. It does not, however, support the property rights theory that proprietary hospitals are more efficient than nonprofit hospitals.

[Integration of a hospital pharmacist in the ICU].

Science.gov (United States)

Moch, C; Pivot, C; Floccard, B; Rimmelé, T; Paillet, C

2014-03-01

The French regulatory system strongly encourages strict regulation of health products' production and distribution, especially concerning risk management and economic aspects. An ICU is an unusual environment for a local pharmacy practice (a nurse for every 2.5 patients, continuous adaptation of therapeutics…). However, a literature review reports interesting data concerning risk management and economics. This article aims to relate the experience of a pharmacist integration in a French teaching hospital ICU (half-time position). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Comparing public and private providers: a scoping review of hospital services in Europe.

Science.gov (United States)

Tynkkynen, Liina-Kaisa; Vrangbæk, Karsten

2018-02-27

What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies. The review was based on a methodological approach inspired by the British EPPI-Centre's methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality. Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for

In-hospital costs associated with chronic constipation in Belgium: a retrospective database study

OpenAIRE

Chevalier, P; Lamotte, M; Joseph, A; Dubois, D; Boeckxstaens, G

2013-01-01

Background Real-life data on the economic burden of chronic idiopathic constipation are scarce. The objectives of this study were to assess hospitalization resource use and costs associated with chronic constipation and its complications in Belgium. Methods This was a single country, retrospective study using the IMS Hospital Disease Database (2008), which comprises data on 34% of acute hospital beds in Belgium and contains information on patient demographics, length of stay (LOS), billed cos...

THE RELEVANCE OF MANAGEMENT ACCOUNTING FOR THE HOSPITALITY INDUSTRY

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Briciu Sorin

2012-07-01

Full Text Available In the contemporary period the tourism and hospitality industry has experienced dynamic growth despite the challenges facing not only the global crisis, but also market changes, consumer behavior and technological trends. Accounting, the language of business is required to keep up with changes made to each particular area of activity so that they can provide timely relevant information to be managed by an efficient information system. Our article focuses on presenting the importance of management accounting and cost information system in the hospitality industry, then consider identifying features of this sector and their impact on accounting. The methodology of our research falls within the economic research, being theoretical, aiming primarily to knowledge objectives and the relevance of management accounting for economic entities, and then we have the characteristics of hospitality industry and possible organizational management accounting in this sector. In our perspective cost calculation for services, packages or travel benefits must take into account the development of the accounts from Class 9, so we propose a possible method to customize them according to the Direct Costing and CVP analysis. Our research will also be explanatory descriptive, trying to answer the questions How? and Why?

Management strategies in hospitals: scenario planning

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Ghanem, Mohamed

2015-06-01

Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Management strategies in hospitals: scenario planning.

Science.gov (United States)

Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

2015-01-01

Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Male factor in infertility: study from a tertiary care hospital

OpenAIRE

Kalavathi D. Biradar

2016-01-01

Background: Infertility is a condition with important psychological, economic, demographic and medical implications. Male infertility refers to a male's inability to result pregnancy in a fertile female. Methods: The present hospital based study was conducted in the Department of Obstetrics and Gynaecology, East Point Hospital, Bangalore. Duration of the study was for 6 months from October 2015 to March 2016. A total of 250 infertile couples couple coming for evaluation to the outpatient d...

Hospital managers' need for information in decision-making--An interview study in nine European countries.

Science.gov (United States)

Kidholm, Kristian; Ølholm, Anne Mette; Birk-Olsen, Mette; Cicchetti, Americo; Fure, Brynjar; Halmesmäki, Esa; Kahveci, Rabia; Kiivet, Raul-Allan; Wasserfallen, Jean-Blaise; Wild, Claudia; Sampietro-Colom, Laura

2015-11-01

Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Infection Control and Prevention: A Review of Hospital-Acquired Infections and the Economic Implications

OpenAIRE

Reed, Deoine; Kemmerly, Sandra A.

2009-01-01

The Centers for Disease Control and Prevention estimates that 2 million patients suffer from hospital-acquired infections every year and nearly 100,000 of them die. Most of these medical errors are preventable. Hospital-acquired infections result in up to $4.5 billion in additional healthcare expenses annually. The U.S. government has responded to this financial loss by focusing on healthcare quality report cards and by taking strong action to curb healthcare spending. The Medicare Program ha...

Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz

Directory of Open Access Journals (Sweden)

Ewa Barczykowska

2016-05-01

4Correction Unit No. 2 in Grudziadz     Mailing address: Marta Lewicka, Collegium Medicum im. L. Rydygiera w Bydgoszczy, UMK w Toruniu, ul. Techników 3, 85-801 Bydgoszcz, Poland; Phone 52 585 21 93, e-mail: marta_grabinska@hotmail.com   Abstract Introduction. Children's and adolescents' injuries are a serious medical problem, as they lead to substantial medical and socio-economic effects. Aim of the paper. The aim of the conducted research was to analyze incidence and causes of hospitalizing children between birth and 18 years of age on the grounds of injuries. Material and methods. Medical histories of 2 832 children between birth and 18 years of age treated for injuries in 2006-2010 in Wladyslaw Bieganski Regional Specialist Hospital in Grudziadz were analyzed. Results. Correlations between treatment method and subsequent years of research (p<0,05, between children's age group and type of injury, and between type of injury and season of the year and hospitalization time, were shown to be statistically significant. No correlation was found in the studied population between subsequent years of research and injury types or residence of the injured. Conclusions. 1. The most frequent causes for placing children in the hospital were cranioencephalic injuries, injuries to the osteoarticular system, and burns. 2. The children's age determined the type of injury inflicted. Children in the youngest age group were most frequently hospitalized for burns, children in the age of 3-6 years for foreign bodies, and in the group of 7-18 years of age for injuries to the chest and to the osteoarticular system. 3. Boys were more frequently injured in a manner requiring hospital treatment than girls were. 4. A decisive majority of injured children required only conservative treatment and a stay in the hospital for no more than 3 days. 5. A constant tendency of higher occurence of injuries in children during spring and summer, was observed. Keywords: children, injuries

The economic impact of Clostridium difficile infection: a systematic review.

Science.gov (United States)

Nanwa, Natasha; Kendzerska, Tetyana; Krahn, Murray; Kwong, Jeffrey C; Daneman, Nick; Witteman, William; Mittmann, Nicole; Cadarette, Suzanne M; Rosella, Laura; Sander, Beate

2015-04-01

With Clostridium difficile infection (CDI) on the rise, knowledge of the current economic burden of CDI can inform decisions on interventions related to CDI. We systematically reviewed CDI cost-of-illness (COI) studies. We performed literature searches in six databases: MEDLINE, Embase, the Health Technology Assessment Database, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, and EconLit. We also searched gray literature and conducted reference list searches. Two reviewers screened articles independently. One reviewer abstracted data and assessed quality using a modified guideline for economic evaluations. The second reviewer validated the abstraction and assessment. We identified 45 COI studies between 1988 and June 2014. Most (84%) of the studies were from the United States, calculating costs of hospital stays (87%), and focusing on direct costs (100%). Attributable mean CDI costs ranged from $8,911 to $30,049 for hospitalized patients. Few studies stated resource quantification methods (0%), an epidemiological approach (0%), or a justified study perspective (16%) in their cost analyses. In addition, few studies conducted sensitivity analyses (7%). Forty-five COI studies quantified and confirmed the economic impact of CDI. Costing methods across studies were heterogeneous. Future studies should follow standard COI methodology, expand study perspectives (e.g., patient), and explore populations least studied (e.g., community-acquired CDI).

Economic impact of an integrated RIS/PACS system in a university hospital

International Nuclear Information System (INIS)

Kroeger, M.; Wetekam, V.; Nissen-Meyer, S.; Reiser, M.

1999-01-01

Problem: The goal of the current article is to demonstrate how qualitative and monetary effects resulting from an integrated RIS/PACS installation can be evaluated. Results: The sample analysis of a RIS/PACS solution specially designed for a university hospital demonstrates positive qualitative and monetary effects of the system. Under ideal conditions the payoff time of the investments is reached after 4 years of an assumed 8 years effective life of the system. Furthermore, under conservative assumptions, the risk analysis shows a probability of 0% for realising a negative net present value at the end of the payoff time period. Conclusion: It should be pointed out that the positive result of this sample analysis will not necessarily apply to other clinics or hospitals. However, the same methods may be used for the individual evaluation of the qualitative and monetary effects of a RIS/PACS installation in any clinic. (orig.) [de

Orthopaedic Implants And Prosthesis: Economic Costs Of Post ...

African Journals Online (AJOL)

OBJECTIVE: To assess the economic impact of post-operative wound infection in trauma patients who had open reduction and internal fixation with implants and prostheses following fractures of the femur. METHOD: This is a 2-year case controlled prospective study carried out at the National Orthopaedic Hospital, Lagos.

[Secondhand smoke in hospitality venues. Exposure, body burden, economic and health aspects in conjunction with smoking bans].

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Fromme, H; Kuhn, J; Bolte, G

2009-04-01

Secondhand smoke was classified by national and international organisations as a known cause of cancer in humans and has many adverse health effects, especially cardiovascular diseases and lung tumours. Global studies have clearly shown that hospitality venues have the highest levels of indoor air pollution containing different substances that are clearly carcinogenic--such as tobacco-related chemicals--compared with other, smoke-free indoor spaces. Data from the human biomonitoring of non-smoking employees in the food service industry confirm this high exposure level. Non-smokers exposed to secondhand smoke in these environments are at increased risk for adverse health effects. The consistent protection of non-smokers in public places such as restaurants and bars through a smoking ban results in a significant reduction of the pollutants in the air (mostly > 90%) and clearly reduces the internal body burden for users and employees. Furthermore, health complaints by non-smoking employees are reduced and the higher risk for lung tumours of employees in the food service industry compared with the general population can be effectively reduced as well. According to current standards of knowledge, other measures such as spatial separation of smoking areas or the use of mechanical venting systems do not achieve a comparably high and effective pollutant reduction under field conditions. Studies concerning the economic effects of prohibiting smoking in public places conducted in various countries have shown that beverage-focused gastronomic enterprises experience a short-term down trend but that food-focused gastronomic enterprises do not experience any negative or even positive effects. The positive effects of a ban on smoking in public places on the general population are a decline in cigarette consumption and the reduction of secondhand smoke exposure by non-smokers. Smoking bans in hospitality venues are not necessarily linked with a shift of the tobacco consumption to

Case mix planning in hospitals: a review and future agenda.

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Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

2017-06-01

The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review.

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Kruse, Florien M; Stadhouders, Niek W; Adang, Eddy M; Groenewoud, Stef; Jeurissen, Patrick P T

2018-03-02

European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector. Copyright © 2018 John Wiley & Sons, Ltd.

HOSPITAL MANAGERS' NEED FOR INFORMATION ON HEALTH TECHNOLOGY INVESTMENTS

DEFF Research Database (Denmark)

Ølholm, Anne Mette; Kidholm, Kristian; Birk-Olsen, Mette

2015-01-01

decision makers, is not well described. The objective was to review empirical studies analysing the information that hospital decision makers need when deciding about health technology (HT) investments. METHODS: A systematic review of empirical studies published in English or Danish from 2000 to 2012...... in the literature related to clinical, economic and political/strategic aspects. Legal, social, and ethical aspects were seldom considered most important. CONCLUSIONS: Hospital decision makers are able to describe their information needs when deciding on HT investments. The different types of information were...

Organizational economics and health care markets.

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Robinson, J C

2001-04-01

As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership.

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

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Jeevan Acharya

critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10-15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

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Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan; Adhikari, Bipin

2016-01-01

critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10-15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery) for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.

Evaluation of laryngoscopes decontamination practices in different hospitals

International Nuclear Information System (INIS)

Ahmad, M.; Hussain, W.; Saleem, A.; Saqib, M

2014-01-01

To find disinfection and sterilization practices of laryngoscope in different hospitals. Study Design: Descriptive study. Materials and Methods: Laryngoscope decontamination practices in different hospitals were evaluated in this study which was based on a telephonic structured questionnaire. Preset questions were asked on phone from operation room technicians of 50 different hospitals. For clarification and confirmation of procedure anesthesiologist of the hospital was contracted. Laryngoscope decontamination practices were asked as per questionnaire and data collected was recorded and analyzed. Results were documented and compared with studies regarding laryngoscope decontamination practices of different countries. Results: Most exercised methods were manual decontamination with simple gauze (50%), alcohol gauze (11%) or tap water (27%). The use of disposable blades and sheathing of blades was not practiced by any of the hospitals. Similarly chemical disinfectants were used rarely (2%). Rinsing laryngoscopes with water (always 27%, sometimes 23%) was very common while, autoclaving or sheathing of blades was not done in any of the hospital. Conclusion: The rate of different postoperative infection is on the increase in our hospitals and one likely contributing source is contaminated laryngoscopes. Lack of awareness and poor practices among health care professionals, over work and economic constraints are the major contributing factors which need to be controlled by adhering to international standards. (author)

Quality competition in local hospital markets: some econometric evidence from the period 1982-1988.

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Chirikos, T N

1992-05-01

This study examines whether American hospitals continued to engage in non-price or quality competition over the recent past as health care markets underwent fundamental structural changes and the economic incentives facing hospital managers were correspondingly altered. It also investigates the degree to which such rivalrous behavior contributes to losses in economic welfare. An econometric model of quality competition is specified that tests, among other things, for the effect of spending by the hospital to enhance the quality of output on annual changes in its share of the local (inpatient) market as well as the effects of competitive conditions in the local market on the annual sum spent on quality enhancement. The model is estimated with panel data on 195 acute care hospitals in the State of Florida for the years 1982-1988. The results suggest that quality competitive behavior continued unabated over this period and that it was stimulated as much by the growth in physician supply and alternative delivery mechanisms as it was by other competing hospitals in the local market. Furthermore, the results show that quality competition yields some inefficiency or waste, but much of it also meets the test of the market.

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation.

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Gates, Simon; Lall, Ranjit; Quinn, Tom; Deakin, Charles D; Cooke, Matthew W; Horton, Jessica; Lamb, Sarah E; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andy; Smyth, Mike; Wilson, Kate; Parcell, Garry; Rosser, Andrew; Whitfield, Richard; Williams, Amanda; Jones, Rebecca; Pocock, Helen; Brock, Nicola; Black, John Jm; Wright, John; Han, Kyee; Shaw, Gary; Blair, Laura; Marti, Joachim; Hulme, Claire; McCabe, Christopher; Nikolova, Silviya; Ferreira, Zenia; Perkins, Gavin D

2017-03-01

Mechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA). Evaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA. Pragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression. Four UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR. Patients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression. There was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical

Comparing the economic burden of ischemic stroke patients with and without atrial fibrillation: a retrospective study in Beijing, China.

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Wen, Liankui; Wu, Jingjing; Feng, Lin; Yang, Li; Qian, Feng

2017-10-01

Little is known about the economic burden for ischemic stroke (IS) patients with atrial fibrillation (AF) in China. We aimed to compare the economic burden of treatment-related costs in IS patients with AF vs. without AF in China. This retrospective analysis used economic burden data from the Beijing urban health insurance database. Using a random sampling method, 10% of the patients diagnosed with IS from 1 January through 31 December 2012 were enrolled. First hospitalization was considered as the index event and hospital utilization after the index event was followed up until September 2013. Overall healthcare cost during the study period was analyzed. In 4061 patients with IS (mean ± SD age, 68.45 ± 13.95 years; AF: 992; without AF: 3069), the AF group had a higher percentage of patients with co-morbidities at baseline. Compared with the non-AF group, the AF group had significantly greater hospitalization at the index event (p economic burden in patients with IS. Therefore, prevention of cardio-embolic events in patients with AF by anticoagulants may decrease the economic burden in patients with IS.

Hospital budget increase for information technology during phase 1 meaningful use.

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Neumeier, Harold; Berner, Eta S; Burke, Darrell E; Azuero, Andres

2015-01-01

Federal policies have a significant effect on how businesses spend money. The 2009 HITECH (Health Information Technology for Economic and Clinical Health Act) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use certified electronic health records privately and securely to achieve specified improvements in care delivery. Federal incentive payments were offered in 2011 for hospitals that had satisfied "meaningful use" criteria. A longitudinal study of nonfederal hospital information technology (IT) budgets (N = 493) during the years 2009 to 2011 found increases in the percentage of hospital annual operating budgets allocated to IT in the years leading up to these federal incentives. This increase was most pronounced among hospitals receiving high proportions of their reimbursements from Medicaid, followed by hospitals receiving high proportions of their reimbursements from Medicare, possibly indicating a budget shift during this period to more IT spending to achieve meaningful-use policy guidelines.

A Model of the Costs of Community and Nosocomial Pediatric Respiratory Syncytial Virus Infections in Canadian Hospitals

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Philip Jacobs

2013-01-01

Full Text Available BACKGROUND: Approximately one in 10 hospitalized patients will acquire a nosocomial infection (NI after admission to hospital, of which 71% are due to respiratory viruses, including the respiratory syncytial virus (RSV. NIs are concerning and lead to prolonged hospitalizations. The economics of NIs are typically described in generalized terms and specific cost data are lacking.

The association of debt financing with not-for-profit hospitals' provision of uncompensated care.

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Magnus, Stephen A; Smith, Dean G; Wheeler, John R C

2004-01-01

Not-for-profit hospitals undertook unprecedented amounts of debt in the mid to late 1990s. Corporate finance theory and the literature on hospital financing suggest that debt may constrain hospitals' capacity to deliver uncompensated care. Using data from audited financial statements for a sample of hospitals, this article explores whether debt financing is associated with hospitals' provision of uncompensated care, an output central to many hospitals' service missions. Contrary to expectations, our analysis finds that higher debt is associated with higher levels of uncompensated care. However, the results may reflect the unusual economic and stock-market conditions prevailing in the mid 1990s, and they are consistent with the views of hospital financial managers and other practitioners whom we interviewed.

The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

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Karara, Gustave; Verbeke, Frank; Nyssen, Marc

2015-01-01

In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals. The percentage of patients who had no health insurer globally decreased from 35% in 2011 to 15% in 2014. The rate of health insurance coverage in hospitals varied between 75% in private hospitals and 84% in public hospitals. The amounts paid by the patients for health services decreased in private hospitals to 25% of the total costs in 2014 (-7.4%) and vary between 14% and 19% in public hospitals. Although the number of insured patients has increased and the patient share decreased over the four years of study, the patients' out-of-pocket payments increased especially for in-patients. This study emphasizes the value of integrated hospital information systems for this kind of health economics research in developing countries.

I. Monographic Section
Hospitals, money and other riches. Writing and practising economy in late medieval Italian charitable institutions

OpenAIRE

Marina Gazzini (a cura di); Antonio Olivieri (a cura di)

2016-01-01

The section contains contributions focusing on the practices and records relating to the economics of hospitals in late medieval Italy. Experts from different disciplines – economic historians, historians of the document, historians of the Middle Ages and of welfare institutions – offer a significant overview of hospitals situated in the north, the center and the south of the Italian peninsula between the fourteenth and sixteenth centuries. They investigate the mechanisms of funding of charit...

The MeSH model for hospital-physician joint ventures.

Science.gov (United States)

Anderson, J G

1985-01-01

The MeSH (Medical Staff-Hospital Joint Venture Company) concept has arisen to meet the perceived need for hospital-physician cooperation in a modern age of prospective payment systems, increased supply of health-care providers, cost conscious consumers, corporate health care organizations, and a general trend toward industrialization of health care. Supply and demand economics have created a situation which threatens the autonomy and financial integrity of both hospitals ans physicians, forcing cooperation or mutual destruction. MeSH seeks to preserve the autonomy and financial integrity of both parties through the creation of a free-standing business entity jointly owned by a hospital and those members of its medical staff who choose to participate. This article presents reasons for the need for cooperation, the objectives of MeSH, a description of its structure and operation, and a list of potential projects the program could include.

Bureaucracy, institutional theory and institutionaucracy: applications to the hospital industry.

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Bolon, D S

1998-01-01

The health care industry is experiencing rapid change and uncertainty. Hospitals, in particular, are redesigning structures and processes in order to maximize efficiencies and remain economically viable. This article uses two organizational theory perspectives (bureaucracy and institutional theory) to examine many of the trends and transitions which are occurring throughout the hospital industry. It suggests that many of the key tenets of bureaucracy (rationality, efficiency, productivity, control, etc.) have been incorporated into the institutional environment as normative expectations. This synthesis or blending of these two perspectives is labeled institutionaucracy, implying that, as productivity and efficiency considerations become institutionalized, hospitals conforming to such operational standards will gain legitimacy and additional resources from their environment.

