WorldWideScience

Sample records for rising healthcare costs

  1. Costing Practices in Healthcare

    DEFF Research Database (Denmark)

    Chapman, Christopher; Kern, Anja; Laguecir, Aziza

    2014-01-01

    .e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.......The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i...

  2. Healthcare costs for new technologies

    International Nuclear Information System (INIS)

    Goyen, Mathias; Debatin, Joerg F.

    2009-01-01

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  3. Healthcare costs for new technologies

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2009-03-15

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  4. The Rise of a European Healthcare Union

    DEFF Research Database (Denmark)

    Vollaard, Hans; Martinsen, Dorte Sindbjerg

    2017-01-01

    Healthcare has only slowly appeared on the European Union’s (EU) policy agenda. EU involvement in policies concerning the organization, financing and the provision of diagnosis, care and cures to ill people developed along three fragmented tracks: (a) EU public health policies concerning the well......-being of all people; (b) the application of the free movement principle to national healthcare systems in particular by the EU’s Court of Justice (CJEU); and (c) the austerity packages and the stricter EU surveillance of national budgets since the debt crises. The key questions of this special issue...... are whether this fragmented EU involvement has now developed into a distinct European healthcare union, and if so what its driving forces have been. Thus, it explores how European integration in healthcare has moved forward despite widespread reluctance. It also examines the underexplored political dynamics...

  5. Nuclear costs: why do they keep rising?

    International Nuclear Information System (INIS)

    MacKerron, Gordon

    1992-01-01

    Nuclear power has performed badly in recent years as a new investment everywhere except Japan and Korea. This has mainly been for orthodox financial and economic reasons. Among the factors contributing to this loss of competitiveness, persistently rising real capital costs have been particularly important. While the nuclear industry has believed it could control and reduce capital costs, increasing regulatory stringency has made designs more complex and correspondingly more costly. These cost increasing factors have far outweighed traditional cost reducing factors (like learning). The only lasting way to meet increasing stringency in safety at acceptably low cost is likely to be the development of new and simpler reactor designs. (author)

  6. Population Aging in Iran and Rising Health Care Costs

    Directory of Open Access Journals (Sweden)

    Mohammad Mirzaie

    2017-09-01

    Conclusion Based on the results of this research, it can be said that people throughout their life cycle always allocate a percentage of their total spending to health care costs, but the percentage of this allocation is different at different ages. In a way the demand for healthcare costs increases with aging, it rises significantly in the old age. At the macro level, due to an increase in the percentage of elderly in the population over the next decade, there will also be an increase in the share of health care costs.

  7. Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

    Science.gov (United States)

    Fleck, Leonard M

    2018-04-01

    Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

  8. Costing and performance in healthcare management

    OpenAIRE

    Tarricone, Rosanna; Torbica, Aleksandra

    2012-01-01

    This chapter describes and discusses the methods for cost analysis of healthcare services in order to assess and compare the economic value of health outputs at the level of healthcare organizations. The economic principles underpinning the assessment of the value of healthcare services – opportunity costs and shadow prices – are presented together with the management accounting approach to cost services. The key features of micro-costing and gross-costing are also discussed and their rele...

  9. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  10. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  11. Consumerism and wellness: rising tide, falling cost.

    Science.gov (United States)

    Domaszewicz, Alexander

    2008-01-01

    Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.

  12. Register-based studies of healthcare costs

    DEFF Research Database (Denmark)

    Kruse, Marie; Christiansen, Terkel

    2011-01-01

    Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...

  13. THE MARKETING MIX FOR LOW COST HEALTHCARE

    OpenAIRE

    Julie George; Dr. Manita D. Shah

    2017-01-01

    The Indian health care industry has a history of dealing with poor doctor-patient ratio, shortage of medical professionals, poor health infrastructure, and low expenditure on healthcare information technology; steep out of pocket spending (OOP), low health insurance coverage, inadequate government spending, poor access to health care facilities and social stigma related to diseases. The unique mindset and ability for frugality has successfully been applied in offering low cost healthcare of u...