Rotec Theory: planning tool to position hospitals on the technology curve.

Science.gov (United States)

Roberts, R

1990-06-01

The mission statement of a prominent California hospital has been revised as part of a strategic planning process less than two years before the hospital began experiencing substantial financial difficulties. When the "red numbers" began to appear, management was quick to blame changing demographic patterns and the competitive environment. Those were not the only problems. A major contributing factor that management failed to recognize was a delay in how quickly the hospital moved to adopt high technology or new medical procedures. In a few short years, it had changed from being the first community hospital to implement state-of-the-art programs to one that was slow to introduce technology. In retrospect, the hospital's mission statement did not address the role of technology and therefore it could not detect the movement away from one of its critical success factors. The Rotec Theory was developed to assist this hospital to understand the economics of technology on its current and planned operations.

Hospitality: transformative service to children, families, and communities.

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Melton, Gary B

2014-11-01

Hospitality is an ancient moral practice that was deeply embedded in early Judaism, Christianity, and Islam. Hospitality requires acceptance of, service to, and respect for people who lack a place in the community. The contemporary importance of this practice reflects the social disconnection and economic disadvantage of many young parents and the high frequency of separation of young people, including many young parents, from their communities. Such social deterioration substantially increases the risk of child maltreatment. Building on the proposals of the U.S. Advisory Board on Child Abuse and Neglect, Strong Communities for Children demonstrated the effectiveness of community building in reducing such risk. It further suggested the importance of both relying on and learning from hospitable people in strengthening support for children and their parents. PsycINFO Database Record (c) 2014 APA, all rights reserved.

STATE OF BUSINESS IN HOSPITALITY IN CHINA

OpenAIRE

Yi Yu

2014-01-01

The article deals with the state of business in the hospitality industry in China, domestic tourism, inbound tourism in China as entrepreneurial activity, outbound tourism from China to other countries. Hospitalityis one of the most important parts of thevast services market, and is a fast-growingand highly profitable industry that coulddirectly, indirectly, so as to infl uence the formation of conditions for sustainable socio-economic growth.

Economic theory and nursing administration research--is this a good combination?

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Jones, Terry L; Yoder, Linda

2010-01-01

Economic theory is used to describe and explain decision making in the context of scarce resources. This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.

The Hospital de Santiago in Cuenca: an institution with 800 years history

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Julián Solís García del Pozo

2018-04-01

Full Text Available The Hospital de Santiago in the city of Cuenca is one of the Spanish healthcare institutions that has maintained its activity for a longer time. Initially, this hospital was an institution for the redemption of captives in a border area of the kingdom of Castile with Al-Andalus, later it functioned as a hospital for the sick poor, maintaining its assistance activity despite the different destructions that the building has gone throughout its history. Currently, the hospital is a geriatric residence. Historical studies on hospitals have extended their scope of action, leaving the particular scope of institutional functioning and entering into areas as the hospital's relationship with the political, religious, social and economic environment. From this point of view, the hospital in Cuenca is still a little-explored ground to study these relationships in a city in interior Spain during a large part of the historical stages it has gone through, and especially from the Modern Age.

[The influence of intellectual capital in performance evaluation: a case-study in the hospital sector].

Science.gov (United States)

Bonacim, Carlos Alberto Grespan; Araújo, Adriana Maria Procópio de

2010-06-01

This paper contributes to public institutions with the adaptation of a performance evaluation tool based on private companies. The objective is to demonstrate how the impact of an educational activity might be measured in the economic value added for the society of a public university hospital. The paper was divided in four parts, despite the introductory and methodological aspects and the final remarks. First, the hospital sector is explained, specifically in the context of the public university hospitals. Then, the definitions, the nature and measure of the intellectual capital are presented, followed by the disclosure of the main economic performance evaluation models. Finally, an adapted model is presented, under the approach of the value based management, considering adjustments of the return and the respective investment measures, showing the impacts of the intellectual capital management and the education activity on the economic result of those institutions. The study was developed based on a methodology supported by a bibliographical research, using a comparative method procedure in the descriptive modality. At last, it is highlighted the importance of accountability for the society regarding the use of public resources and how this study can help in this way.

Risks in hospitals. Assessment and Management

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Bradea Ioana-Alexandra

2014-12-01

Full Text Available In a complex world, characterized by a multitude of risks, managers need to manage the risks they encounter, in an efficient way and in the shortest time possible. In the current economic crisis, the concept of hospital risk management, as the process in which is identified, analyzed, reduced, or avoided a risk that may affect the hospital, gained great importance. The Romanian health system, distinguished by: lack of transparency, poor funding, the loss of the valuable medical staff, lack of hospitals in villages and small towns, inability to engage patients due to the old and poor equipment, lack of research and problems in information privacy and cyber-security, requires an appropriate management, enabling risk managers to take decisions in order to avoid the occurrence of risks. Important for the functioning of every hospital is the perception of patients and their degree of satisfaction, regarding the quality of services, which depend largely on the quality of human resources. But what are the human resources weaknesses and risks from the patient point of view? What are the risk indicators which must be monitored to avoid risks? And also, which is the most useful method for measurement and assessment of risk?

CURRENT TRENDS IN HOSPITALITY INDUSTRY

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Ivica Batinić

2013-10-01

Full Text Available Hospitality industry is a complex product-service economic activity which besides accommodation, food and beverages offers a variety of complementary and ancillary services in order to meet modern needs, demands and desires of tourists consumers. Contemporary needs, demands and desires of tourists consumers (increased need for security and preservation of health; emphasis on ecology and healthy food; pure nature stay; growing demand for adventure activities and excitement; convention facilities and incentive offerings; visits to towns, big sports, cultural, religious, business events; new travel motivation have led to the emergence of new trends in hospitality offering design. Wellness and spa hotels, boutique hotels, all inclusive hotels, slow-food restaurants, and wine and lounge bars are just some of the main trends, and successful hoteliers and caterers will examine each of the trends and devise development politics in accordance with the new requirements and global market needs.

The clinical effectiveness and cost-effectiveness of clinical nurse specialist-led hospital to home transitional care: a systematic review.

Science.gov (United States)

Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Donald, Faith; Martin-Misener, Ruth; Kilpatrick, Kelley; Harbman, Patricia; Kaasalainen, Sharon; Marshall, Deborah; Charbonneau-Smith, Renee; DiCenso, Alba

2015-10-01

Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed. © 2015 John Wiley & Sons, Ltd.

Establishing a general medical outpatient clinic for cancer survivors in a public city hospital setting.

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Goytia, Elliott J; Lounsbury, David W; McCabe, Mary S; Weiss, Elisa; Newcomer, Meghan; Nelson, Deena J; Brennessel, Debra; Rapkin, Bruce D; Kemeny, M Margaret

2009-11-01

Many cancer centers and community hospitals are developing novel models of survivorship care. However, few are specifically focused on services for socio-economically disadvantaged cancer survivors. To describe a new model of survivorship care serving culturally diverse, urban adult cancer patients and to present findings from a feasibility evaluation. Adult cancer patients treated at a public city hospital cancer center. The clinic provides comprehensive medical and psychosocial services for patients within a public hospital cancer center where they receive their oncology care. Longitudinal data collected over a 3-year period were used to describe patient demographics, patient needs, and services delivered. Since inception, 410 cancer patients have been served. Demand for services has grown steadily. Hypertension was the most frequent comorbid condition treated. Pain, depression, cardiovascular disease, hyperlipidemia, and bowel dysfunction were the most common post-treatment problems experienced by the patients. Financial counseling was an important patient resource. This new clinical service has been well-integrated into its public urban hospital setting and constitutes an innovative model of health-care delivery for socio-economically challenged, culturally diverse adult cancer survivors.

A methodological framework of preparing economic evidence for selection of medicines in the Chinese setting.

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Sun, Xin; Faunce, Thomas Alured

2010-08-01

Medicines are becoming a major component of health expenditure in China. Selection of effective and cost-effective medicines represents an important effort to improve medicines use. A guideline on cost-effectiveness studies has been available in China. This guideline, however, fails to be a practical tool to prepare and critically appraise economic evidence. This article discusses, in the Chinese context, the approach to integrating economic component into the medicines selection, and elaborates the methods of producing economic evidence, including conducing economic reviews and primary economic studies. © 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.

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Sun, Shawn X; Liu, Gordon G; Christensen, Dale B; Fu, Alex Z

2007-10-01

To review the literature addressing the economic outcomes of nonadherence in the treatment of schizophrenia, and to utilize the review results to provide an update on the economic impact of hospitalizations among schizophrenia patients related to antipsychotic nonadherence. A structured search of EMBASE, Ovid MEDLINE, PubMed and PsycINFO for years 1995-2007 was conducted to identify published English-language articles addressing the economic impact of antipsychotic nonadherence in schizophrenia. The following key words were used in the search: compliance, noncompliance, adherence, nonadherence, relapse, economic, cost, and schizophrenia. A bibliographic search of retrieved articles was performed to identify additional studies. For a study to be included, the date of publication had to be from 1/1/1995 to 6/1/2007, and the impact of nonadherence had to be measured in terms of direct healthcare costs or inpatient days. Subsequently, an estimate of incremental hospitalization costs related to antipsychotic non adherence was extrapolated at the US national level based on the reviewed studies (nonadherence rate and hospitalization rate) and the National Inpatient Sample of Healthcare Cost and Utilization Project (average daily hospitalization costs). Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results. Despite the varied adherence measures across studies, all articles reviewed showed that antipsychotic nonadherence was related to an increase in hospitalization rate, hospital days or hospital costs. We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005. The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program. Additionally, the studies we reviewed did not capture the newer antipsychotic drugs

Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial.

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Sharma, Yogesh; Thompson, Campbell; Miller, Michelle; Shahi, Rashmi; Hakendorf, Paul; Horwood, Chris; Kaambwa, Billingsley

2018-02-05

Prevalence of malnutrition in older hospitalized patients is 30%. Malnutrition is associated with poor clinical outcomes in terms of high morbidity and mortality and is costly for hospitals. Extended nutrition interventions improve clinical outcomes but limited studies have investigated whether these interventions are cost-effective. In this randomized controlled trial, 148 malnourished general medical patients ≥60 years were recruited and randomized to receive either an extended nutritional intervention or usual care. Nutrition intervention was individualized and started with 24 h of admission and was continued for 3 months post-discharge with a monthly telephone call whereas control patients received usual care. Nutrition status was confirmed by Patient generated subjective global assessment (PG-SGA) and health-related quality of life (HRQoL) was measured using EuroQoL 5D (EQ-5D-5 L) questionnaire at admission and at 3-months follow-up. A cost-effectiveness analysis was conducted for the primary outcome (incremental costs per unit improvement in PG-SGA) while a cost-utility analysis (CUA) was undertaken for the secondary outcome (incremental costs per quality adjusted life year (QALY) gained). Nutrition status and HRQoL improved in intervention patients. Mean per included patient Australian Medicare costs were lower in intervention group compared to control arm (by $907) but these differences were not statistically significant (95% CI: -$2956 to $4854). The main drivers of higher costs in the control group were higher inpatient ($13,882 versus $13,134) and drug ($838 versus $601) costs. After adjusting outcomes for baseline differences and repeated measures, the intervention was more effective than the control with patients in this arm reporting QALYs gained that were higher by 0.0050 QALYs gained per patient (95% CI: -0.0079 to 0.0199). The probability of the intervention being cost-effective at willingness to pay values as low as $1000 per unit

Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia, Prospective Population Based Data Linkage Study.

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McAuley, Kimberley; McAullay, Daniel; Strobel, Natalie A; Marriott, Rhonda; Atkinson, David N; Marley, Julia V; Stanley, Fiona J; Edmond, Karen M

2016-01-01

Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77-2.04, p = disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96-1.13, p = 0.356). WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.

The economic burden of schizophrenia in Malaysia

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Teoh SL

2017-07-01

Full Text Available Siew Li Teoh,1 Huey Yi Chong,1 Salina Abdul Aziz,2 Norliza Chemi,2 Abdul Razak Othman,2 Nurzuriana Md Zaki,2 Possatorn Vanichkulpitak,3 Nathorn Chaiyakunapruk1,4–6 1School of Pharmacy, Monash University Malaysia, Selangor, 2Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, 4Center of Pharmaceutical Outcomes Research (CPOR, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 5School of Pharmacy, University of Wisconsin, Madison, WI, USA; 6Health and Well-being Cluster, Global Asia in the 21st Century (GA21 Platform, Monash University Malaysia, Selangor, MalaysiaIntroduction: Schizophrenia (SCZ is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia.Methods: A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL. The medical charts were identified electronically by matching the unique patient’s identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted.Results: The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million

The financial impact of hospitals on the local economy--2 new factors.

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Rotarius, Timothy; Liberman, Aaron

2014-01-01

This research effort presents a descriptive analysis of the financial impact that several hospitals have on their local economy. An earlier study published by the authors included 3 distinct, yet overlapping components of financial impact: (1) the hospital system as a major health care provider, (2) the hospital system as a large employer, and (3) the hospital system as an entity whose employees contribute greatly to their local community. This new study added additional financial impact factors: (4) the hospital system as an organization committed to major construction projects in pursuit of its health services mission, and (5) the hospital system as an entity that pays taxes to government agencies. The inextricable relationship of these 5 categories both increases and enhances the impact of the hospital system on the local region. The results of this updated and expanded analysis suggest strongly that the hospital system represents 1 of the primary contributors to the economy of the region. The hospital system adds $3 billion to the $28 billion local economy, which means that the hospital system and its employees are responsible for 10.7% of the total economic prowess of the region.

Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients

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Tang, Wen; Grace, Blair; McDonald, Stephen P.; Hawley, Carmel M.; Badve, Sunil V.; Boudville, Neil C.; Brown, Fiona G.; Clayton, Philip A.; Johnson, David W.

2015-01-01

♦ Background: The aim of the present study was to investigate the relationship between socio-economic status (SES) and peritoneal dialysis (PD)-related peritonitis. ♦ Methods: Associations between area SES and peritonitis risk and outcomes were examined in all non-indigenous patients who received PD in Australia between 1 October 2003 and 31 December 2010 (peritonitis outcomes). SES was assessed by deciles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Disadvantage (IRSD), Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), Index of Economic Resources (IER) and Index of Education and Occupation (IEO). ♦ Results: 7,417 patients were included in the present study. Mixed-effects Poisson regression demonstrated that incident rate ratios for peritonitis were generally lower in the higher SEIFA-based deciles compared with the reference (decile 1), although the reductions were only statistically significant in some deciles (IRSAD deciles 2 and 4 – 9; IRSD deciles 4 – 6; IER deciles 4 and 6; IEO deciles 3 and 6). Mixed-effects logistic regression showed that lower probabilities of hospitalization were predicted by relatively higher SES, and lower probabilities of peritonitis-associated death were predicted by less SES disadvantage status and greater access to economic resources. No association was observed between SES and the risks of peritonitis cure, catheter removal and permanent hemodialysis (HD) transfer. ♦ Conclusions: In Australia, where there is universal free healthcare, higher SES was associated with lower risks of peritonitis-associated hospitalization and death, and a lower risk of peritonitis in some categories. PMID:24497587

Hospital Viability during a Pandemic Influenza Outbreak

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2009-06-01

intentional release may be a naturally occurring disease such as smallpox, or it may be a genetically engineered virus with no known cure . Whatever...be overwhelmed with a myriad of issues as well as, absenteeism , which will require prior planning on the hospitals‘ part to ensure adequate...logistical resupply, but when economic systems may be hanging by a thread due to absenteeism , it is likely hospitals will not be receiving regular

STATE OF BUSINESS IN HOSPITALITY IN CHINA

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Yi Yu

2014-01-01

Full Text Available The article deals with the state of business in the hospitality industry in China, domestic tourism, inbound tourism in China as entrepreneurial activity, outbound tourism from China to other countries. Hospitalityis one of the most important parts of thevast services market, and is a fast-growingand highly profitable industry that coulddirectly, indirectly, so as to infl uence the formation of conditions for sustainable socio-economic growth.

Not-for-profit hospital CEO performance and pay: some evidence from Connecticut.

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Kramer, Jeffrey; Santerre, Rexford E

2010-01-01

This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.

The economic burden of nurse-sensitive adverse events in 22 medical-surgical units: retrospective and matching analysis.

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Tchouaket, Eric; Dubois, Carl-Ardy; D'Amour, Danielle

2017-07-01

The aim of this study was to assess the economic burden of nurse-sensitive adverse events in 22 acute-care units in Quebec by estimating excess hospital-related costs and calculating resulting additional hospital days. Recent changes in the worldwide economic and financial contexts have made the cost of patient safety a topical issue. Yet, our knowledge about the economic burden of safety of nursing care is quite limited in Canada in general and Quebec in particular. Retrospective analysis of charts of 2699 patients hospitalized between July 2008 - August 2009 for at least 2 days of 30-day periods in 22 medical-surgical units in 11 hospitals in Quebec. Data were collected from September 2009 to August 2010. Nurse-sensitive adverse events analysed were pressure ulcers, falls, medication administration errors, pneumonia and urinary tract infections. Descriptive statistics identified numbers of cases for each nurse-sensitive adverse event. A literature analysis was used to estimate excess median hospital-related costs of treatments with these nurse-sensitive adverse events. Costs were calculated in 2014 Canadian dollars. Additional hospital days were estimated by comparing lengths of stay of patients with nurse-sensitive adverse events with those of similar patients without nurse-sensitive adverse events. This study found that five adverse events considered nurse-sensitive caused nearly 1300 additional hospital days for 166 patients and generated more than Canadian dollars 600,000 in excess treatment costs. The results present the financial consequences of the nurse-sensitive adverse events. Government should invest in prevention and in improvements to care quality and patient safety. Managers need to strengthen safety processes in their facilities and nurses should take greater precautions. © 2017 John Wiley & Sons Ltd.

I. Monographic Section Hospitals, money and other riches. Writing and practising economy in late medieval Italian charitable institutions

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Marina Gazzini (a cura di

2016-05-01

Full Text Available The section contains contributions focusing on the practices and records relating to the economics of hospitals in late medieval Italy. Experts from different disciplines – economic historians, historians of the document, historians of the Middle Ages and of welfare institutions – offer a significant overview of hospitals situated in the north, the center and the south of the Italian peninsula between the fourteenth and sixteenth centuries. They investigate the mechanisms of funding of charities, the social and public implications of hospital care, the techniques and the accounting systems of revenue and expenditure, and finally, the religious merits connected not only to the care of the poor and sick, but also to the scriptures that recorded this activity.

Efficiency, ownership, and financing of hospitals: the case of Austria.

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Czypionka, Thomas; Kraus, Markus; Mayer, Susanne; Röhrling, Gerald

2014-12-01

While standard economic theory posits that privately owned hospitals are more efficient than their public counterparts, no clear conclusion can yet be drawn for Austria in this regard. As previous Austrian efficiency studies rely on data from the 1990s only and are based on small hospital samples, the generalizability of these results is questionable. To examine the impact of ownership type on efficiency, we apply a Data Envelopment Analysis which extends the existing literature in two respects: first, it evaluates the efficiency of the Austrian acute care sector, using data on 128 public and private non-profit hospitals from the year 2010; second, it additionally focusses on the inpatient sector alone, thus increasing the comparability between hospitals. Overall, the results show that in Austria, private non-profit hospitals outperform public hospitals in terms of technical efficiency. A multiple regression analysis confirms the significant association between efficiency and ownership type. This conclusive result contrasts some international evidence and can most likely be attributed to differences in financial incentives for public and private non-profit hospitals in Austria. Therefore, by drawing on the example of the Austrian acute care hospital sector and existing literature on the German acute care hospital sector, we also discuss the impact of hospital financing systems and their incentives on efficiency. This paper thus also aims at providing a proof of principle, pointing out the importance of the respective market conditions when internationally comparing hospital efficiency by ownership type.

Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system.

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Polyzos, Nikolaos; Karanikas, Haralampos; Thireos, Eleftherios; Kastanioti, Catherine; Kontodimopoulos, Nick

2013-01-01

Until recently, in-patient NHS hospital care in Greece was reimbursed via an anachronistic and under-priced retrospective per diem system, which has been held primarily responsible for continuous budget deficits. The purpose of this paper is to present the efforts of the Ministry of Health (MoH) to implement a new DRG-based payment system. As in many countries, the decision was to adopt a patient classification from abroad and to refine it for use in Greece with national data. Pricing was achieved with a combination of activity-based costing with data from selected Greek hospitals, and "imported" cost weights. Data collection, IT support and monitoring are provided via ESY.net, a web-based facility developed and implemented by the MoH. After an initial pilot testing of the classification in 20 hospitals, complete DRG reimbursement data was reported by 113 hospitals (85% of total) for the fourth quarter of 2011. The recorded monthly increase in patient discharges billed with the new system and in revenue implies increasing adaptability by the hospitals. However, the unfavorable inlier vs. outlier distribution of discharges and revenue observed in some health regions signifies the need for corrective actions. The importance of this reimbursement reform is discussed in light of the current crisis faced by the Greek economy. There is yet much to be done and many projects are currently in progress to support this effort; however the first cost containment results are encouraging. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

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Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

2016-06-01

Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital

[The family-friendly hospital: (how) does it work?].

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Heller, A R; Heller, S C

2009-06-01

The demographic development in Germany is heading towards a significant shortage in specialists within the next 10-15 years with an increased demand for health services at the same time. The three-stage model of family life planning (work, family phase, return) will also be gradually replaced by a model of simultaneous compatibility of family and work. This change in values, although initiated by the parents themselves, may turn out to be a crucial countermeasure in national economy against the demography-related loss of qualified personnel. For these three trends the economic need arises to minimize family-related absence of our well-trained, motivated and reliable doctors from the clinical departments through implementation of family-friendly human resources policies and supporting measures by the employers. In a representative survey 26% of respondents with children had in the past already changed their workplace to ensure a better match of work and family duties. In this regard the compatibility of family and professional responsibilities had a higher impact on the selection of the employer than a high income. Accordingly, a work-life competence oriented business plan will represent the crucial factor within the competition between universities, hospitals and professional disciplines to attract high potential bearers although a sustained change of the traditional hospital culture is mandatory. Anaesthesia-related fields of development regarding family-friendly corporate governance are working hours and organization of work, part-time jobs even for managers and fathers, and staff development. In the hospital daily routine, in particular, creative solutions meeting the local demands are deemed necessary that do not involve the use of high financial resources. Family-friendly personnel policy not only arises from altruistic enthusiasm but also pays off economically. This article discusses the necessity, opportunities and threads of family-oriented hospital

Contract-program evaluation: Impact of the DRG classification system on hospitals' outputs

OpenAIRE

Alves, Helder António Pereira Gomes

2010-01-01

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics The present work project aims at evaluating the impact of contract-program implementation in 2003 and of incentives created in 2007 on hospital output, under the DRG inpatient classification system. A sample of five Portuguese acute public district hospitals was chosen as sample, between 2002 and 2007. Results of hypothesis testing ...

Behavioral economics strategies for promoting adherence to sleep interventions.

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Stevens, Jack

2015-10-01

Cognitive-behavioral treatment for insomnia and continuous positive airway pressure therapy for obstructive sleep apnea are among the most efficacious sleep interventions. Unfortunately, adherence levels are disappointingly low for these interventions. Behavioral economics offers a promising framework for promoting adherence, often through relatively brief and straightforward strategies. The assumptions, goals, and key strategies of behavioral economics will be introduced. These strategies include providing social norms information, changing defaults, using the compromise effect, utilizing commitment devices, and establishing lottery-based systems. Then, this review will highlight specific behavioral economic approaches to promote patient adherence for three major sleep interventions: 1) behavioral treatment for pediatric insomnia, 2) cognitive-behavioral treatment for adult insomnia, and 3) continuous positive airway pressure for obstructive sleep apnea. Next, behavioral economic strategies will be discussed as ways to improve health care provider adherence to clinical practice guidelines regarding appropriate prescribing of hypnotics and ordering sleep-promoting practices for hospitalized inpatients. Finally, possible concerns that readers may have about behavioral economics strategies, including their efficacy, feasibility, and sustainability, will be addressed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Direct economic burden and influencing factors in patients with hepatitis B virus related diseases in Jiangsu, China.

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Zhang, Hua; Chao, Jianqian; Zhu, Liguo; Song, Long; Li, Xiyan; Liu, Pei

2015-03-01

The purpose of this study was to explore direct economic burden and its influencing factors in patients with hepatitis B virus (HBV) related diseases. Time phasing continuous sampling was used to select patients from August 1, 2012, to December 31, 2012, in 3 county hospitals of 3 model regions in Jiangsu Province, China. A total of 436 outpatients and 196 inpatients were observed. The average direct economic burden of HBV-associated admission was US$107.11 for outpatients, and drug fees accounted for 74%; the burden was US$3193.47 for inpatients, and the direct medical costs accounted for 96%. Multivariate linear regression analysis showed that drug fee, examination fee, and antiviral therapy were influencing factors for outpatients, while hospitalization stay, drug ratio, and patient's age were influencing factors for inpatients. It can be concluded that the direct economic burden of patients with HBV-related diseases was high compared to their household income. Measures should be taken to reduce the economic burden of patients. © 2014 APJPH.

Estimation of hospital efficiency--do different definitions and casemix measures for hospital output affect the results?

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Vitikainen, Kirsi; Street, Andrew; Linna, Miika

2009-02-01

Hospital efficiency has been the subject of numerous health economics studies, but there is little evidence on how the chosen output and casemix measures affect the efficiency results. The aim of this study is to examine the robustness of efficiency results due to these factors. Comparison is made between activities and episode output measures, and two different output grouping systems (Classic and FullDRG). Non-parametric data envelopment analysis is used as an analysis technique. The data consist of all public acute care hospitals in Finland in 2005 (n=40). Efficiency estimates were not found to be highly sensitive to the choice between episode and activity descriptions of output, but more so to the choice of DRG grouping system. Estimates are most sensitive to scale assumptions, with evidence of decreasing returns to scale in larger hospitals. Episode measures are generally to be preferred to activity measures because these better capture the patient pathway, while FullDRGs are preferred to Classic DRGs particularly because of the better description of outpatient output in the former grouping system. Attention should be paid to reducing the extent of scale inefficiency in Finland.

Psychotropic drug effects contributing to psychiatric hospitalization of children: a preliminary study.

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Fialkov, M J; Hasley, S

1984-12-01

Over an 11-month period on a Children's Psychiatric Unit 5% of 60 first admissions for hospitalization were apparently associated with adverse effects of psychotropic medication. Forty (66%) of the first admissions had used, prior to hospitalization, a wide variety of drugs including stimulants, major and minor tranquilizers, anticonvulsants, antidepressants and over-the-counter drugs containing antihistamines and analgesics. It is suggested that inappropriate and injudicious use of psychotropic medications may be associated with unanticipated adverse behavioral effects, which can result in deterioration of a child's functioning to the point of necessitating psychiatric hospitalization. Early identification of these unwanted psychotropic effects has diagnostic, prognostic, economic, and legal implications.

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

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Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

[Strategic management of hospitals in France: balance and perspectives].

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Crémadez, Michel

2010-08-01

The strategic management was introduced in French hospitals in the late 80s, in a context of inefficiency and the need to control healthcare expenditure. This concept has inspired a series of government reforms, the organization and dynamics of hospitals and the mode of regulating the French health system, assuming a real change of professional culture. The changes in the economic context and in the finance of hospitals, the behavior of users, the population aging, the development of chronic diseases and increased competition, are the new challenges to be faced. The involvement of stakeholders is crucial and the strategic management, based on mobilizing these actors, is today, a method of administration particularly well adapted to the health area. This article aims to present the impact of the concept of strategic management in the evolution of French hospitals and the consequences of these developments on the outlook for the dissemination of strategic management in the health sector. To do so, it is examined the evolution of the French context until 2010, the new challenges that French hospitals must face and, finally, the consequences of these challenges on how to design services, manage the relationships between the actors of the health system and organize the operational functioning of hospitals.

Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States.

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Bartsch, S M; McKinnell, J A; Mueller, L E; Miller, L G; Gohil, S K; Huang, S S; Lee, B Y

2017-01-01

The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat; however, its economic burden is unknown. We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third-party payer, and societal, perspectives and to evaluate the health and economic burden of CRE to the USA. Depending on the infection type, the median cost of a single CRE infection can range from $22 484 to $66 031 for hospitals, $10 440 to $31 621 for third-party payers, and $37 778 to $83 512 for society. An infection incidence of 2.93 per 100 000 population in the USA (9418 infections) would cost hospitals $275 million (95% CR $217-334 million), third-party payers $147 million (95% CR $129-172 million), and society $553 million (95% CR $303-1593 million) with a 25% attributable mortality, and would result in the loss of 8841 (95% CR 5805-12 420) quality-adjusted life years. An incidence of 15 per 100 000 (48 213 infections) would cost hospitals $1.4 billion (95% CR $1.1-1.7 billion), third-party payers $0.8 billion (95% CR $0.6-0.8 billion), and society $2.8 billion (95% CR $1.6-8.2 billion), and result in the loss of 45 261 quality-adjusted life years. The cost of CRE is higher than the annual cost of many chronic diseases and of many acute diseases. Costs rise proportionally with the incidence of CRE, increasing by 2.0 times, 3.4 times, and 5.1 times for incidence rates of 6, 10, and 15 per 100 000 persons. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Assessment of dedicated revenue of non-educational hospitals in Guilan University of Medical Sciences (2012

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S. Asefzadeh

2015-06-01

Full Text Available Hospitals, as one of the main providers of health services, are of great importance in health and economy. The aim of this descriptive study was to assess the dedicated revenue of all non-educational hospitals in Guilan University of Medical Sciences (14 hospitals in 2012. On average, 22.35% of income was provided by cash earnings and 77.65% was provided by insurance organizations.There was 1.25% deficit by insurance. The net income of small hospitals with few available beds was very low and they were not economically affordable. The out of pocket to total income ratio was higher in the hospitals located in deprived areas due to lack of full insurance coverage.

Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms.

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Silingardi, Roberto; Gennai, Stefano; Coppi, Giovanni; Chester, Johanna; Marcheselli, Luigi; Brunetti, Massimo

2017-12-01

The aim of this study was to assess clinical and contemporary costs associated with elective endovascular repair of intact descending thoracic aortic aneurysms (DTAA) into the mid-term follow-up. A retrospective review of a prospectively maintained clinical database including 29 consecutive patients from July 2005 to December 2009 treated with elective endovascular repair (TEVAR) or TEVAR and surgical infrarenal repair (hybrid) of intact DTAA was performed. Mean age was 74.5 years old (±7.1). Primary clinical endpoints include mortality and major morbidity. Additionally a comprehensive economic appraisal of individual in-hospital and follow-up costs was executed. Economic endpoints include in-hospital and follow-up costs and patient discharge status. Elective endovascular and open repairs' clinical and economical outcomes in contemporary literature were assessed for comparison according to PRISMA standards. Immediate mortality was 6.9% (1/24 TEVAR and 1/5 hybrid). Three respiratory complications were recorded (11%; 2 TEVAR, 1 hybrid). Renal and cardiac complication rates were 7.4% (1 TEVAR, 1 hybrid) and 3.7% (1 TEVAR) respectively. Routine discharge home was achieved for 85% of patients (95.7% TEVAR, 25% hybrid). Three endoleaks were treated throughout the follow-up (2 TEVAR, 1 hybrid; mean 30.4 mo, ±19.9) rendering an 11% (3/27) reintervention rate. Average immediate cost was €21,976.87 for elective endovascular repair and €33,783.21 for elective endovascular hybrid repair. Additional reintervention and routine follow-up costs augmented immediate costs by 12.4%. This study supports satisfying immediate clinical outcomes for TEVAR and TEVAR+surgical infrarenal procedures. Although limited by a small population size and difficulties in economic comparisons, this study presents the real world social and economic cost scenario for both elective TEVAR and TEVAR hybrid treatment of DTAA of both the in-hospital and at mid term follow-up periods.

Do hospital chief executive officers extract rents from Certificate of Need laws?

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Eichmann, Traci L; Santerre, Rexford E

2011-01-01

Prior research suggests that Certificate of Need (CON) laws reduce competition in the hospital services industry. As a result, this study empirically investigates if not-for-profit hospital chief executive officers (CEOs) are able to extract rents from CON laws in the form of higher compensation. A sample of 256 not-for-profit hospital CEOs in states with and without CON laws and data for 2007 are used in the empirical analysis. The study considers the endogenous nature of a CON law and allows such a law to indirectly affect CEO compensation through its impact on the number of hospitals and beds. The multiple regression results indicate that special and public interests both motivate the decision of a state to maintain a CON law. CON laws are shown to reduce the number of beds at the typical hospital by 12 percent, on average, and the number of hospitals per 100,000 persons by 48 percent. These reductions ultimately lead urban hospital CEOs in states with CON laws to extract economic rents of $91,000 annually.

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism.

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Barraclough, S

1997-01-01

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.

Does better information about hospital quality affect patients’ choice? Empirical findings from Germany

OpenAIRE

Wübker, Ansgar; Sauerland, Dirk; Wübker, Achim

2008-01-01

Background: Economic theory strongly suggests that better information about the quality of care affects patients’ choice of health service providers. However, we have little empirical evidence about the impact of information provided on provider’s choice in Germany. Problem: In Germany, we recently find publicly available information about hospital quality. For example, 50 percent of the hospitals in the Rhine-Ruhr area do now publish their quality data voluntarily in a comprehensive, underst...

The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013.

Science.gov (United States)

Beck, Andrew F; Huang, Bin; Wheeler, Kathryn; Lawson, Nikki R; Kahn, Robert S; Riley, Carley L

2017-11-01

To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions. Copyright © 2017 Elsevier Inc. All rights reserved.

[Engineering and expertise in sustainable development in hospitals].

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Barat, Pascal

2012-01-01

Sustainable development is nowadays a concept shared by most people even if it is sometimes hard to grasp. Combining good economic management, social progress and the protection of the environment is not always easy. It is however an essential exercise in order not to compromise the ability of future generations to meet their requirements. Tours University Hospital embarked on a sustainable development strategy in 2008.

Access to capital: implications for hospital consolidation.

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Grauman, Daniel M; Harris, John M; Martin, Christine

2010-04-01

Recent economic challenges have left many independent hospitals and their boards concerned about long-term viability of their organizations as stand-alone facilities. The CFO's role should be to facilitate a candid, objective assessment of the organization's ability to continue to go it alone. Key indicators that should be considered in such an assessment include patient volume, degree of physician alignment, profitability, current debt burden, cash, available capital versus capital requirements, and credit rating changes.

An ideal hospital.

Science.gov (United States)

Chandrasiri, Singithi Sidney

2017-07-03

Purpose The purpose of this paper is to explore a novel overarching strategy in tackling the key issues raised by the recent inquiry into bullying, harassment and discrimination in surgical practice and surgical training in Australian and New Zealand hospitals. Design/methodology/approach The approach taken is an analysis of the available evidence-based literature to inform the proposed viewpoint. The theoretical subject scope presented is a discussion of how and why the various strategies put forward in this paper should be integrated into and led from an overarching workforce engagement platform. Findings The key themes isolated from the Inquiry into Australian and New Zealand surgical practice ranged from abuse of power by those in leadership positions, gender inequity in the surgical workforce, opaque and corrupt complaints handling processes, excessive surgical trainee working hours to bystander silence secondary to a fear of reprisal. A workforce engagement perspective has elicited the potential to counter various impacts, that of clinical ineffectiveness, substandard quality and safety, inefficient medical workforce management outcomes, adverse economic implications and the operational profitability of a hospital. Generic strategies grounded in evidence-based literature were able to then be aligned with specific action areas to provide a new leadership framework for addressing these impacts. Originality/value To the author's knowledge, this is one of the first responses providing a framework on how medical managers and hospital executives can begin to lead a comprehensive and practical strategy for changing the existing culture of bullying, harassment and discrimination in surgical practice by using a staff engagement framework.

The Affect of Mobile Performance Support Devices on Anxiety and Self-Efficacy of Hospital Float Staff

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Riley McKee, Megan

2012-01-01

Floating describes the act of staff moving from one unit to another based on the needs of the patients in a hospital. Many staff who float to different units express negative feelings, including anxiety and lack in self-efficacy. However, floating is both an economical and efficient method to use staff across the hospital, especially with current…

The role of the Director Zmago Slokan in the development of Maribor General Hospital in the first period after the Second World War (1953-1970).

Science.gov (United States)

Pivec, Gregor

2015-12-01

The author explores and explains the role of the director of Maribor General Hospital in the first period after Second World War. The period was problematic on account of the difficult economic situation and changes in the political system. On one hand the hospital suffered relatively large damage due to bombing attacks during the war and on the other it had to face numerous staffing problems, especially with a lack of physicians and trained nursing staff (from 1948 an executive order entered into force forbidding the nursing nuns from performing nursing care in hospitals). The change in the political system required the management of the hospital to be taken over by an individual who enjoyed the political, professional and economic trust of the then authorities. Based on his engagement during the Second World War, the director, Zmago Slokan, represented a form of guarantee for the political system of that time, which nevertheless wanted the quality-based, professional and economic progress of the hospital. Using his personal characteristics, professional medical and economic knowledge as well as political experience, he was able to manage different tendencies to continue the quality-based progress of the institution. Thus, he set a proper foundation for its development in the periods that followed, in the Socialist Federative Republic of Yugoslavia as well as in the independent Republic of Slovenia (after 1991). The author discusses the role of the director in the hospital's progress chronologically.

Costs of the Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in a University Hospital

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Fatma Yıldırım

2015-12-01

, noninvasive mechanical ventilation (NIMV requirement were existing factors that didn’t increase the cost of patients (p>0.05. Only the use of antibiotics was detected as independent factors that increase the total cost (95% CI 0.487 to 12.984, p=0.030. Conclusion: Acute exacerbation of COPD continues to be an important cause of mortality and economic burden in the hospitalized COPD patients in pulmonary clinics.

Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

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McPake, Barbara; Hongoro, Charles; Russo, Giuliano

2011-06-02

Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the

Two-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services

Directory of Open Access Journals (Sweden)

Russo Giuliano

2011-06-01

Full Text Available Abstract Background Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. Methods A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. Results The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. Discussion While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total, where capital and drug costs were surprisingly low (2 and 4% respectively. We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic

Economic Analysis of Social Common Capital

Science.gov (United States)

Uzawa, Hirofumi

2005-06-01

Social common capital provides members of society with those services and institutional arrangements that are crucial in maintaining human and cultural life. The term æsocial common capital' is comprised of three categories: natural capital, social infrastructure, and institutional capital. Natural capital consists of all natural environment and natural resources including the earth's atmosphere. Social infrastructure consists of roads, bridges, public transportation systems, electricity, and other public utilities. Institutional capital includes hospitals, educational institutions, judicial and police systems, public administrative services, financial and monetary institutions, and cultural capital. This book attempts to modify and extend the theoretical premises of orthodox economic theory to make them broad enough to analyze the economic implications of social common capital. It further aims to find the institutional arrangements and policy measures that will bring about the optimal state of affairs.

Pharmaco-economics of levosimendan in cardiology: a European perspective.

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Nieminen, M S; Buerke, M; Parissis, J; Ben-Gal, T; Pollesello, P; Kivikko, M; Karavidas, A; Severino, P; Comín-Colet, J; Wikström, G; Fedele, F

2015-11-15

Heart failure places a significant economic burden on health care. Acute heart failure requires hospitalization and often frequent re-hospitalization in expensive wards where vasoactive rescue therapy is often added on top of standard medications. In these lean times, there is a growing need for cost-effective therapeutic options that supply superior support and in addition shorten the length of stay in hospital and reduce re-hospitalization rates. The inodilator levosimendan represents the latest addition to the vasoactive treatments of acute heart failure patients, and it appears to meet these expectations. Our aim was to answer the question whether the treatment efficacy of levosimendan - when selected as therapy for patients hospitalized for acute heart failure - brings savings to hospitals in various European countries representing different economies. We took a conservative approach and selected some a fortiori arguments to simplify the calculations. We selected seven European countries to represent different economies: Italy, Spain, Greece, Germany, Sweden, Finland and Israel. Data on the costs of medications and on the cost per day were collected and fed in a simple algorithm to detect savings. These saving varied from country to country, from a minimum of €0.50 in Germany to a maximum of €354.64 in Sweden. The use of levosimendan as a therapy for patients hospitalized for acute heart failure provides a net saving to hospitals driven by a reduction in the length of hospital stay. This finding is true in each of the countries considered in this study. Copyright © 2015. Published by Elsevier Ireland Ltd.