  14. Developing a standardized healthcare cost data warehouse.

    Science.gov (United States)

    Visscher, Sue L; Naessens, James M; Yawn, Barbara P; Reinalda, Megan S; Anderson, Stephanie S; Borah, Bijan J

    2017-06-12

    Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients. The warehouse is based on a National Institutes of Research-funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries. We describe the two institutions' administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request. The resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information. After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data

  15. Do randomized controlled trials discuss healthcare costs?

    Directory of Open Access Journals (Sweden)

    G Michael Allan

    Full Text Available BACKGROUND: Healthcare costs, particularly pharmaceutical costs, are a dominant issue for most healthcare organizations, but it is unclear if randomized controlled trials (RCTs routinely discuss costs. Our objective was to assess the frequency and factors associated with the inclusion of costs in RCTs. METHODS AND FINDINGS: We randomly sampled 188 RCTs spanning three years (2003-2005 from six high impact journals. The sample size for RCTs was based on a calculation to estimate the inclusion of actual drug costs with a precision of +/-3%. Two reviewers independently extracted cost data and study characteristics. Frequencies were calculated and potential characteristics associated with the inclusion of costs were explored. Actual drug costs were included in 4.7% (9/188 of RCTs; any actual costs were included in 7.4% (14/188 of RCTs; and any mention of costs was included in 27.7% (52/188 of RCTs. As the amount of industry funding increased across RCTs, from non-profit to mixed to fully industry funded RCTs, there was a statistically significant reduction in the number of RCTs with any actual costs (Cochran-Armitage test, p = 0.005 and any mention of costs (Cochran-Armitage test, p = 0.02. Logistic regression analysis also indicated funding was associated with the inclusion of any actual cost (OR = 0.34, p = 0.009 or any mention of costs (OR = 0.63, p = 0.02. Journal, study conclusions, study location, primary author's country and product age were not associated with inclusion of cost information. CONCLUSION: While physicians are encouraged to consider costs when prescribing drugs for their patients, actual drug costs were provided in only 5% of RCTs and were not mentioned at all in 72% of RCTs. Industry funded trials were less likely to include cost information. No other factors were associated with the inclusion of cost information.

  16. Do randomized controlled trials discuss healthcare costs?

    Science.gov (United States)

    Allan, G Michael; Korownyk, Christina; LaSalle, Kate; Vandermeer, Ben; Ma, Victoria; Klein, Douglas; Manca, Donna

    2010-08-23

    Healthcare costs, particularly pharmaceutical costs, are a dominant issue for most healthcare organizations, but it is unclear if randomized controlled trials (RCTs) routinely discuss costs. Our objective was to assess the frequency and factors associated with the inclusion of costs in RCTs. We randomly sampled 188 RCTs spanning three years (2003-2005) from six high impact journals. The sample size for RCTs was based on a calculation to estimate the inclusion of actual drug costs with a precision of +/-3%. Two reviewers independently extracted cost data and study characteristics. Frequencies were calculated and potential characteristics associated with the inclusion of costs were explored. Actual drug costs were included in 4.7% (9/188) of RCTs; any actual costs were included in 7.4% (14/188) of RCTs; and any mention of costs was included in 27.7% (52/188) of RCTs. As the amount of industry funding increased across RCTs, from non-profit to mixed to fully industry funded RCTs, there was a statistically significant reduction in the number of RCTs with any actual costs (Cochran-Armitage test, p = 0.005) and any mention of costs (Cochran-Armitage test, p = 0.02). Logistic regression analysis also indicated funding was associated with the inclusion of any actual cost (OR = 0.34, p = 0.009) or any mention of costs (OR = 0.63, p = 0.02). Journal, study conclusions, study location, primary author's country and product age were not associated with inclusion of cost information. While physicians are encouraged to consider costs when prescribing drugs for their patients, actual drug costs were provided in only 5% of RCTs and were not mentioned at all in 72% of RCTs. Industry funded trials were less likely to include cost information. No other factors were associated with the inclusion of cost information.

  17. Nuclear operating costs are rising exponentially - official

    International Nuclear Information System (INIS)

    Thomas, S.