Hospital-Level Factors Associated with Pediatric Emergency Department Return Visits.

Science.gov (United States)

Pittsenbarger, Zachary; Thurm, Cary; Neuman, Mark; Spencer, Sandra; Simon, Harold; Gosdin, Craig; Shah, Samir; McClead, Richard; Stack, Anne; Alpern, Elizabeth

2017-07-01

Return visits (RVs) and RVs with admission (RVAs) are commonly used emergency department quality measures. Visit- and patient-level factors, including several social determinants of health, have been associated with RV rates, but hospital-specific factors have not been studied. To identify what hospital-level factors correspond with high RV and RVA rates. Multicenter mixed-methods study of hospital characteristics associated with RV and RVA rates. Pediatric Health Information System with survey of emergency department directors. Adjusted return rates were calculated with generalized linear mixed-effects models. Hospitals were categorized by adjusted RV and RVA rates for analysis. Twenty-four hospitals accounted for 1,456,377 patient visits with an overall adjusted RV rate of 3.7% and RVA rate of 0.7%. Hospitals with the highest RV rates served populations that were more likely to have government insurance and lower median household incomes and less likely to carry commercial insurance. Hospitals in the highest RV rate outlier group had lower pediatric emergency medicine specialist staffing, calculated as full-time equivalents per 10,000 patient visits: median (interquartile range) of 1.9 (1.5-2.1) versus 2.9 (2.2-3.6). There were no differences in hospital population characteristics or staffing by RVA groups. RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care. © 2017 Society of Hospital Medicine

Status of Waste Management in Selected Hospitals of Isfahan in 2014

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Elham Amiri

2017-01-01

Full Text Available Background: Hospital wastes are considered as a serious threat for public health. Hospital waste management may help to control disease transmission and have remarkable economic advantages. The purpose of this study was to assess  the hospitals' waste management in Isfahan, Iran in 2014. Methods: Data of this descriptive and cross-sectional study were collected through a check list for surveying hospital waste management. Validity of checklist was confirmed by analysis of face validity and field experts' opinions. Cronbach's alpha of 0.80 was calculated. Data were then analyzed using descriptive statistics in Excell software. Results: In the studied hospitals "Elimination" dimension was inappropriate while the "Human resources involved in waste management" dimension was estimated relatively appropriate. Other dimensions were estimated as appropriate. Infectious wastes consisted of about 10.89 % of the total wastes in hospitals and the average of waste generation for each bed was 3.67 kg per day. There was no environmental unit in the studied hospitals and only one of them did not have waste management unit. Conclusion: Despite the fact that waste management status in hospitals under study was relatively appropriate, but given the importance of the issue, it is essential to improve the current situation especially in some aspects of waste management. 

Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.

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Martínez-Martínez, M M; Martínez-Sánchez, P; Fuentes, B; Cazorla-García, R; Ruiz-Ares, G; Correas-Callero, E; Lara-Lara, M; Díez-Tejedor, E

2013-02-01

Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

Science.gov (United States)

Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

2017-11-01

The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

[Assessing the economic impact of adverse events in Spanish hospitals by using administrative data].

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Allué, Natalia; Chiarello, Pietro; Bernal Delgado, Enrique; Castells, Xavier; Giraldo, Priscila; Martínez, Natalia; Sarsanedas, Eugenia; Cots, Francesc

2014-01-01

To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

The effect of smoke-free policies on hospitality industry revenues in Cyprus: an econometric approach.

Science.gov (United States)

Talias, Michael A; Savva, Christos S; Soteriades, Elpidoforos S; Lazuras, Lambros

2015-10-01

Smoke-free policies aiming to improve quality of indoor air and significantly reduce exposure to secondhand smoke in the hospitality industry are faced with strong opposition from the tobacco industry and hospitality venue owners claiming that they lead to reductions of revenues. The objective of our study was to examine the impact of a recently introduced smoke-free legislation on the revenues of the hospitality industry in Cyprus. Anonymous information on revenues was obtained from the Cyprus government value added tax office for the entire hospitality industry in Cyprus including hotels, bars, restaurants and cafeterias between 2005 and 2011. Panel data methodology was used to examine the effect of a smoke-free legislation, on tourism, businesses' revenues adjusting for gross domestic product, inflation, unemployment rate, tourists' arrivals, seasonal variation and the economic crisis. Our study showed that the implementation of the smoke-free policy did not have negative effects on the hospitality industry profitability. We conclude that even in regions with relatively high smoking rates, pro-smoking societal attitudes and weak social norms against tobacco control, and even during periods of economic crisis, smoke-free legislation does not impact negatively on hospitality industry revenues and if anything may lead to a small positive increase. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Five Years After the Hawai‘i Smoke-free Law: Tourism and Hospitality Economic Indicators Appear Unharmed

Science.gov (United States)

Rivard, Cheryl; Lipsher, Julian; Hyland, Andrew

2013-01-01

Opponents of Hawai‘i's smoke-free law argued that such a law would lead to a decrease in tourism. The purpose of this study is to determine if there is evidence of an adverse impact of Hawai‘i's smoke-free law on tourism utilizing data obtained from Hawai‘i's Department of Business, Economic Development & Tourism website for tourists from the United States. Descriptive statistics were reported before and after the law and linear regression was used to assess the relationship between the implementation of the law and changes in indicators of tourism while adjusting for underlying economic factors. The most pronounced fluctuations observed with all tourism indicators occurred around the time the US entered the recession (December 2007), with steady increases following the end of the US recession. While controlling for economic and seasonal trends, the presence of the smoke-free law was associated with an increase in arrivals (β= 42847.9; 95% CI: 16303.3, 69392.5), accommodation employees (β= 969.0; 95% CI: 351.1, 1586.8) and food services & beverage places employees (β=3390.8; 95% CI: 2326.9, 4454.7). Fluctuations in tourism indicators are likely to be associated with greater economic forces, such as decreasing GDP and consumer confidence in the United States and greater global economic trends, rather than the smoke-free law. PMID:24167770

Five years after the Hawai'i smoke-free law: tourism and hospitality economic indicators appear unharmed.

Science.gov (United States)

Dobson Amato, Katharine A; Rivard, Cheryl; Lipsher, Julian; Hyland, Andrew

2013-10-01

Opponents of Hawai'i's smoke-free law argued that such a law would lead to a decrease in tourism. The purpose of this study is to determine if there is evidence of an adverse impact of Hawai'i's smoke-free law on tourism utilizing data obtained from Hawai'i's Department of Business, Economic Development & Tourism website for tourists from the United States. Descriptive statistics were reported before and after the law and linear regression was used to assess the relationship between the implementation of the law and changes in indicators of tourism while adjusting for underlying economic factors. The most pronounced fluctuations observed with all tourism indicators occurred around the time the US entered the recession (December 2007), with steady increases following the end of the US recession. While controlling for economic and seasonal trends, the presence of the smoke-free law was associated with an increase in arrivals (β= 42847.9; 95% CI: 16303.3, 69392.5), accommodation employees (β= 969.0; 95% CI: 351.1, 1586.8) and food services & beverage places employees (β=3390.8; 95% CI: 2326.9, 4454.7). Fluctuations in tourism indicators are likely to be associated with greater economic forces, such as decreasing GDP and consumer confidence in the United States and greater global economic trends, rather than the smoke-free law.

Medical and health economic evaluation of prevention- and control measures related to MRSA infections or -colonisations at hospitals

Directory of Open Access Journals (Sweden)

Korczak, Dieter

2010-03-01

Full Text Available Introduction: Methicillin-resistant Staphylococcus aureus (MRSA are dangerous agents of nosocomial infections. In 2007 the prevalence of MRSA is 20.3% in Germany (Oxacilline-resistance according to EUCAST-criteria [EUCAST = European Committee on Antimicrobial Susceptibility Testing]. Objectives: * Which measurements are effective in the prevention and control of MRSA-infections in the hospital? * How effective are contact precautions, screening, decolonisation, education and surveillance? * Which recommendations can be given to health care politics on the basis of cost-effectiveness studies? * Have there been any adverse effects on patients and clinical staff? * What kind of liability problems exist?MethodsBased on a systematic review of the literature studies are included which have been published in German or English language since 2004. Results: 1,508 articles have been found. After having surveyed the full text, 33 medical, eight economic and four ethical/juridical studies are included for the Health Technology Assessment (HTA report. The key result of the HTA report is that different measurements are effective in the prevention and control of MRSA-infections in hospitals, though the majority of the studies has a low quality. Effective are the conduction of differentiated screening measurements if they take into account the specific endemic situation, the use of antibiotic-control programs and the introduction and control of hygienic measurements. The break even point of preventive and control measurements cannot be defined because the study results differ too much. In the future it has to be more considered that MRSA-infections and contact precautions lead to a psycho-social strain for patients. Discussion: It is hardly possible to describe causal efficacies because in the majority of the studies confounders are not sufficiently considered. In many cases bundles of measurements have been established but not analyzed individually. The

Medical and health economic evaluation of prevention- and control measures related to MRSA infections or -colonisations at hospitals.

Science.gov (United States)

Korczak, Dieter; Schöffmann, Christine

2010-03-16

Methicillin-resistant Staphylococcus aureus (MRSA) are dangerous agents of nosocomial infections. In 2007 the prevalence of MRSA is 20.3% in Germany (Oxacilline-resistance according to EUCAST-criteria [EUCAST = European Committee on Antimicrobial Susceptibility Testing]). Which measurements are effective in the prevention and control of MRSA-infections in the hospital?How effective are contact precautions, screening, decolonisation, education and surveillance?Which recommendations can be given to health care politics on the basis of cost-effectiveness studies?Have there been any adverse effects on patients and clinical staff?What kind of liability problems exist? Based on a systematic review of the literature studies are included which have been published in German or English language since 2004. 1,508 articles have been found. After having surveyed the full text, 33 medical, eight economic and four ethical/juridical studies are included for the Health Technology Assessment (HTA) report. The key result of the HTA report is that different measurements are effective in the prevention and control of MRSA-infections in hospitals, though the majority of the studies has a low quality. Effective are the conduction of differentiated screening measurements if they take into account the specific endemic situation, the use of antibiotic-control programs and the introduction and control of hygienic measurements. The break even point of preventive and control measurements cannot be defined because the study results differ too much. In the future it has to be more considered that MRSA-infections and contact precautions lead to a psycho-social strain for patients. It is hardly possible to describe causal efficacies because in the majority of the studies confounders are not sufficiently considered. In many cases bundles of measurements have been established but not analyzed individually. The internal and external validity of the studies is too weak to evaluate single interventions

Quantification classification and management of hospital waste in Lahore city

International Nuclear Information System (INIS)

Khan, M.R.; Riaz, M

2010-01-01

Systematic disposal of hospital waste is a major problem encountered by different countries including Pakistan. Efforts are on the way to achieve this objective techno-economically. To quantify infectious and total waste produced by the hospitals of Lahore, classify it to know the nature of their components and to collect information about its management. The background information and secondary data were collected by consultation of literature in the libraries and visiting different websites on Internet. The primary data were collected by gathering the responses of the Chief Executives, Medical Superintendents and Medical and Environmental Staff of all hospitals scheduled as reference models through interview. The total quantity of infectious waste produced by the hospitals and other health care units is approximately 785 million tons per annum while the total waste including municipal component is approximately 3,925 million tons per annum. The current status of awareness about proper health care waste disposal is improving but at a slow pace. It may be concluded that the management of hospital waste in five hospitals of Lahore city is systematic. However, the staff handling the waste was not fully trained for proper segregation of the hospital wastes. Incinerators being used for waste disposal are a major source of secondary air pollution therefore, this method should be discouraged. Instead, the feasibility of thermoelectric power generation may be looked into. Proper disposal of hospital wastes should be in placed in every hospital and trained staff should be employed for the job. (author)

Economic burden of glaucoma in Rivers State, Nigeria

Directory of Open Access Journals (Sweden)

Adio AO

2012-12-01

Full Text Available Adedayo O Adio,1 Alfred A Onua21University Of Port Harcourt Teaching Hospital, 2Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, NigeriaBackground: Primary open angle glaucoma is reported to blind 150,000 people in the Nigerian population and over 7000 in Rivers State, and requires constant follow-up. Compliance is a challenge, given that most inhabitants live below the poverty line. This study was performed to determine how Nigerian patients are affected economically by the disease.Methods: Consecutive adult patients attending the eye clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, with a diagnosis of primary open angle glaucoma and on outpatient antiglaucoma treatment in the first 6 months of 2006, were recruited for the study. The lowest paid government worker was on USD50 (N7500.00 per month and the gross domestic product per capita was USD1150 for the period under review.Results: We enrolled 120 consecutive patients of mean age 52.7 ± 10.4 years, with a male to female ratio of 2:3. The most common occupations were in the civil service (n = 56, 46.7%. All participants were on topical antiglaucoma treatment. The average cost of medical antiglaucoma medication was N6000 (USD40 per month. Computed to include indirect costs, including medical laboratory tests, transportation, and care by patient escorts, an average sum of USD105.4 (N15,810 was spent by each patient per month. Most of the patients (73.3% were responsible for their own treatment costs. No patient accepted the cheaper option of surgery (USD275.4, N41,310. Eighty of the patients (66.7% visited our eye clinic monthly. Direct and indirect loss to the economy was USD3,064587 per annum from those already blind. This was in addition to the USD 4.1 million being spent yearly on medical treatment by those who were visually impaired by glaucoma.Conclusion: Middle-income earners spent over 50% of their monthly income and low

Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective.

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Leblanc, Soline; Blein, Cécile; Andremont, Antoine; Bandinelli, Pierre-Alain; Galvain, Thibaut

2017-08-01

OBJECTIVE To describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspective DESIGN Burden of illness study SETTING All acute-care hospitals in France METHODS Data were extracted from the French national hospitalization database (PMSI) for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10 th revision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs. RESULTS Overall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262). CONCLUSION CDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs. Infect Control Hosp Epidemiol 2017;38:906-911.

An analysis of the economic and patient outcome impact of an integrated COPD service in east London.

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Garner, Anna; Hodson, Matthew; Ketsetzis, Georgios; Pulle, Laurence; Yorke, Janelle; Bhowmik, Angshu

2017-01-01

Exacerbations of COPD carry a huge burden of morbidity and a significant economic impact. It has been shown that home care may be useful for exacerbations of COPD. This article presents a review of an integrated COPD service in east London. Hospital Episode Statistics, Public Health Mortality Files and clinical data were used to analyze differences in health care usage and COPD patient outcomes, including COPD assessment test (CAT) scores for a subsample, before and after the introduction of the integrated service. There was a significant (30%) reduction in the number of hospital bed days for COPD patients ( P economic model shows that the economic benefits of the service (via impact on place of death and reduction in length of hospital stay) were almost equal to the cost of the service. The increase in proportion of short-stay admissions and the reduction in bed days suggest an impact of the service on early supported discharge and that this along with an improvement in patient clinical outcomes and in quality of end-of-life care shows that an exemplar integrated COPD service can provide benefits that equate to a nearly cost-neutral service.

Defibrotide in Severe Sinusoidal Obstruction Syndrome: Medicine and Economic Issues.

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Steelandt, Julie; Bocquet, François; Cordonnier, Anne-Laure; De Courtivron, Charlotte; Fusier, Isabelle; Paubel, Pascal

2017-02-01

In Europe, Defitelio (defibrotide) has a Market Authorization in curative treatment of severe sinusoidal obstruction syndrome (SOS) but not in prophylaxis (2013). In France, defibrotide has had a compassionate-use program since 2009. Today, the high cost of defibrotide remains a major hurdle for hospital budgets. Medicine and economic issues were evaluated for the 39 hospitals of the French Public Assistance-Hospitals of Paris (AP-HP). We analyzed literature reviews, consumption, and expenditures through AP-HP data in 2014 and patient profiles with defibrotide in the corresponding diagnostic-related groups (DRGs) and consulted a board of hematologists. Finally, 18 publications were selected. Between 2011 and 2014 consumption increased to €5.2M. In 2014, 80 patients receiving defibrotide were mainly ascribed to the DRG "hematopoietic stem cell transplantation" levels 3 or 4. The tariffs attributed to drugs (€3544 to 4084) cover a small part of treatment costs (€97,524 for an adult). French experts thus recommended a harmonization of indications in prophylaxis (off-label use), improvement of pretransplant care, and optimization of the number of vials used. The economic impact led experts to change their practices. They recommended the restriction of defibrotide use to SOS curative treatment and to high-risk situations in prophylaxis. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia.

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Hooi, Lai Seong; Lim, Teck Onn; Goh, Adrian; Wong, Hin Seng; Tan, Chwee Choon; Ahmad, Ghazali; Morad, Zaki

2005-02-01

This is a multi-centre study to determine cost efficiency and cost effectiveness of the Ministry of Health centre haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) programme. Forty-four haemodialysis and 11 CAPD centres were enrolled in this study in 2001. Sixty patients, 30 from each modality, were evaluated. Micro-costing was used to determine costs. The number of haemodialyses conducted ranged from 402 to 23,000 procedures per year, while for CAPD, output ranged from 70 to 2300 patient months/year. Cost ranged from RM79.61 to RM475.79 per haemodialysis treatment, with a mean cost of RM169 per HD (USD 1 = RM 3.80). The cost of CAPD treatment ranged from RM1400 to RM3200 per patient month, with a mean of RM2186. Both modalities incurred similar outpatient costs. The cost of erythropoeitin per year is RM4500 and RM2500 for haemodialysis and CAPD, respectively. The number of life years saved is 10.96 years for haemodialysis and 5.21 years for CAPD. Cost per life year saved is RM33 642 for haemodialysis and RM31 635 for CAPD. The cost for land, building, equipment, overheads, and staff were higher for haemodialysis, while consumables and hospitalization cost more for CAPD. Sensitivity analysis was performed for two discount rates (3 and 5%), varying erythropoietin doses and maximum and minimum overheads. Relative cost effectiveness of haemodialysis and CAPD was unchanged in all sensitivity scenarios, except for overhead costs, which influenced the cost effectiveness of HD. It is economically viable to promote the use of both CAPD and haemodialysis because the cost effectiveness of both are nearly equal.

The impact of economic rationalization, prioritization and rationing on job satisfaction, motivation and team cohesion in hospitals: a survey among retired physician executives in Germany.

Science.gov (United States)

Schnoor, Joerg; Braehler, Elmar; Ghanem, Mohamed; Heyde, Christoph E

2017-01-01

The growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.e. rationalization, prioritization and rationing, on job satisfaction, motivation and team cohesion should be quantified. The experiences of former and now retired physician executives in numerous hospitals in Saxony were determined. For this purpose, an anonymously written survey using a standardized questionnaire was conducted in the first quarter of 2016. Rationalization measures were confirmed by 88% of respondents. In more than a third of cases, former executives also experienced prioritization and rationing. The impact of these management techniques on job satisfaction, motivation and team cohesion was carried out in a differentiated manner. There was a tendency to regard rationalization and prioritization measures indifferently to rather disadvantageous, while rationing was predominantly rated negatively. In addition to rationalization, prioritization and rationing measures have now been part of working strategy at the hospitals. On one hand, the conceptual distinction between the terms still seems imprecise; on the other hand, a creeping and imperceptible medico-ethical transgression of the prioritization to rationing seems to have already taken place.

Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.

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Choi, Soki; Brommels, Mats

2009-01-01

The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.

[The implementation of strategy of medicinal support in multi-type hospital].

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Ludupova, E Yu

2016-01-01

The article presents brief review of implementation of strategy of medicinal support of population of the Russian Federation and experience of application of at the level of regional hospital. The necessity and importance of implementation into practice of hospitals of methodology of pharmaco-economical management of medicinal care using modern technologies of XYZ-, ABC and VEN-analysis is demonstrated. The stages of development and implementation of process of medicinal support of multifield hospital applying principles of system of quality management (processing and systemic approaches, risk management) on the basis of standards ISO 9001 are described. The significance of monitoring of results ofprocess of medicinal support of the basis of implementation of priority target programs (prevention of venous thrombo-embolic complications, system od control of anti-bacterial therapy) are demonstrated in relation to multi-field hospital using technique of ATC/DDD-analysis for evaluating indices of effectiveness and efficiency.