    1988-01-01

    The Energy Information Agency of the United States Department of Energy has collected data on the operations of nuclear power plants in the United States. A statistical regression analysis was made of this data base. This shows that the escalation in annual, real non-fuel operating costs is such that the operating cost savings made by closing down an old nuclear plant would be sufficient to pay the capital and operating costs of replacing it with a brand new coal-fired plant. The main reason for the increasing operating and maintenance costs is the cost of replacement power i.e. the higher the economic penalty of plant breakdown the more the utility has to spend on maintenance. Another reason is time -not the age of the plant - but the year the data was collected. The economic case for nuclear power is seriously challenged. (U.K.)

  18. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    .... In Healthcare Beyond Reform: Doing It Right for Half the Cost, Joe Flower, a well respected healthcare futurist and industry thought leader, lays out his compelling practical vision of how healthcare can work better, and how we can get...

  19. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    .... In Healthcare Beyond Reform: Doing It Right for Half the Cost, Joe Flower, a well respected healthcare futurist and industry thought leader, lays out his compelling practical vision of how healthcare can work better, and how we...

  20. Reducing healthcare costs facilitated by surgical auditing: a systematic review.

    Science.gov (United States)

    Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

    2015-07-01

    Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

  1. Impact of transaction costs on healthcare outcomes.

    Science.gov (United States)

    Stiles, Renée A; So, Stephanie A

    2003-06-01

    This article reviews transaction cost economics to frame a discussion of how inefficiencies in healthcare delivery processes affect clinical outcomes and differentiate between inefficiencies that are tractable from those that are transitional or intractable. Recognizing and quantifying these effects improves the ability of organizations to calculate returns on investment in quality improvement, research and development and related value enhancing, but it is subject to high-risk undertakings.

  2. Integrating conservation costs into sea level rise adaptive conservation prioritization

    Directory of Open Access Journals (Sweden)

    Mingjian Zhu

    2015-07-01

    Full Text Available Biodiversity conservation requires strategic investment as resources for conservation are often limited. As sea level rises, it is important and necessary to consider both sea level rise and costs in conservation decision making. In this study, we consider costs of conservation in an integrated modeling process that incorporates a geomorphological model (SLAMM, species habitat models, and conservation prioritization (Zonation to identify conservation priorities in the face of landscape dynamics due to sea level rise in the Matanzas River basin of northeast Florida. Compared to conservation priorities that do not consider land costs in the analysis process, conservation priorities that consider costs in the planning process change significantly. The comparison demonstrates that some areas with high conservation values might be identified as lower priorities when integrating economic costs in the planning process and some areas with low conservation values might be identified as high priorities when considering costs in the planning process. This research could help coastal resources managers make informed decisions about where and how to allocate conservation resources more wisely to facilitate biodiversity adaptation to sea level rise.

  3. Applying activity-based costing to healthcare settings.

    Science.gov (United States)

    Canby, J B

    1995-02-01

    Activity-based costing (ABC) focuses on processes that drive cost. By tracing healthcare activities back to events that generate cost, a more accurate measurement of financial performance is possible. This article uses ABC principles and techniques to determine costs associated with the x-ray process in a midsized outpatient clinic. The article also provides several tips for initiating an ABC cost system for an entire healthcare organization.

  4. Direct healthcare costs of spinal disorders in Brazil

    NARCIS (Netherlands)

    Luiz Carregaro, Rodrigo; da Silva, Everton Nunes; van Tulder, Maurits

    2018-01-01

    OBJECTIVES: To investigate the direct healthcare costs of spinal disorders in Brazil, over 2016. METHODS: Prevalence-based cost-of-illness study, top-down approach and public healthcare system's perspective. International Classification of Diseases codes related to spinal disorders were included.

  5. The healthcare costs of secondhand smoke exposure in rural China.

    Science.gov (United States)

    Yao, Tingting; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Max, Wendy

    2015-10-01

    The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China. We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach. The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income. The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China. 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.