Economic effects of Ohio's smoke-free law on Kentucky and Ohio border counties.

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Pyles, Mark K; Hahn, Ellen J

2011-01-01

To determine if the Ohio statewide smoke-free law is associated with economic activity in Ohio or Kentucky counties that lie on the border between the two states. In November 2006, Ohio implemented a comprehensive statewide smoke-free law for all indoor workplaces. A feasible generalised least squares (FLGS) time series design to estimate the impact of the Ohio smoke-free law on Kentucky and Ohio border counties. Six Kentucky and six Ohio counties that lie on the border between the two states. All reporting hospitality and accommodation establishments in all Kentucky and Ohio counties including but not limited to food and drinking establishments, hotels and casinos. Total number of employees, total wages paid and number of reported establishments in all hospitality and accommodation services, 6 years before Ohio's law and 1 year after. There is no evidence of a disproportionate change in economic activity in Ohio or Kentucky border counties relative to their non-border counterparts. There was no evidence of a relation between Ohio's smoke-free law and economic activity in Kentucky border counties. The law generated a positive influence on wages and number of establishments in Ohio border counties. The null result cannot be explained by low test power, as minimum changes necessary in the dependent variables to detect a significant influence are very reasonable in size. Our data add to the large body of evidence that smoke-free laws are neutral with respect to the hospitality business across jurisdictions with and without laws.

The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals.

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Varabyova, Yauheniya; Blankart, Carl Rudolf; Schreyögg, Jonas

2017-02-01

Changes in performance due to learning may dynamically influence the results of a technology evaluation through the change in effectiveness and costs. In this study, we estimate the effect of learning using the example of two minimally invasive treatments of abdominal aortic aneurysms: endovascular aneurysm repair (EVAR) and fenestrated EVAR (fEVAR). The analysis is based on the administrative data of over 40,000 patients admitted with unruptured abdominal aortic aneurysm to more than 500 different hospitals over the years 2006 to 2013. We examine two patient outcomes, namely, in-hospital mortality and length of stay using hierarchical regression models with random effects at the hospital level. The estimated models control for patient and hospital characteristics and take learning interdependency between EVAR and fEVAR into account. In case of EVAR, we observe a significant decrease both in the in-hospital mortality and length of stay with experience accumulated at the hospital level; however, the learning curve for fEVAR in both outcomes is effectively flat. To foster the consideration of learning in health technology assessments of medical devices, a general framework for estimating learning effects is derived from the analysis. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.

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Le Monnier, A; Duburcq, A; Zahar, J-R; Corvec, S; Guillard, T; Cattoir, V; Woerther, P-L; Fihman, V; Lalande, V; Jacquier, H; Mizrahi, A; Farfour, E; Morand, P; Marcadé, G; Coulomb, S; Torreton, E; Fagnani, F; Barbut, F

2015-10-01

The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied. The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals. A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used. A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences. The economic burden of CDI is substantial and directly impacts healthcare systems in France. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform

OpenAIRE

Aakvik, Arild; Holmås, Tor Helge; Kjerstad, Egil

2012-01-01

A health policy reform aiming to reduce hospital waiting times and sickness absences, the Faster Return to Work (FRW) scheme, is evaluated by creating treatment and control groups to facilitate causal interpretations of the empirical results. We use a unique dataset on individuals where we match hospital data with social security data and socio-economic characteristics. The main idea behind the reform is that long waiting times for hospital treatment lead to unnecessarily long periods of sick...

On the disposal of solid radioactive wastes at hospitals

International Nuclear Information System (INIS)

Rogge, B.; Lewe, P.

1987-01-01

The disposal of radioactive materials in hospitals represents a considerable problem from the point of view of economics and organisation as well as from the point of view of radiological safety. On the one-hand, groups of people (nursing personal and clean-up crews) are involved in the handling of contaminated materials who can be instructed in special handling procedures only to a limited degree with the result that simple and clear procedures must be developed; on the other hand, such simply structured routes of disposal result in enormous volumes of radioactive waste, which represent a considerable cost factor. At the Offenbach City Hospital a concept has been created which takes these problems into account. It consists of nuclide-specific collection in groups, reduction of volume by breaking up of materials, interim storage, and government approved disposal as special hospital waste materials. (orig.) [de

Nurses' hospital orientation and future research challenges: an integrative review.

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Peltokoski, J; Vehviläinen-Julkunen, K; Miettinen, M

2016-03-01

This study aimed to describe the research on registered nurses' orientation processes in specialized hospital settings in order to illustrate directions for future research. The complex healthcare environment and the impact of nursing shortage and turnover make the hospital orientation process imperative. There is a growing recognition regarding research interests to meet the needs for evidence-based, effective and economically sound hospital orientation strategies. An integrative literature review was performed on publications from the period 2000 to 2013 included in the CINAHL and PubMed databases. English-language studies were included. Themes guiding the analysis were definition of the hospital orientation process, research topics, data collection and instruments and research evidence. Narrative synthesis was used. Eleven papers met the inclusion criteria. The conceptualization of orientation process reflected the complexity of the phenomenon. Less attention has been paid to designs to establish correlations or relationships between selected variables and hospital orientation process. The outcomes of hospital orientation programmes were limited primarily to retention and job satisfaction. The research evidence therefore cannot be evaluated as strong. The lack of an evidence-based approach makes it difficult to develop a comprehensive orientation process. Further research should explore interventions that will enhance the quality of hospital orientation practices to improve nurses' retention and job satisfaction. To provide a comprehensive hospital orientation process, hospital administrators have to put in place human resource development strategies along with practice implications and research efforts. Comprehensive hospital orientation benefits and outcomes should be visible to policy makers. © 2016 International Council of Nurses.

The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study.

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Nanwa, Natasha; Kwong, Jeffrey C; Krahn, Murray; Daneman, Nick; Lu, Hong; Austin, Peter C; Govindarajan, Anand; Rosella, Laura C; Cadarette, Suzanne M; Sander, Beate

2016-09-01

BACKGROUND High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making. OBJECTIVE To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective. METHODS We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars. RESULTS We identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0-107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192-$36,005), $34,843 ($29,298-$40,027), and $37,171 ($30,364-$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221-$22,609), $26,074 ($25,180-$27,014), and $29,944 ($28,873-$31,086), respectively. CONCLUSIONS Hospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease. Infect Control Hosp Epidemiol 2016;37:1068-1078.

Dehydration in the Elderly: A Review Focused on Economic Burden.

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Frangeskou, M; Lopez-Valcarcel, B; Serra-Majem, L

2015-06-01

Dehydration is the most common fluid and electrolyte problem among elderly patients. It is reported to be widely prevalent and costly to individuals and to the health care system. The purpose of this review is to summarize the literature on the economic burden of dehydration in the elderly. A comprehensive search of several databases from database inception to November 2013, only in English language, was conducted. The databases included Pubmed and ISI Web of Science. The search terms «dehydration» / "hyponaremia" / "hypernatremia" AND «cost» AND «elderly» were used to search for comparative studies of the economic burden of dehydration. A total of 15 papers were identified. Dehydration in the elderly is an independent factor of higher health care expenditures. It is directly associated with an increase in hospital mortality, as well as with an increase in the utilization of ICU, short and long term care facilities, readmission rates and hospital resources, especially among those with moderate to severe hyponatremia. Dehydration represents a potential target for intervention to reduce healthcare expenditures and improve patients' quality of life.

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

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Fellows, Jeffrey L; Mularski, Richard; Waiwaiole, Lisa; Funkhouser, Kim; Mitchell, Julie; Arnold, Kathleen; Luke, Sabrina

2012-08-01

Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Fellows Jeffrey L

2012-08-01

Full Text Available Abstract Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of ‘forced abstinence’ for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231. Methods/Design The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW and at Oregon Health & Science University (OHSU hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR follow-up calls, compared to usual care inpatient counseling (UC. In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed

A population-based estimate of the economic burden of influenza in Peru, 2009-2010.

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Tinoco, Yeny O; Azziz-Baumgartner, Eduardo; Rázuri, Hugo; Kasper, Matthew R; Romero, Candice; Ortiz, Ernesto; Gomez, Jorge; Widdowson, Marc-Alain; Uyeki, Timothy M; Gilman, Robert H; Bausch, Daniel G; Montgomery, Joel M

2016-07-01

Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Hospital Presbiteriano Valley

Directory of Open Access Journals (Sweden)

Luckman, Charles

1964-12-01

Full Text Available This hospital is built on the circular system. This arrangement has economic and functional advantages. The nurses walk 40 % less distance than in a hospital of similar size, of conventional layout. The rooms are situated along the external perimeter and the beds are orientated towards the corridor, rather than towards the window. However, the patients can see out of doors by turning on their side. The hospital is most carefully fitted out, and is very comfortable. There is air conditioning, and patients can control their own TV sets. There are also curtains separating each bed form the rest, thus providing maximum independence. Warm colours have been adopted in the decoration of rooms facing north, whilst those facing south are painted in cooler tones. The circular design arrangement makes the distribution far more flexible, and it will be easier to include further units later on; by adding small adjustments to the central building. To reduce external noise, and to improve the surrounding landscape, small sand hills have been provided in the garden, and the parking site also serves to partially absorb the noise.Presenta esta solución de unidades circulares numerosas ventajas de tipo económico, ahorra espacio y da eficiencia a la circulación— las enfermeras recorren un 40 por 100 menos de camino que en otro hospital de dimensiones similares—. Las habitaciones están distribuidas a lo largo del perímetro exterior y tienen las camas orientadas hacia los corredores, en lugar de hacia las ventanas, pero de tal modo que los pacientes puedan contemplar el exterior al volverse sobre uno de sus costados. Están cuidadosamente diseñadas y dotadas de las máximas comodidades: aire acondicionado y aparatos de televisión controlados por el paciente; así como cortinas divisorias que le proporcionan el grado de aislamiento deseado.

Building patient-centeredness: hospital design as an interpretive act.

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Bromley, Elizabeth

2012-09-01

Hospital designs reflect the sociocultural, economic, professional, and aesthetic priorities prevalent at a given time. As such, hospital buildings concretize assumptions about illness, care and healing, patienthood, and medical providers' roles. Trends in hospital design have been attributed to the increasing influence of consumerism on healthcare, the influx of business-oriented managers, and technological changes. This paper describes the impact of the concept of patient-centeredness on the design of a new hospital in the USA. Data come from 35 interviews with planners, administrators, and designers of the new hospital, as well as from public documents about the hospital design. Thematic content analysis was used to identify salient design principles and intents. For these designers, administrators, and planners, an interpretation of patient-centeredness served as a heuristic, guiding the most basic decisions about space, people, and processes in the hospital. I detail the particular interpretation of patient-centeredness used to build and manage the new hospital space and the roles and responsibilities of providers working within it. Three strategies were central to the implementation of patient-centeredness: an onstage/offstage layout; a concierge approach to patients; and the scripting of communication. I discuss that this interpretation of patient-centeredness may challenge medical professionals' roles, may construct medical care as a product that should sate the patient's desire, and may distance patients from the realities of medical care. By describing the ways in which hospital designs reflect and reinforce contemporary concepts of patienthood and caring, this paper raises questions about the implementation of patient-centeredness that deserve further empirical study by medical social scientists. Copyright © 2012 Elsevier Ltd. All rights reserved.

The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients.

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Francesco Blasi

Full Text Available Chronic Obstructive Pulmonary Disease (COPD is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD on disease progression and costs.This is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status.15857 patients were enrolled -9911 males, mean age: 76 years (SD 10. Over a mean follow-up time of 2.4 years (1.36, 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590-6863. Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests.COPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.

Financial and economic costs of scaling up the provision of HAART ...

African Journals Online (AJOL)

Objectives: To provide new information on the financial and economic costs of providing highly active antiretroviral therapy (HAART) to health care workers in public-sector hospital settings in KwaZulu-Natal. Design: An Excel model was used to estimate the cost of providing HAART to health care workers at two ...

Materiality and Visualization in Hospital Design

DEFF Research Database (Denmark)

Harty, Chris; Tryggestad, Kjell

healthcare systems, single bed rooms are being seen as the preferred alternative to more traditional ward-style accommodation, as it has advantages for privacy and dignity for patients, less disruption to other patients and better control of hospital acquired infections. But fundamentally, single rooms mean...... of different representations and visualizations – economic calculations, drawings, and virtual and physical models. We use these cases to discuss the roles of different sorts of representations and visualizations in design process, in terms of opening up and settling controversies (such as room size), in terms...

Technical and organisational aspects in enterprise resource planning systems implementation: lessons from a Spanish public hospital

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Escobar-Rodriguez, Tomas; Escobar-Pérez, Bernabe; Monge-Lozano, Pedro

2014-09-01

Public resources should always be managed efficiently, more so in times of crisis. Due to the specific characteristics of the healthcare sector, there is a need for special attention, especially in regards to hospitals. Administrators need useful tools to be able to efficiently manage available resources, such as enterprise resource planning (ERP) systems. Therefore, an analysis of the effects of their implementation and use in hospitals is valuable. This study has two purposes. One is to analyse the role ERP systems play in aiding the integration of hospital data, with focus on user satisfaction as well as possible resistance to change. The other purpose is to analyse the effects of implanting and using ERP systems in the hospital environment and identifying how certain variables influence the process, especially the existence of different organisational cultures. Results indicate that clinical information has become notably more integrated, despite the lack of flow in the economic-financial area. The heterogeneous nature of the different groups, clinical (Medical, Nursing) and non-clinical (Economic-Financial, Accounting), had a negative influence on the implementation process, and limited the integration of information as well as the system's performance.

Economic impact of a head and neck oncologic surgeon: the case mix index.

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Jalisi, Scharukh; Sanan, Akshay; Mcdonough, Katie; Hussein, Khalil; Platt, Michael; Truong, Minh Tam; Couch, Marion; Burkey, Brian B

2014-10-01

Head and neck oncologic surgery is a time-consuming specialty that requires extensive resources and manpower. Case mix index (CMI) is used in evaluating the complexity and economic impact of surgeons. Head and neck oncologic surgeons generate significant revenue for hospitals, yet compensation is relatively low. Retrospective review of a tertiary hospital's case mix data for 605 otolaryngology admissions from 2009 to 2011 was performed. CMI comparison for head and neck oncologic surgeons versus general otolaryngology was performed. In an otolaryngology department of 9 surgeons; there was a significant difference (p 1) favoring head and neck oncologic surgeons. Head and neck oncologic surgeons increase the CMI for hospitals and ultimately influence the hospital's reimbursement. There is a need for increased collaboration between hospitals and departments in fostering and furthering their head and neck surgical oncology programs by taking CMI into consideration. © 2013 Wiley Periodicals, Inc.

Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia.

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Sadat-Ali, Mir; Al-Dakheel, Dakheel A; Azam, Md Q; Al-Bluwi, Mohammed T; Al-Farhan, Mohammed F; AlAmer, Hussein A; Al-Meer, Zakaria; Al-Mohimeed, Abdallah; Tabash, Ibrahim K; Karry, Maher O; Rassasy, Yaseen M; Baragaba, Mohammed A; Amer, Ahmed S; AlJawder, Abdallah; Al-Bouri, Kamil M; ElTinay, Mohammed; Badawi, Hamed A; Al-Othman, Abdallah A; Tayara, Badar K; Al-Faraidy, Moaad H; Amin, Ahmed H

2015-01-01

The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended. Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia. The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site. Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can

[Costs of chronic dialysis in a public hospital: myths and realities].

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Lamas, J; Alonso, M; Saavedra, J; García-Trío, G; Rionda, M; Ameijeiras, M

2001-01-01

In this study regular dialysis treatment costs during 1998 and 1999 in a public hospital, which is responsible for a population of 178,000, has been analysed. Hemodialysis (HD) and peritoneal dialysis (PD) costs have been differentiated and compared with those of external providers. The best technical and productive efficiency of both treatments have been estimated by analyzing the "treatment cost/human resources of the community utilized" relationship. The HD treatment costs per patient per year were 20,343 and 18,871 euros in 1988 and 1,999, respectively, lower than the costs reported in other studies. In 1999 these costs were similar to those of external providers and lower than the PD treatment costs (23,295 euros). HD retains its advantage even after costs of erythropoietin, hospital admissions and transport are included. In the hospital studied, the best technical efficiency in HD would be reached with 64 patients on treatment (17,851 euros per patient per year) and in PD with 48 patients (21,167 euros per patient per year). If we take into account our population characteristics and consider a patient distribution of 70% on HD and 30% on PD, the best productive efficiency would be reached with 56 patients on HD (17,916 euros per patient per year) and 24 patients on PD (21,813 euros per patient per year). HD confers the greatest economic and social benefits on the population supplied by the hospital since it provides the community with more jobs than PD in relation to treatment costs while the two yield the same clinical results. In conclusion, HD in a public hospital, at least in our environment, may be efficient and competitive with HD from external providers and it may be more efficient and provide a bigger economic and social profit for the population serviced by the hospital than PD, at least while the current supply systems for this treatment in our country are maintained.

Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications

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Foglia E

2017-06-01

Full Text Available Emanuela Foglia,1 Lucrezia Ferrario,1 Elisabetta Garagiola,1 Giuseppe Signoriello,2 Gianluca Pellino,3 Davide Croce,1,4 Silvestro Canonico3 1Centre for Health Economics, Social and Health Care Management - LIUC University, Castellanza, Italy; 2Department of Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 3School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 4School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South \tAfrica Purpose: Surgical-site complications (SSCs affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures.Patients and methods: A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment.Results: Patients developing an SSC absorbed i 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05 and ii 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05. If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483

CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

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Dragoi Mihaela Cristina

2011-12-01

Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

The main indicators for iranian hospital ethical accreditation

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SEYED ALI ENJOO

2015-07-01

Full Text Available Introduction: The application of organizational ethics in hospitals is one of the novel ways to improve medical ethics. Nowadays achieving efficient and sufficient ethical hospital indicators seems to be inevitable. In this connection, the present study aims to determine the best indicators in hospital accreditation. Methods: 69 indicators in 11 fields to evaluate hospital ethics were achieved through a five-step qualitative and quantitative study including literature review, expert focus group, Likert scale survey, 3 rounded Delphi, and content validity measurement. Expert focus group meeting was conducted, employing Nominal Group Technique (NGT. After running NGT, a three rounded Delphi and parallel to Delphi and a Likert scale survey were performed to obtain objective indicators for each domain. The experts were all healthcare professionals who were also medical ethics researchers, teachers, or Ph.D students. Content validity measurements were computed, using the viewpoints of two different expert groups, some ethicists, and some health care professionals (n=46. Results: After conducting NGT, Delphi, Likert survey, 11 main domains were listed including: Informed consent, Medical confidentiality, Physician-patient economic relations, Ethics consultation policy in the hospital, Ethical charter of hospital, Breaking bad medical news protocol, Respect for the patients’ rights, Clinical ethics committee, Spiritual and palliative care unit programs in the hospitals, Healthcare professionals’ communication skills, and Equitable access to the healthcare. Also 71 objective indicators for these 11 domains were listed in 11 tables with 5 to 8 indicators per table. Content Validity Ratio (CVR measurements were done and 69 indicators were highlighted. Conclusion: The domains listed in this study seem to be the most important ones for evaluating hospital ethics programs and services. Healthcare organizations’ accreditation and ranking are crucial for

Does economic crisis affect prevention services? An Italian region as a study case

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Corrado De Vito

2014-06-01

Full Text Available Background: The Latium Region in Italy is currently under pressure from national government to achieve economic consolidation of regional health services and is subject to a formal regional recovery plan.Methods: Using recognized health indicators together with a government assessment tool, we evaluate the impact of the economic downturn on the health of the Latium Region population.Results: We find that healthcare spending in the Latium Region needs to become more efficient by improving primary healthcare and by restoring efficiency in hospitals.Conclusions: Prevention activities should not only be defended in the current financial and economic crisis, but also streamlined and strengthened.

Economic Theory, Economic Reality And Economic Policy

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Dmitry Evgenievich Sorokin

2015-03-01

Full Text Available This paper analyzes the opposition between the «liberals» and «statists» in the Russian political and economic thought. It demonstrates that the economic liberalization is an absolute prerequisite for the transition to sustainable socio-economic development. Such development must rely on investment activities of the state, which in the current circumstances is a necessary but not sufficient measure for reversing the negative trends. The negative developments can be prevented only through implementation, along with the institutional changes in the economic area that form a strata of economically independent entrepreneurs-innovators, of no less profound transformation in political institutions aimed at democratization of public life

HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence.

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Miniati, Roberto; Dori, Fabrizio; Cecconi, Giulio; Gusinu, Roberto; Niccolini, Fabrizio; Gentili, Guido Biffi

2013-01-01

A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.

The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005

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Hagen Terje P

2011-10-01

Full Text Available Abstract Background There has been a marked increase in the number of Caesarean sections in many countries during the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased by about 260% (adjusted for inflation. Methods The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included. Results The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p Conclusion The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.

Leadership and priority setting: the perspective of hospital CEOs.

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Reeleder, David; Goel, Vivek; Singer, Peter A; Martin, Douglas K

2006-11-01

The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.

Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy.

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Janati, Ali; Sarabchian, Mohamad Ali; Mohaghegh, Bahram; Aghmohamadzadeh, Naser; Seyedin, Hesam; Gholizadeh, Masumeh; Hasanpoor, Edris

2017-11-01

Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care. A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

Has Health Care Reform Legislation Reduced the Economic Burden of Hospital Readmissions Following Primary Total Joint Arthroplasty?

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Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-11-01

The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs. The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA. The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age. Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. Copyright © 2017 Elsevier Inc. All rights reserved.

Underestimated uncertainties. Hospital-at-home for COPD exacerbations and methodological issues in the economic evaluation of healthcare

NARCIS (Netherlands)

L.M.A. Goossens (Lucas)

2013-01-01

textabstractEconomic evaluation has been defined as `the comparative analysis of alternative courses of action in terms of both their costs and consequences’. In an economic evaluation in healthcare, two or more interventions are compared in terms of costs and health outcomes. This results in

A Model for the Development of Hospital Beds Using Fuzzy Analytical Hierarchy Process (Fuzzy AHP).

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Ravangard, Ramin; Bahadori, Mohammadkarim; Raadabadi, Mehdi; Teymourzadeh, Ehsan; Alimomohammadzadeh, Khalil; Mehrabian, Fardin

2017-11-01

This study aimed to identify and prioritize factors affecting the development of military hospital beds and provide a model using fuzzy analytical hierarchy process (Fuzzy AHP). This applied study was conducted in 2016 in Iran using a mixed method. The sample included experts in the field of military health care system. The MAXQDA 10.0 and Expert Choice 10.0 software were used for analyzing the collected data. Geographic situation, demographic status, economic status, health status, health care centers and organizations, financial and human resources, laws and regulations and by-laws, and the military nature of service recipients had effects on the development of military hospital beds. The military nature of service recipients (S=0.249) and economic status (S=0.040) received the highest and lowest priorities, respectively. Providing direct health care services to the military forces in order to maintain their dignity, and according to its effects in the crisis, as well as the necessity for maintaining the security of the armed forces, and the hospital beds per capita based on the existing laws, regulations and bylaws are of utmost importance.

[Improvement approaches in the hospital setting: From total quality management to Lean].

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Curatolo, N; Lamouri, S; Huet, J-C; Rieutord, A

2015-07-01

Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean. Copyright © 2014. Published by Elsevier Masson SAS.

Strategic competition: the application of business planning techniques to the hospital marketplace.

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Morris, D E; Rau, S E

1985-01-01

Survival in the increasingly turbulent and uncertain health care environment should raise the application of business planning and corporate strategy to the highest levels of institutional consciousness. With hospital mergers and networking arrangements expected to account for over 60% of the hospital beds in the nation by 1990, and with government and business cost containment efforts squeezing hospital margins, the survivors are going to be those institutions able to develop and maintain a sustainable economic advantage over the competition in the programs and services that comprise the major portion of their business. The successful players will be those that allow the institution to identify and exploit new opportunities and concentrate management and financial resources in those segments of the market where competitive advantages are real and attainable.

In Preparation or Response: Examining Health Care Coalitions Amid a Changing Economic and Political Landscape.

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Dornauer, Mark E

2015-12-01

The Office of the Assistant Secretary for Preparedness and Response within the US Department of Health and Human Services leads the nation in preparing for, responding to, and recovering from the adverse health effects of public health emergencies, in part through formal collaborations between hospitals, health systems, community health centers, public health departments, and community organizations via health care coalitions (HCCs). HCCs endeavor to meet the medical surge demands inherent to disasters and to improve health outcomes before, during, and after public health emergencies. Nevertheless, significant changes in health economics and policy can impact the operations, capabilities, and scope of HCCs. Specifically, hospital consolidation and the Affordable Care Act (ACA) are altering the national health care landscape, as well as the emergency preparedness sector, and are challenging HCCs to adapt to large-scale, industry-wide transformations. This article examines HCCs in the context of the developments of hospital consolidation and the ACA in order to facilitate future discourse regarding the strategy and policy of HCCs amid a changing economic and political landscape.

Health and economic growth among the states of Brazil from 1991 to 2000

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Kenya Noronha

2010-12-01

Full Text Available Health status can affect economic growth through at least three mechanisms: 1 directly, through the relationship between health status and individual earnings, 2 indirectly, through the effect of health on levels of education, and 3 through physical capital investments. Poor health status causes considerable losses in individual income by decreasing labor productivity, numbers of hours worked, and participation in the labor force. These losses can affect a population's level of wealth and contribute to decreased social well-being. The main goal of this study is to assess the relationship between health and economic growth among the Brazilian states between 1991 and 2000. In order to take into account the different epidemiological and morbidity profiles observed among the states, several health measures were selected such as infant mortality rate, hospital mortality rate in the public healthcare system due to perinatal complications, and proportion of deaths from selected causes (vascular diseases, diabetes, cancer, AIDS and other communicable diseases, homicides and ill-defined causes. Our main findings show that in Brazil health correlates positively with economic growth. We also found that decreases in infant mortality rates are closely associated with higher rates of economic growth. We found a significant negative relationship for health indicators that are related to poverty, less access to health care services and deaths from avoidable causes, such as communicable diseases and hospital mortality rates due to perinatal complications. In contrast, we found a positive and significant correlation between the proportion of deaths from diabetes and cancer, on the one hand, and economic growth, on the other.

Nosocomial infections among acute leukemia patients in China: An economic burden analysis.

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Wu, Xiaohui; Yan, Tianyuan; Liu, Yunhong; Wang, Jingna; Li, Yingxia; Wang, Shuhui

2016-10-01

The economic burden associated nosocomial infections (NIs) in patients with acute leukemia (AL) in China was unclear. A prospective study was conducted to quantify the medical cost burden of NIs among AL patients. Nine hundred ninety-four patients diagnosed with AL between January 2011 and December 2013 were included. Relevant necessary information was extracted from the hospital information system and hospital infection surveillance system. The primary outcome was incidence of NIs and the secondary was economic burden results, including extra medical costs and prolonged length of stay (LOS). We estimated the total incremental cost of NIs by comparing all-cause health care costs in patients with versus without infections. Prolonged duration of stay was compared in patients with different infections. Of 994 patients with AL, 277 (27.9%) experienced NIs. NI was associated with a total incremental cost of $3,092 per patient ($5,227 vs $2,135; P economic burden on patients with AL. The study highlights the influence of NIs on LOS and health care costs and appeal to the establishment of prophylactic measures for NIs to reduce the unnecessary waste of medical resources in the long run. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Review on importance of energy efficiency in hospitality

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Barjaktarović Dragan

2017-01-01

Full Text Available Taking into consideration that lately tourism has become one of the most significant economic activities, and hospitality as its main key part there is a need to observe constant market trend changes in order to achieve business improvements for hoteliers. Modern technologies in hospitality influence on cost reduction, increase of profit and competitiveness, and finally on enhancing guests' satisfaction. The usage of modern technologies in rational use of energy is of strategic importance for every hotel company due to reduction of costs, strengthens of competitiveness, increases of productivity, and on the other side, becomes a strategic tool which influences on business efficiency improvement. Therefore, there is a natural need and feeling of those who are stakeholders of tourism and hospitality to inform themselves about new technologies. The aim of this article is to provide insight into the latest trends, necessities and current issues in the field of for rational use of energy in all areas of hotel operations, which will result in the creation of high-quality services and provide full customer satisfaction.

Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia, Prospective Population Based Data Linkage Study.

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Kimberley McAuley

Full Text Available Indigenous infants (infants aged under 12 months have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants.Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA. Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] on hospital utilisation and to understand the causes of hospital utilisation.There were 3,382 (5.4% Indigenous and 59,583 (94.6% non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77-2.04, p = <0.001 and emergency department presentation (aOR 2.15, 95% CI 1.98-2.33, p = <0.001 compared to non-Indigenous infants. Fifty nine percent (59.0% of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88-2.39. The risk of hospital admission in the most disadvantaged (IRSD 1 infants in the total cohort (35.7% was similar to the risk in the least disadvantaged (IRSD 5 infants (30.6% (aOR 1.04, 95% CI 0.96-1.13, p = 0.356.WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.

Hospital staffing and hospital costs.

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Andrew, R R

1976-08-07

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

Complementary effect of patient volume and quality of care on hospital cost efficiency.

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Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

2017-06-01

This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

Home hospitalization in the spectrum of community geriatric care.

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Stessman, J; Hammerman-Rozenberg, R; Cohen, A

1997-04-01

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

HOSPITAL MANAGERS' NEED FOR INFORMATION ON HEALTH TECHNOLOGY INVESTMENTS.

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Ølholm, Anne Mette; Kidholm, Kristian; Birk-Olsen, Mette; Christensen, Janne Buck

2015-01-01

There is growing interest in implementing hospital-based health technology assessment (HB-HTA) as a tool to facilitate decision making based on a systematic and multidisciplinary assessment of evidence. However, the decision-making process, including the informational needs of hospital decision makers, is not well described. The objective was to review empirical studies analysing the information that hospital decision makers need when deciding about health technology (HT) investments. A systematic review of empirical studies published in English or Danish from 2000 to 2012 was carried out. The literature was assessed by two reviewers working independently. The identified informational needs were assessed with regard to their agreement with the nine domains of EUnetHTA's Core Model. A total of 2,689 articles were identified and assessed. The review process resulted in 14 relevant studies containing 74 types of information that hospital decision makers found relevant. In addition to information covered by the Core Model, other types of information dealing with political and strategic aspects were identified. The most frequently mentioned types of information in the literature related to clinical, economic and political/strategic aspects. Legal, social, and ethical aspects were seldom considered most important. Hospital decision makers are able to describe their information needs when deciding on HT investments. The different types of information were not of equal importance to hospital decision makers, however, and full agreement between EUnetHTA's Core Model and the hospital decision-makers' informational needs was not observed. They also need information on political and strategic aspects not covered by the Core Model.

Hospitality industry veteran and Hampton Roads Center team up to present workshop on ensuring success

OpenAIRE

Felker, Susan B.

2008-01-01

Hospitality industry veteran Howard Feiertag is hosting a workshop aimed at novice and experienced hotel sales managers, directors and general managers looking for ways to reinvigorate their team's efforts and ensuring success during economic shifts.

A Race to the Top? Competitive Pressure and Magnet Adoption Among US Hospitals 1997-2012.

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Richards, Michael R; Lasater, Karen; McHugh, Matthew

2017-04-01

Care quality continues to be a focal point within US health care. One quality innovation is the Magnet recognition program for hospitals, which is a nurse-driven initiative emphasizing care and patient-safety improvements. To date, Magnet hospitals have been associated with better outcomes, but their distribution is highly uneven. Relatedly, little research has characterized what factors drive Magnet adoption (eg, competitive pressure from other hospitals). To examine if hospitals respond to more competing hospitals becoming Magnets by also becoming Magnet institutions. We use longitudinal data from the American Hospital Association, 1997-2012, and estimate hospital-level fixed-effect regressions to capture the association between Magnet adoption among competitors and a hospital's own likelihood of becoming a Magnet. We also explore heterogeneity in the relationships according to a hospital's standing within its market. Having more competitors become Magnets strongly predicts that a given hospital seeks Magnet recognition; yet, a hospital's market position and prevailing competition levels are moderating influences. A large literature links Magnet hospitals with better outcomes for patients and nurses, and more recent evidence suggests a business case for becoming a Magnet. We find evidence that hospitals seem motivated by competitive pressure, which suggests economic considerations in the decision to invest in costly care improvements.

Financial impact of surgical training on hospital economics: an income analysis of 1184 out-patient clinic consultations.

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Fitzgerald, J E F; Ravindra, P; Lepore, M; Armstrong, A; Bhangu, A; Maxwell-Armstrong, C A

2013-01-01

In many countries healthcare commissioning bodies (state or insurance-based) reimburse hospitals for their activity. The costs associated with post-graduate clinical training as part of this are poorly understood. This study quantified the financial revenue generated by surgical trainees in the out-patient clinic setting. A retrospective analysis of surgical out-patient ambulatory care appointments under 6 full-time equivalent Consultants (Attendings) in one hospital over 2 months. Clinic attendance lists were generated from the Patient Access System. Appointments were categorised as: 'new', 'review' or 'procedure' as per the Department of Health Payment by Results (PbR) Outpatient Tariff (Outpatient Treatment Function Code 104; Outpatient Procedure Code OPRSI1). During the study period 78 clinics offered 1184 appointments; 133 of these were not attended (11.2%). Of those attended 1029 had sufficient detail for analysis (98%). 261 (25.4%) patients were seen by a trainee. Applying PbR reimbursement criteria to these gave a projected annual income of £GBP 218,712 (€EU 266,527; $USD 353,657) generated by 6 surgical trainees (Residents). This is equivalent to approximately £GBP 36,452 (€EU 44,415; $USD 58,943) per trainee annually compared to £GBP 48,732 (€EU 59,378; $USD 78,800) per Consultant. This projected yearly income off-set 95% of the trainee's basic salary. Surgical trainees generated a quarter of the out-patient clinic activity related income in this study, with each trainee producing three-quarters of that generated by a Consultant. This offers considerable commercial value to hospitals. Although this must offset productivity differences and overall running costs, training bodies should ensure hospitals offer an appropriate return. In a competitive market hospitals could be invited to compete for trainees, with preference given to those providing excellence in training. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights

Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure.

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Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D

2015-05-01

We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient's characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP's being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All

Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible?

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Jit, Mark; Hutubessy, Raymond

2016-06-01

Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve.

Primary kidney disease and post-renal transplantation hospitalization costs.

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Ghoddousi, K; Ramezani, M K; Assari, S; Lankarani, M M; Amini, M; Khedmat, H; Hollisaaz, M T

2007-05-01

This study sought to assess posttransplantation hospitalizations costs in diabetic and nondiabetic subjects to see whether diabetes mellitus (DM) as a primary cause of end-stage renal disease (ESRD) increased posttransplantation hospitalization costs. From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively compared for two groups: patients with ESRD due to DM (n=71) and those with ESRD of non-DM etiologies (n=316). The hospitalization costs included the costs of hotel, medications, surgical procedures, paraclinical tests, imaging tests, health personnel time, special services (ie, patient transportation by ambulance), and miscellaneous costs. Societal perspective was used with costs expressed in PPP$ purchase power parity dollars (PPP$) estimated to be equal to 272 Iranian rials. Compared with the non-DM group, DM patients experienced significantly higher median costs both in total (1262 vs 870 PPP$, P=.001) and in cost components related to hotel (384 vs 215 PPP$, P=.001), health personnel time (235 vs 115 PPP$, P<.001), paraclinical tests (177 vs 149 PPP$, P=.012), and special services (100 vs 74 PPP$, P=.041). The mean of age was higher (P<.001), and the transplantation hospitalization time interval was also shorter in the DM group (median: 2.7 vs 12, P=.025). Considering DM as a leading cause of ESRD and its increasing prevalence in some countries, the association between hospitalization costs of posttransplant patients and DM may be of great economic importance to many transplantation centers.

The economic burden of schizophrenia in Malaysia.

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Teoh, Siew Li; Chong, Huey Yi; Abdul Aziz, Salina; Chemi, Norliza; Othman, Abdul Razak; Md Zaki, Nurzuriana; Vanichkulpitak, Possatorn; Chaiyakunapruk, Nathorn

2017-01-01

Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.

An energy saving system for hospital laundries

Energy Technology Data Exchange (ETDEWEB)

Katsanis, J.S.; Tsarabaris, P.T.; Polykrati, A.D.; Proios, A.N. [National Technical Univ. of Athens, Athens (Greece). School of Electrical and Computer Engineering; Koufakis, E.I. [Public Power Corp. S.A., Crete (Greece)

2009-07-01

Hospital laundries are one of the largest consumers of water and electrical and thermal energy. This paper examined the energy savings achieved by a system using the hot wastewater from the washing process. Hospital laundries consume thermal energy using steam, which is produced in boilers by burning diesel oil or natural gas. Electrical energy for the mechanical drives, ventilation and also the lighting required in the laundry area are big consumers of energy. The paper presented the proposed system and discussed the parameters of the system and system dimensioning. The paper also provided and discussed an interpretation of steam and energy savings. The proposed system was considered to be economically viable, simple in its construction, installation and operation. From the application of the suggested system, the cost savings resulted in a satisfactory payback period for the capital invested of approximately three to five years. 14 refs., 4 tabs., 2 figs.

The health care market: can hospitals survive?

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Goldsmith, J C

1980-01-01

Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.

Hospitality within hospital meals—Socio-material assemblages

DEFF Research Database (Denmark)

Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent E.

2016-01-01

Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic fie...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future......Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...

[Transparency in public sector acquisitions. The case of hospitals in the City of Buenos Aires].

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Rossi, T; Murillo Fort, C; Puente Karolys, J C

2002-01-01

This paper deals with corruption and the lack of transparency in public sector purchases as well as with the main instruments to obtain adequate results in purchase negotiation.Firstly, we discuss how corruption causes concern to national governments, international organizations, academic centers, non-governmental organizations and society in general. The consequences of corruption in Argentina and other Latin American countries are highlighted, especially the effect of corruption on economic growth and the way it creates economic inefficiency and inequality.Secondly, the database created by the Subsecretary of Strategic Management of the Autonomous Government of the City of Buenos Aires is analyzed. The central purpose of this study is to evaluate the impact of the Administrative Reform of 1998 on the prices of 24 products acquired by 13 general acute care hospitals from 1998-1999. The weighted prices, the number of units purchased and the total number of contracts given in this period, as well as the products with the greatest utilization rate, are analyzed. Multivariante analysis was used to identify hospitals with appropriate activity and efficient budget administration (activity and negotiation indicators). Price development was analyzed using the regression technique (ordinary least squares), which demonstrated an 8% reduction in prices for the year 1999. The contribution of each hospital to this variation is presented using dummy variables. Thus, six of the 13 hospitals significantly contributed to the decrease in prices. Of these six, three hospitals also contributed to reduction in price dispersion. The results obtained allow us to conclude that, if public hospitals have adequate purchase negotiation instruments and a uniform legal framework, they can achieve a good level of activity. Furthermore, public hospitals can contribute to reductions in price and price dispersion, at the same time as improving efficiency in the assignation and utilization of

Applying hospital evidence to paramedicine: issues of indirectness, validity and knowledge translation.

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Bigham, Blair; Welsford, Michelle

2015-05-01

The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.

Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems

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Glenn A. Melnick PhD

2016-06-01

Full Text Available A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113% than prices paid to all other California hospitals (70%. Prices were similar in both groups at the start of the period (approximately $9200 per admission. By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country.

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

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Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

2013-01-01

Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. 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. 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). 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.

Impact of a hand hygiene campaign in a tertiary hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and economic evaluation of the campaign.

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Chun, June Young; Seo, Hye Kyung; Kim, Min-Kyung; Shin, Myoung Jin; Kim, Su Young; Kim, Moonsuk; Kim, Chung-Jong; Song, Kyoung-Ho; Kim, Eu Suk; Lee, Heeyoung; Kim, Hong Bin

2016-12-01

Hand hygiene (HH) is the most important factor affecting health care-associated infections. We introduced a World Health Organization HH campaign in October 2010. The monthly procurement of hand sanitizers per 1,000 patient days was calculated, and the monthly incidence of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), classified into community- and hospital-onset (HO), was measured from a microbiologic laboratory database. Trends of MRSAB incidence were assessed using Bayesian structural time series models. A cost-benefit analysis was also performed based on the economic burden of HO MRSAB in Korea. Procurement of hand sanitizers increased 134% after the intervention (95% confidence interval [CI], 120%-149%), compared with the preintervention period (January 2008-September 2010). In the same manner, HH compliance improved from 33.2% in September 2010 to 92.2% after the intervention. The incidence of HO MRSAB per 100,000 patient days decreased 33% (95% CI, -57% to -7.8%) after the intervention. Because there was a calculated reduction of 65 HO MRSAB cases during the intervention period, the benefit outweighed the cost (total benefit [$851,565]/total cost [$167,495] = 5.08). Implementation of the HH campaign led to increased compliance and significantly reduced HO MRSAB incidence; it was also cost saving. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence.

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Milte, R K; Ratcliffe, J; Miller, M D; Crotty, M

2013-12-01

Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost-effectiveness studies made synthesis of results challenging, cost-benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary, the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.

Adopting new medical technologies in Russian hospitals: what causes inefficiency? (qualitative study).

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Shishkin, Sergey; Zasimova, Liudmila

2018-01-01

The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006-2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals' and authorities' motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities' main concern is the initial cost of the technology.

The billing process at a teaching hospital specialized in cardiology and pulmonology

Directory of Open Access Journals (Sweden)

Gabriela Favaro Faria Guerrer

2014-09-01

Full Text Available The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences between patient charts and the patient’s hospital bill. doi: 10.5216/ree.v16i3.23487.

Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

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Hasan Onur Topcu

2015-03-01

Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000: 113-118

The challenge of corporatisation: the experience of Portuguese public hospitals.

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Rego, Guilhermina; Nunes, Rui; Costa, José

2010-08-01

The inability of traditional state organisations to respond to new economic, technological and social challenges and the associated emerging problems has made it necessary to adopt new methods of health management. As a result, new directions have emerged in the reform of Public Administration together with the introduction of innovative models. The aim is to achieve a type of management that focuses on results as well as on effort and efficiency. We intend to analyse to what extent the adoption of business management models by hospital healthcare units can improve their performance, mainly in terms of standards of efficiency. Data envelopment analysis (DEA) was used to investigate the efficiency of a set of public Portuguese hospitals. The aim was to evaluate the impact of business management in Portuguese public hospitals with regards to efficiency, specifically taking into account the fact that lack of resources and increased health care needs are a present and future reality. From a total of 83 public hospitals, a sample of 59 hospitals was chosen, of which 21 are state-owned hospital enterprises (SA) and 38 are traditional public administration sector hospitals (SPA). This study evaluates hospital performance by calculating two efficiency measures associated with two categories of inputs. The first efficiency measures the costs associated with hospital production lines and the number of beds (representing fixed capacity) as inputs. The annual costs generated by the hospitals in the consumption of capital and work (direct and indirect costs) are used. A second measure of efficiency is calculated separately. This measure includes in the inputs the number of beds as well as the human resources available (number of doctors, number of nurses and other personnel) in each hospital. With regard to output, the variables that best reflect the hospital services rendered were considered: number of inpatient days, patients discharged, outpatient visits, emergencies

Trends in hospitalization for atrial fibrillation: epidemiology, cost, and implications for the future.

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Sheikh, Azfar; Patel, Nileshkumar J; Nalluri, Nikhil; Agnihotri, Kanishk; Spagnola, Jonathan; Patel, Aashay; Asti, Deepak; Kanotra, Ritesh; Khan, Hafiz; Savani, Chirag; Arora, Shilpkumar; Patel, Nilay; Thakkar, Badal; Patel, Neil; Pau, Dhaval; Badheka, Apurva O; Deshmukh, Abhishek; Kowalski, Marcin; Viles-Gonzalez, Juan; Paydak, Hakan

2015-01-01

Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the most common arrhythmia leading to hospitalization. Due to a substantial increase in incidence and prevalence of AF over the past few decades, it attributes to an extensive economic and public health burden. The increasing number of hospitalizations, aging population, anticoagulation management, and increasing trend for disposition to a skilled facility are drivers of the increasing cost associated with AF. There has been significant progress in AF management with the release of new oral anticoagulants, use of left atrial catheter ablation, and novel techniques for left atrial appendage closure. In this article, we aim to review the trends in epidemiology, hospitalization, and cost of AF along with its future implications on public health. Published by Elsevier Inc.

Economic implications of home births and birth centers: a structured review.

Science.gov (United States)

Henderson, Jane; Petrou, Stavros

2008-06-01

It is widely perceived that home births and birth centers may help decrease the costs of maternity care for women with uncomplicated pregnancies and deliveries. This structured review examines the literature relating to the economic implications of home births and birth center care compared with hospital maternity care. The bibliographic databases MEDLINE (from 1950), CINAHL (from 1982), EMBASE (from 1980), and an "in-house" database, Econ2, were searched for relevant English language publications using MeSH and free text terms. Data were extracted with respect to the study design, inclusion criteria, clinical and cost results, and details of what was included in the cost calculations. Eleven studies were included from the United Kingdom, United States, Australia, and Canada. Two studies focused on home births versus other forms and locations of care, whereas nine focused on birth centers versus other forms and locations of care. Resource use was generally lower for women cared for at home and in birth centers due to lower rates of intervention, shorter lengths of stay, or both. However, this fact did not always translate into lower costs because, in the U.K. where many studies were conducted, more midwives of a higher grade were employed to manage the birth centers than are usually employed in maternity units, and because of costs of converting existing facilities into delivery rooms. The quality of much of the literature was poor, although no studies were excluded for this reason. Selection bias was likely to be a problem in those studies not based on randomized controlled trials because, even where birth center eligibility was applied throughout, women who choose to deliver at home or in a birth center are likely to be different in terms of expectations and approach from women choosing to deliver in hospital. This review highlights the paucity of economic literature relating to home births and birth centers. Differences in results between studies may be

Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review.

Science.gov (United States)

Farbman, L; Avni, T; Rubinovitch, B; Leibovici, L; Paul, M

2013-12-01

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with 6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Use of acute care hospital services by immigrant seniors in Ontario: A linkage study.

Science.gov (United States)

Ng, Edward; Sanmartin, Claudia; Tu, Jack; Manuel, Doug

2014-10-01

Seniors constitute the largest group of hospital users. The increasing share of immigrants in Canada's senior population can affect the demand for hospital care. This study used the linked 2006 Census-Hospital Discharge Abstract Database to examine hospitalization during the 2004-to-2006 period, by immigrant status, of Ontario seniors living in the community. Hospitalization was assessed with logistic regressions; cumulative length of stay, with zero-truncated negative binomial regressions. All-cause hospitalization and hospitalizations specific to circulatory and digestive diseases were examined. Immigrant seniors had significantly low age-/sex-adjusted odds of hospitalization, compared with Canadian-born seniors (OR = 0.81). The odds varied from 0.4 among East Asians to 0.89 among Europeans, and rose with length of time since arrival from 0.54 for recent (1994 to 2003) to 0.86 for long-term (before 1984) immigrants. Adjustment for demographic and socio-economic characteristics did not change the overall patterns. Immigrants' cumulated length of hospital stay tended to be shorter than or similar to that of Canadian-born seniors. Immigrant seniors, especially recent arrivals, had lower odds of hospitalization and similar time in hospital, compared with Canadian-born seniors. These patterns likely reflect differences in health status. Variations by world region and disease reflect the diverse health care needs of immigrant seniors.

Healthcare Costs for Acute Hospitalized and Chronic Heart Failure in South Korea: A Multi-Center Retrospective Cohort Study.

Science.gov (United States)

Ku, Hyemin; Chung, Wook Jin; Lee, Hae Young; Yoo, Byung Soo; Choi, Jin Oh; Han, Seoung Woo; Jang, Jieun; Lee, Eui Kyung; Kang, Seok Min

2017-09-01

Although heart failure (HF) is recognized as a leading contributor to healthcare costs and a significant economic burden worldwide, studies of HF-related costs in South Korea are limited. This study aimed to estimate HF-related costs per Korean patient per year and per visit. This retrospective cohort study analyzed data obtained from six hospitals in South Korea. Patients with HF who experienced ≥one hospitalization or ≥two outpatient visits between January 1, 2013 and December 31, 2013 were included. Patients were followed up for 1 year [in Korean won (KRW)]. Among a total of 500 patients (mean age, 66.1 years; male sex, 54.4%), the mean 1-year HF-related cost per patient was KRW 2,607,173, which included both, outpatient care (KRW 952,863) and inpatient care (KRW 1,654,309). During the post-index period, 22.2% of patients had at least one hospitalization, and their 1-year costs per patient (KRW 8,530,290) were higher than those of patients who had only visited a hospital over a 12-month period (77.8%; KRW 917,029). Among 111 hospitalized patients, the 1-year costs were 1.7-fold greater in patients (n=52) who were admitted to the hospital via the emergency department (ED) than in those (n=59) who were not (KRW 11,040,453 vs. KRW 6,317,942; pSouth Korea was related to hospitalization, especially admissions via the ED. Appropriate treatment strategies including modification of risk factors to prevent or decrease hospitalization are needed to reduce the economic burden on HF patients. © Copyright: Yonsei University College of Medicine 2017

The new strategic orientation in innovating hospitality logistics system

OpenAIRE

Christian Stipanović; Elena Rudan

2014-01-01

Purpose – This paper investigates ways how to innovate logistics processes in the hospitality industry aimed at achieving spatio - temporal transformation of resource base into competitive advantages based on innovation and quality. Economic goal of modern logistics based on knowledge is to provide a unique experience for tourists at minimum cost in order to multiply operational profit. Operational profit has to be largely reinvested in the new strategic orientations as well as in new inta...

Corporate social responsibility reporting: The case of Portuguese hospitals

OpenAIRE

Oliveira, Joana Nicolau

2012-01-01

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics This research investigated Portuguese Hospitals’ Corporate Social Responsibility reporting practices, by analyzing Hospitals’ Annual Reports and websites. The main hospital stakeholders were presented and activities pertaining to each group included. Overall, it appears that there is a lack of strategic CSR reporting on both private and publ...

What do hypnotics cost hospitals and healthcare? [version 2; referees: 2 approved

Directory of Open Access Journals (Sweden)

Daniel F. Kripke

2017-06-01

Full Text Available Hypnotics (sleeping pills are prescribed widely, but the economic costs of the harm they have caused have been largely unrecognized. Randomized clinical trials have observed that hypnotics increase the incidence of infections. Likewise, hypnotics increase the incidence of major depression and cause emergency admissions for overdoses and deaths.  Epidemiologically, hypnotic use is associated with cancer, falls, automobile accidents, and markedly increased overall mortality.  This article considers the costs to hospitals and healthcare payers of hypnotic-induced infections and other severe consequences of hypnotic use. These are a probable cause of excessive hospital admissions, prolonged lengths of stay at increased costs, and increased readmissions. Accurate information is scanty, for in-hospital hypnotic benefits and risks have scarcely been studied -- certainly not the economic costs of inpatient adverse effects.  Healthcare costs of outpatient adverse effects likewise need evaluation. In one example, use of hypnotics among depressed patients was strongly associated with higher healthcare costs and more short-term disability. A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion. More research is needed to more accurately assess unnecessary and excessive hypnotics costs to providers and insurers, as well as financial and health damages to the patients themselves.

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

Science.gov (United States)

Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

2017-02-01

to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these

Paediatric tracheostomy and ventilation home care with challenging socio-economic circumstances in South Africa.

Science.gov (United States)

Groenendijk, Ilse; Booth, Jane; van Dijk, Monique; Argent, Andrew; Zampoli, Marco

2016-05-01

Children discharged home with a tracheostomy need a safe home environment and access to health care. We described the indications, clinical characteristics, socio-economic circumstances and outcomes of children enroled in a tracheostomy home care programme in South Africa. We performed a retrospective chart review of children receiving a tracheostomy and enroled in the Breatheasy programme at the Red Cross War Memorial Children's Hospital, Cape Town. Medical and background characteristics were recorded. Influences of socio-economic variables and underlying medical conditions on length of hospital stay, unplanned readmissions and mortality in the first year after discharge were evaluated. In the period 2008-2012, 157 patients were discharged home with a tracheostomy. Median hospital stay after tracheostomy insertion was significantly longer when parents had incomplete schooling compared to completed secondary school or higher education; 30 days (IQR 21-53) versus 23 days (IQR 16-33), respectively. Unplanned readmissions in the first year were documented for 72 patients (45.9%). The risk for unplanned readmission was 2.6 times higher in families with substance abuse the risk of respiratory infections was two-fold in case of household cigarette smoke exposure (OR 2.3.) Tracheostomy-related mortality was low (1.2%). An underlying medical condition was the only independent significant risk factor for mortality (OR 5.1, 95% CI 1.8-14.3). This study demonstrates that despite difficult socio-economic circumstances, home ventilation of children with a tracheostomy is safe, provided caregivers are adequately trained and supported. Copyright © 2016. Published by Elsevier Ireland Ltd.

The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada

OpenAIRE

Ishak Khajak J; Migliaccio-Walle Kristen; Caro J Jaime; Proskorovsky Irina; O'Brien Judith A

2006-01-01

Abstract Background Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. Methods Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 19...

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study.

Science.gov (United States)

de Bruijne, Martine C; van Rosse, Floor; Uiters, Ellen; Droomers, Mariël; Suurmond, Jeanine; Stronks, Karien; Essink-Bot, Marie-Louise

2013-12-01

Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02-1.08] for other non-Western patients to 1.14 (95% CI 1.07-1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18-1.30) and Surinamese patients (OR 1.11, 95% CI 1.07-1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals' control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.

Nowhere to run, or hide. Current economic downturn may exacerbate hospitals' weakness with buildings, technology costs, reimbursements.

Science.gov (United States)

Becker, Cinda

2008-04-21

As the economy moves through what many believe is a recession, healthcare won't be immune, experts say. "I don't know much in the economy that is recession-proof, and I don't think healthcare is either," says W. David Bradford, left, a Medical University of South Carolina economics professor. Because of the current economic conditions, some systems are rethinking where they put their money.

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

Science.gov (United States)

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

[The role of university hospital executive board members].

Science.gov (United States)

Debatin, J F; Rehr, J

2009-09-01

Demographic changes and medical progress in combination with vastly altered regulatory and economic environments have forced considerable change in the structure of German university hospitals in recent years. These changes have affected medical care as well as research and medical school training. To allow for more flexibility and a higher level of reactivity to the changing environment German university hospitals were transferred from state agencies to independent corporate structures. All but one remains wholly owned by the respective state governments. The governing structure of these independent medical hospitals consists of an executive board, generally made up of a medical director, a financial director, a director for nursing, and the dean of the medical faculty. In most hospitals, the medical director serves as chief executive officer. The regulations governing the composition and responsibility of the members of the executive board differ from state to state. These differences do affect to some degree the interactive effectiveness of the members of the executive boards. Modalities that stress the overall responsibility for all board members seem to work better than those that define clear portfolio limits. Even more than organizational and regulatory differences, the effectiveness of the work of the executive boards is influenced by the personality of the board members themselves. Success appears to be a clear function of the willingness of all members to work together.

Economic Cost of Dengue in Puerto Rico

Science.gov (United States)

Halasa, Yara A.; Shepard, Donald S.; Zeng, Wu

2012-01-01

Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008–2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70% was for adults (age 15+ years). Hospitalized patients accounted for 63% of the cost of dengue illness, and fatal cases represented an additional 17%. Households funded 48% of dengue illness cost, the government funded 24%, insurance funded 22%, and employers funded 7%. Including dengue surveillance and vector control activities, the overall annual cost of dengue was $46.45 million ($12.47 per capita). PMID:22556069

Struggle against privatization: a case history in the use of comparative performance evaluation of public hospitals.

Science.gov (United States)

Oh, Juhwan; Lee, Jin-Seok; Choi, Yong-Jun; Park, Hyeung-Keun; Do, Young Kyung; Eun, Sang-Jun

2011-01-01

After the 1997 economic crisis, the South Korean government implemented neoliberal policies in many sectors. In health care, the government attempted to privatize nine public hospitals, framing the initiative as "better management." In this discourse, public hospital workers were stereotyped as lazy and incompetent, while public hospitals were portrayed as poorly managed and of low quality. However, the government did not present any relevant evidence of improvement in already privatized hospitals, even though three hospitals had been semi-privatized at that time. In this study, the authors evaluated the effects of the semi-privatization, comparing the performance of the semi-privatized hospitals with that of the nine other hospitals targeted for privatization. The study found adverse effects on performance, unlike the claims made by the government. Semi-privatization intensified the workloads of hospital workers and the instability of employment, froze or decreased real wages, and drastically increased hospital revenue per patient stay. The changes may have resulted from redefining profit as the goal of the hospitals, as opposed to the previous focus on decision-making on public health. These research findings played a decisive role in the struggle to keep the targeted public hospitals free of privatization, especially in two of the nine hospitals targeted for privatization in 2001.

The health services wastes management of a sample of brazilian hospitals

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Claude Machline

2006-07-01

Full Text Available This paper focuses the Health Services wastes management of 70 Brazilian hospitals. As the outcome of a distance course, in 2003, each hospital was required to describe its existing Health Services wastes system and its Plan for improvement.The project was administered by an association of two leading Brazilian educational entities, the Fundação Getulio Vargas and the Universidade Federal de Santa Catarina. Data concerning collection, disposal and final treatment of infectious, hazardous, chemical, radioactive and common wastes were tabulated and analysed. Water supply, liquid effluents and gaseous emissions were also investigated..Their technical and economical aspects were appraised. The research indicates that the sampled hospitals are still in an incipient stage of wastes management. An extensive gap exists between the present situation and the legal and acceptable requirements they should comply with, both on health care and on environmental standpoints.

Can hospitals compete on quality? Hospital competition.

Science.gov (United States)

Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

2015-09-01

In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

Encouraging Healthful Dietary Behavior in a Hospital Cafeteria: A Field Study Using Theories from Social Psychology and Behavioral Economics

OpenAIRE

Mazza, Mary Carol

2013-01-01

Public policy efforts to curb obesity often adhere to a rational actor model of human behavior, asserting that consumer behavior will change provided proper economic incentives, nutritional information, and health education. However, rigorous academic research related to such questions remains limited in scope and appears inconclusive as to the success of such economic and cognitive interventions. In contrast, research in social psychology and behavioral economics suggests that decision mak...

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

Science.gov (United States)

Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto

2016-11-01

The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

The declining demand for hospital care as a rationale for duty hour reform.

Science.gov (United States)

Jena, Anupam B; DePasse, Jacqueline W; Prasad, Vinay

2014-10-01

The regulation of duty hours of physicians in training remains among the most hotly debated subjects in medical education. Although recent duty hour reforms have been chiefly motivated by concerns about resident well-being and medical errors attributable to resident fatigue, the debate surrounding duty hour reform has infrequently involved discussion of one of the most important secular changes in hospital care that has affected nearly all developed countries over the last 3 decades: the declining demand for hospital care. For example, in 1980, we show that resident physicians in US teaching hospitals provided, on average, 1,302 inpatient days of care per resident physician compared to 593 inpatient days in 2011, a decline of 54%. This decline in the demand for hospital care by residents provides an under-recognized economic rationale for reducing residency duty hours, a rationale based solely on supply and demand considerations. Work hour reductions and growing requirements for outpatient training can be seen as an appropriate response to the shrinking demand for hospital care across the health-care sector.

Predicting appointment misses in hospitals using data analytics

Science.gov (United States)

Karpagam, Sylvia; Ma, Nang Laik

2017-01-01

Background There is growing attention over the last few years about non-attendance in hospitals and its clinical and economic consequences. There have been several studies documenting the various aspects of non-attendance in hospitals. Project Predicting Appoint Misses (PAM) was started with the intention of being able to predict the type of patients that would not come for appointments after making bookings. Methods Historic hospital appointment data merged with “distance from hospital” variable was used to run Logistic Regression, Support Vector Machine and Recursive Partitioning to decide the contributing variables to missed appointments. Results Variables that are “class”, “time”, “demographics” related have an effect on the target variable, however, prediction models may not perform effectively due to very subtle influence on the target variable. Previously assumed major contributors like “age”, “distance” did not have a major effect on the target variable. Conclusions With the given data it will be very difficult to make any moderate/strong prediction of the Appointment misses. That being said with the help of the cut off we are able to capture all of the “appointment misses” in addition to also capturing the actualized appointments. PMID:28567409

Environmental and economic evaluation of the Massachusetts Smoke-Free Workplace Law.

Science.gov (United States)

Alpert, Hillel R; Carpenter, Carrie M; Travers, Mark J; Connolly, Gregory N

2007-08-01

An environmental and economic evaluation of the smoke-free law in Massachusetts provides a broad appreciation of how a state-wide smoking ban affects the health of patrons and workers as well as the industries that are commonly concerned about the effects of smoking bans on business. The aim of this study is to evaluate environmental and economic effects of the statewide Massachusetts statewide Smoke-Free Workplace Law. Before and after the smoking ban, air quality testing was conducted in a sample (n = 27) of hospitality venues and state-wide economic changes were assessed. Compliance, in terms of patronage was measured by person-counts. Environmental outcomes were respirable suspended particles (RSP) less than 2.5 microns in diameter (PM2.5). Economic outcomes were meals tax collections, employment in the food services and drinking places and accommodations industries. On average, levels of respirable suspended particles (RSPs) less than 2.5 microns in diameter (PM2.5) decreased 93% in these venues after the Massachusetts Smoke-free Workplace Law went into effect. No statistically significant changes were observed among the economic indicators. This evaluation demonstrates that the state-wide Massachusetts law has effectively improved indoor air quality in a sample of Massachusetts venues and has not negatively affected several economic indicators.

Economic burden of stroke in a large county in Sweden

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Persson Josefine

2012-09-01

Full Text Available Abstract Background Stroke remains to be a major burden of disease, often causing death or physical impairment or disability. This paper estimates the economic burden of stroke in a large county of 1.5 million inhabitants in western Sweden. Methods The economic burden of stroke was estimated from a societal perspective with an incidence approach. Data were collected from clinical registries and 3,074 patients were included. In the cost calculations, both direct and indirect costs were estimated and were based on costs for 12 months after a first-ever stroke. Results The total excess costs in the first 12 months after the first-ever stroke for a population of 1.5 million was 629 million SEK (€69 million. Men consumed more acute care in hospitals, whereas women consumed more rehabilitation and long-term care provided by the municipalities. Younger patients brought a significantly higher burden on society compared with older patients due to the loss of productivity and the increased use of resources in health care. Conclusions The results of this cost-of-illness study were based on an improved calculation process in a number of fields and are consistent with previous studies. In essence, 50% of costs for stroke care fall on acute care hospital, 40% on rehabilitation and long-time care and informal care and productivity loss explains 10% of total cost for the stroke disease. The result of this study can be used for further development of the methods for economic analyses as well as for analysis of improvements and investments in health care.

Global economic cost of smoking-attributable diseases.

Science.gov (United States)

Goodchild, Mark; Nargis, Nigar; Tursan d'Espaignet, Edouard

2018-01-01

The detrimental impact of smoking on health has been widely documented since the 1960s. Numerous studies have also quantified the economic cost that smoking imposes on society. However, these studies have mostly been in high income countries, with limited documentation from developing countries. The aim of this paper is to measure the economic cost of smoking-attributable diseases in countries throughout the world, including in low- and middle-income settings. The Cost of Illness approach is used to estimate the economic cost of smoking attributable-diseases in 2012. Under this approach, economic costs are defined as either 'direct costs' such as hospital fees or 'indirect costs' representing the productivity loss from morbidity and mortality. The same method was applied to 152 countries, which had all the necessary data, representing 97% of the world's smokers. The amount of healthcare expenditure due to smoking-attributable diseases totalled purchasing power parity (PPP) $467 billion (US$422 billion) in 2012, or 5.7% of global health expenditure. The total economic cost of smoking (from health expenditures and productivity losses together) totalled PPP $1852 billion (US$1436 billion) in 2012, equivalent in magnitude to 1.8% of the world's annual gross domestic product (GDP). Almost 40% of this cost occurred in developing countries, highlighting the substantial burden these countries suffer. Smoking imposes a heavy economic burden throughout the world, particularly in Europe and North America, where the tobacco epidemic is most advanced. These findings highlight the urgent need for countries to implement stronger tobacco control measures to address these costs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Budget impact of somatostatin analogs as treatment for metastatic gastroenteropancreatic neuroendocrine tumors in US hospitals

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Ortendahl JD

2017-08-01

Full Text Available Jesse D Ortendahl,1 Sonia J Pulgar,2 Beloo Mirakhur,3 David Cox,3 Tanya GK Bentley,1 Alexandria T Phan4 1Health Economics, Partnership for Health, LLC, Beverly Hills, CA, USA; 2Health Economics and Outcomes Research, Ipsen Biopharmaceuticals, Basking Ridge, NJ, USA; 3Medical Affairs, Oncology, Ipsen Biopharmaceuticals, Basking Ridge, NJ, USA; 4GI Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA Objective: With the introduction of new therapies, hospitals have to plan spending limited resources in a cost-effective manner. To assist in identifying the optimal treatment for patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors, budget impact modeling was used to estimate the financial implications of adoption and diffusion of somatostatin analogs (SSAs. Patients and methods: A hypothetical cohort of 500 gastroenteropancreatic neuroendocrine tumor patients was assessed in an economic model, with the proportion with metastatic disease treated with an SSA estimated using published data. Drug acquisition, preparation, and administration costs were based on national pricing databases and published literature. Octreotide dosing was based on published estimates of real-world data, whereas for lanreotide, real-world dosing was unavailable and we therefore used the highest indicated dosing. Alternative scenarios reflecting the proportion of patients receiving lanreotide or octreotide were considered to estimate the incremental budget impact to the hospital. Results: In the base case, 313 of the initial 500 gastroenteropancreatic neuroendocrine tumor patients were treated with an SSA. The model-predicted per-patient cost was US$83,473 for lanreotide and US$89,673 for octreotide. With a hypothetical increase in lanreotide utilization from 5% to 30% of this population, the annual model-projected hospital costs decreased by US$488,615. When varying the inputs in one-way sensitivity

Early discharge hospital at home.

Science.gov (United States)

Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

2017-06-26

-certainty evidence).Studies recruiting people undergoing elective surgeryThree studies did not report higher rates of mortality with hospital at home compared with inpatient care (data not pooled, N = 856, low-certainty evidence; mainly orthopaedic surgery). Hospital at home may lead to little or no difference in readmission to hospital for people who were mainly recovering from orthopaedic surgery (N = 1229, low-certainty evidence). We could not establish the effects of hospital at home on the risk of living in institutional care, due to a lack of data. The intervention might slightly improve patient satisfaction (N = 1229, low-certainty evidence). People recovering from orthopaedic surgery allocated to early discharge hospital at home were discharged from the intervention on average four days earlier than people allocated to usual inpatient care (4.44 days earlier, 95% CI 6.37 to 2.51 days earlier, , N = 411, 4 trials, moderate-certainty evidence). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence). Despite increasing interest in the potential of early discharge hospital at home services as a less expensive alternative to inpatient care, this review provides insufficient evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

A Systematic Review of Economic Evaluations of Pacemaker Telemonitoring Systems.

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López-Villegas, Antonio; Catalán-Matamoros, Daniel; Martín-Saborido, Carlos; Villegas-Tripiana, Irene; Robles-Musso, Emilio

2016-02-01

Over the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. We searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. Seven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. Compared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

[Health system reforms, economic constraints and ethical and legal values].

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Caillol, Michel; Le Coz, Pierre; Aubry, Régis; Bréchat, Pierre-Henri

2010-01-01

Health system and hospital reforms have led to important and on-going legislative, structural and organizational changes. Is there any logic at work within the health system and hospitals that could call into question the principle of solidarity, the secular values of ethics that govern the texts of law and ethics? In order to respond, we compared our experiences to a review of the professional and scientific literature from 1992 to 2010. Over the course of the past eighteen years, health system organization was subjected to variations and significant tensions. These variations are witnesses to a paradigm shift: although a step towards the regionalization of the health system integrating the choice of public health priorities, consultation and participatory democracy has been implemented, nevertheless the system was then re-oriented towards the trend of returning to centralization on the basis of uniting economics, technical modernization and contracting. This change of doctrine may undermine the social mission of hospitals and the principle of solidarity. Progress, the aging population and financial constraints would force policy-makers to steer the health system towards more centralized control. Hospitals, health professionals and users may feel torn within a system that tends to simplify and minimize what is becoming increasingly complex and global. Benchmarks on values, ethics and law for the hospitals, healthcare professionals and users are questioned. These are important elements to consider when the law on the reform of hospitals, patients, health care and territories and regional health agencies is implemented.

Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.

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Gabriel, L; Beriot-Mathiot, A

2014-09-01

In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden associated with it. A comprehensive literature review selected papers describing the costs and LOS for hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in US dollars, were $6,774-$10,212 for CDI requiring admission, $2,992-$29,000 for hospital-acquired CDI, and $2,454-$12,850 where no categorization was made. The ranges for LOS values were 5-13.6, 2.7-21.3, and 2.8-17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the various budget holders to invest in prevention so that CDI prevention is optimized globally. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

LENUS (Irish Health Repository)

Hannon, Niamh

2014-10-30

No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

Assessment of service delays and impact on bed utilisation in a major teaching hospital.

LENUS (Irish Health Repository)

Conway, R

2010-12-14

BACKGROUND: Increasing economic pressures coupled with an expanding and ageing population and a hostile economic climate have led to growing interest in the optimisation of bed usage within hospitals. There are many causes for delay in a patient\\'s discharge. METHODS: This prospective observational study assessed consecutive patients admitted and discharged from hospital within a 52-day period for waiting times in the provision of requested diagnostic tests and services. RESULTS: Seventy patients were included in the study. There were median delays of 2 and 3 days for an MRI and colonoscopy, a delay of 3 days for a Holter monitor report, and 9 days for an occupational therapy referral. The median wait for consults was 1 day across all three services. CONCLUSIONS: Significant remediable delays exist during the course of many acute medical admissions. Addressing these factors will enable the provision of a faster and more cost-efficient service.

Process management in healthcare. Sant Camil Hospital case study

OpenAIRE

Sánchez Ruiz, Lidia; Blanco Rojo, Beatriz; Simón, Rosa María

2013-01-01

Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management i...

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

DEFF Research Database (Denmark)

Sanchez Martinez, Gerardo; Spadaro, Joseph V.; Chapizanis, Dimitris

2018-01-01

the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution...... was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m³) could have....... Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city....

Governance and performance: the performance of Dutch hospitals explained by governance characteristics.

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Blank, Jos L T; van Hulst, Bart Laurents

2011-10-01

This paper describes the efficiency of Dutch hospitals using the Data Envelopment Analysis (DEA) method with bootstrapping. In particular, the analysis focuses on accounting for cost inefficiency measures on the part of hospital corporate governance. We use bootstrap techniques, as introduced by Simar and Wilson (J. Econom. 136(1):31-64, 2007), in order to obtain more efficient estimates of the effects of governance on the efficiency. The results show that part of the cost efficiency can be explained with governance. In particular we find that a higher remuneration of the board as well as a higher remuneration of the supervisory board does not implicate better performance.

The relationship between the Balanced Budget Act (BBA) and hospital profitability.

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Younis, Mustafa Z

2006-01-01

The Balanced Budget Act of 1997 (BBA) reduced the payment for fees for service providers and reduced the subsidy paid by the government for teaching hospitals. Since the passage of such cost containment measures, debates regarding their impact on hospitals, graduate medical education, and access to health care were raised. The need to examine the effect of such payment reduction on hospital profitability was widely ignored. We examined the relationship between the BBA and hospital profitability by using return on assets to measure profitability, by running an ordinary least squares regression for 1996 as pre-BBA and 1999 as post-BBA. We controlled for variables that were not included in previous literature, such as disproportionate share hospital status, critical access hospital status, and graduate medical education, measured by teaching hospitals to measure the effect of BBA cuts on teaching hospitals. Furthermore we incorporated several economic, financial, and utilization variables in the model. We used 1996 and 1999 data in our analysis to bridge potential effects of the BBA. To locate hospitals that changed ownership status we cross-matched the Medicare Cost Report data with the American Hospital Association Annual Survey. We found that overall hospital profitability declined as a result of the introduction of the BBA; however, small rural hospitals that converted to critical access status enjoyed improvement in financial status over the period of our study. Hospitals that converted to for-profit status did not improve in financial status, and showed a lower earning after the conversation. Our results show that the BBA had a negative effect on hospitals because of cuts in its reimbursement policy, except for critical access hospitals, which show improvement because of their exemption from the prospective payment system. Our study differs from others by using national comprehensive data for years that focus exclusively on the Balanced Budget Act period. We

The Quiet Crisis: The Impact of the Economic Downturn on the Nonprofit Sector

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Bridgeland, John M.; McNaught, Mary; Reed, Bruce; Dunkelman, Marc

2009-01-01

This report was written to shine a spotlight on the under-reported plight of America's nonprofit organizations and to make recommendations for how the nation can respond. In the wake of the economic downturn, hospitals, nursing homes, nursery schools, senior centers, soup kitchens, and other nonprofit organizations have been hit by a triple…

Ecological economics and economic growth.

Science.gov (United States)

Victor, Peter A

2010-01-01

Boulding's 1966 paper on the economics of spaceship Earth established the framework for ecological economics and an understanding of economic growth. In ecological economics, economies are conceptualized as open subsystems of the closed biosphere and are subject to biophysical laws and constraints. Economic growth measured as an increase in real gross domestic product (GDP) has generally been associated with increases in the use of energy and materials and the generation of wastes. Scale, composition, and technology are the proximate determinants of environmental impacts. They are often reduced to two: scale (GDP) and intensity (impact per unit GDP). New work described in this paper defines "green" growth as intensity that declines faster than scale increases. Similarly, "brown" growth occurs when intensity declines more slowly than increases in scale, and "black" growth happens when both scale and intensity increase. These concepts are then related to the environmental Kuznets curve, which can be understood as a transition from brown to green growth. Ecological economics provides a macroperspective on economic growth. It offers broad policy principles, and it challenges the primacy of economic growth as a policy objective, but many important questions remain.

Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study.

Science.gov (United States)

Tamez, Hector; Généreux, Philip; Yeh, Robert W; Amin, Amit P; Fan, Weihong; White, Harvey D; Kirtane, Ajay J; Stone, Gregg W; Gibson, C Michael; Harrington, Robert A; Bhatt, Deepak L; Pinto, Duane S

2018-05-04

Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies. PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. Bleeding and IPTE, defined as abrupt vessel closure (transient or sustained), new/suspected thrombus, new clot on wire/catheter, no reflow, side-branch occlusion, procedural stent thrombosis or urgent need for CABG were identified. Costs were calculated according to whether a complication occurred and type of event. Multivariate analyses were used to estimate the incremental costs of IPTE and postprocedural events. IPTE occurred in 4.3% and were associated with higher catheterization laboratory and overall index hospitalization costs by $2,734 (95%CI $1,117, $4,351; P = 0.001) and $6,354 (95% CI $4,122, $8,586; P < 0.001), respectively. IPTE were associated with MI (35.4% vs. 3.6%; P < 0.001), out-of-laboratory stent thrombosis (4.2% vs. 0.1%; 0 = 0.005), ischemia driven revascularization (12.5% vs. 0.3%; P < 0.001), but not mortality (2.1% vs. 0.2%; P = 0.12) vs. no procedural thrombotic complication. By comparison, ACUITY minor bleeding increased hospitalization cost by $1,416 (95%CI = 312, $2,519; P = 0.012). ACUITY major bleeding increased cost of hospitalization by $7,894 (95%CI $4,154, $11,635; P < 0.001). IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI. © 2018 Wiley Periodicals, Inc.

Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010.

Science.gov (United States)

Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm-Ramirez, Katharine; Gurley, Emily S; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, Asm; Rahman, Mahmudur; Ortega-Sanchez, Ismael R; Azziz-Baumgartner, Eduardo

2017-06-01

Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children 50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV-associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7-16 million), the median indirect cost was US$ 3.0 million (IQR: 2-5 million) in 2010. RSV-associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship.

Economic impact of the new oral treatments for multiple sclerosis.

Science.gov (United States)

Álvarez Ayuso, L; Rodríguez Marrodán, B; Blasco Quílez, M R; García-Merino, J A; Sánchez Guerrero, A

2018-01-11

Multiple sclerosis (MS) is a chronic disease affecting the central nervous system and is characterised by inflammation, demyelination, gliosis, and axonal damage. The introduction of dimethyl fumarate and teriflunomide has led to an increase in the number of alternative first-line therapies for MS. The objective of this study was to evaluate the economic impact of the incorporation of new oral therapies at the reference unit (CSUR) at Hospital Universitario Puerta de Hierro Majadahonda. We performed a retrospective observational study including patients diagnosed with MS, who underwent treatment with disease-modifying drugs in 2015 and were followed up for a minimum mean time of one year. Data were collected from patients' electronic clinical histories and the pharmacy service's programme for dispensing drugs to outpatients. Evaluating the cost of changing 125 patients' treatment from other drugs to dimethyl fumarate and teriflunomide, and comparing this with the cost that would have resulted from maintaining their previous treatment, demonstrated a total saving of €169,107.31 over the study period. In addition to contributing new therapeutic alternatives, dimethyl fumarate and teriflunomide produced an economic saving in MS treatment at our hospital. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Economic Impact of Smoke-Free Legislation: Did the Spanish Tobacco Control Law Affect the Economic Activity of Bars and Restaurants?

Science.gov (United States)

García-Altés, Anna; Pinilla, Jaime; Marí-Dell'Olmo, Marc; Fernández, Esteve; López, Maria José

2015-11-01

The potential of smoke-free bans to negatively impact the hospitality business has been an argument of the hospitality and tobacco industry against such legislation. A partial smoke-free legislation was introduced in Spain in 2006 allowing smoking in most bars and restaurants due to the pressure of the hospitality sector. However, this partial ban was later amended in 2011 to include all the hospitality premises without exceptions. The stepped Spanish process permits to evaluate whether the entry into force of the smoke-free legislation had any effect on the economic activity of the hospitality sector. We employed a pooled time series cross-sectional design, with national data over 6 years (2006-2011). The dependent variable used was the total number of bars and restaurants per 100,000 inhabitants. The explanatory variables used were the average amount of spending per household in bars and restaurants, and the total unemployment rate in Spain by regions. For every 1% increase in the unemployment rate there was a 0.05% decrease in the number of bars and restaurants. In 2007, the number of bars and restaurants was significantly reduced by 13.06% (all others factors being held constant), 4.87% in 2008, and 10.42% in 2009. No statistically significant effect of the smoke-free legislation emerged from 2010 (6.76%) to 2011 (7.69%). The new Spanish smoke-free legislation had no effect on the number of bars and restaurants. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Therapy costs of adult patients admitting to emergency unit of a university hospital with asthma acute attack].

Science.gov (United States)

Serinken, Mustafa; Dursunoğlu, Neşe; Cimrin, Arif H

2009-01-01

In the present study, hospital costs of patients who admitted to the emergency department with asthma attack and several variables that could effect this cost were analyzed and data were collected in order to reduce economical burden of that disease was aimed. Between September 2005 and February 2007 patients with acute asthma attack, admitted to Pamukkale University Hospital Emergency Department were retrospectively evaluated. Totally 108 patients who met the inclusion criteria admitted to the emergency department with asthma acute attack. Of those 97 were women (89.8%). Forty mild, 51 moderate, 15 severe and 2 life-threatening attacks were detected. Severe and life-threatening attacks were more frequent in patients graduated from primary school compared with the other groups. Mean therapy costs of the patients who were hospitalized and treated in the emergency department were 836.60 +/- 324.30 TL (Turkish Lira) and 170.66 +/- 86.71 TL respectively. Treatment procedures consisted of 45.8% of and 38.5% hospital costs for patients treated in the emergency department and for patients hospitalized respectively. There was a statistically significant difference in the comparison of costs according to the attack severity (p= 0.0001). Education level of the patients had a significant effect on hospital costs (p= 0.025). Comorbidities were found a significant increasing factor of treatment costs (p= 0.017). There were no effects of sex, age, medical insurance or duration of asthma disease on the hospital costs. The relation between low-education level, living in the rural area and admissions with severe attacks of asthma to emergency department show the importance of treatment success with patient compliance. Positive and negative factors effecting disease control should be detected by evaluating larger populations to reduce economical burden of asthma.