  6. South Africa’s rising logistics costs: An uncertain future

    Directory of Open Access Journals (Sweden)

    Jan H. Havenga

    2014-12-01

    Full Text Available A country’s competitiveness can be severely hampered by an uncompetitive freight logistics system. During the first decade of the 21st century, two in-depth models were developed for South Africa which provide a framework for measuring and improving the country’s freight logistics system – the cost of logistics survey and the freight demand model. These models also allow for the development of scenarios for key identified risks. The objectives of this study were to provide an overview of South Africa’s surface freight transport industry,identify key risks to national competitiveness and suggest ways in which these risks could be mitigated. Freight flows were modelled by disaggregating the national input–output model into 372 origin–destination pairs and 71 commodity groups, followed by distance decay gravity-modelling. Logistics costs were calculated by relating commodity-level freight flows to the costs of fulfilling associated logistical functions. South Africa’s economy is highly transport intensive. Excessive dependence on road freight transport exacerbates this situation. Furthermore, the road freight transport’s key cost driver is fuel, driven in turn by the oil price. Scenario analysis indicated the risk posed by this rising and volatile input and should provide impetus for policy instruments to reduce transport intensity. As such, this study concluded that a reduction in freight transport intensity is required to reduce exposure to volatile international oil prices.

  7. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  8. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  9. Controlling cost escalation of healthcare: making universal health coverage sustainable in China

    Science.gov (United States)

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China. There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable. PMID:22992484

  10. The effects of rising energy costs and transportation mode mix on forest fuel procurement costs

    International Nuclear Information System (INIS)

    Rauch, Peter; Gronalt, Manfred

    2011-01-01

    Since fossil fuels have been broadly recognized as a non-renewable energy source that threatens the climate, sustainable and CO 2 neutral energy sources - such as forest fuels - are being promoted in Europe, instead. With the expeditiously growing forest fuel demand, the strategic problem of how to design a cost-efficient distribution network has evolved. This paper presents an MILP model, comprising decisions on modes of transportation and spatial arrangement of terminals, in order to design a forest fuel supply network for Austria. The MILP model is used to evaluate the impacts of rising energy costs on procurement sources, transport mix and procurement costs on a national scale, based on the example of Austria. A 20% increase of energy costs results in a procurement cost increase of 7%, and another 20% increase of energy costs would have similar results. While domestic waterways become more important as a result of the first energy cost increase, rail only does so after the second. One way to decrease procurement costs would be to reduce the share of empty trips with truck and trailer. Reducing this share by 10% decreases the average procurement costs by up to 20%. Routing influences the modal split considerably, and the truck transport share increases from 86% to 97%, accordingly. Increasing forest fuel imports by large CHPs lowers domestic competition and also enables smaller plants to cut their procurement costs. Rising forest fuel imports via ship will not significantly decrease domestic market shares, but they will reduce procurement costs considerably. (author)

  11. Estimating healthcare costs of acute gastroenteritis and human campylobacteriosis in Switzerland.

    Science.gov (United States)

    Schmutz, C; Mäusezahl, D; Bless, P J; Hatz, C; Schwenkglenks, M; Urbinello, D

    2017-03-01

    Rising numbers of campylobacteriosis case notifications in Switzerland resulted in an increased attention to acute gastroenteritis (AG) in general. Patients with a laboratory-confirmed Campylobacter infection perceive their disease as severe and around 15% of these patients are hospitalized. This study aimed at estimating healthcare costs due to AG and campylobacteriosis in Switzerland. We used official health statistics, data from different studies and expert opinion for estimating individual treatment costs for patients with different illness severity and for extrapolating overall costs due to AG and campylobacteriosis. We estimated that total Swiss healthcare costs resulting from these diseases amount to €29-45 million annually. Data suggest that patients with AG consulting a physician without a stool diagnostic test account for €9·0-24·2 million, patients with a negative stool test result for Campylobacter spp. for €12·3 million, patients testing positive for Campylobacter spp. for €1·8 million and hospitalized campylobacteriosis patients for €6·5 million/year. Healthcare costs of campylobacteriosis are high and most likely increasing in Switzerland considering that campylobacteriosis case notifications steadily increased in the past decade. Costs and potential cost savings for the healthcare system should be considered when designing sectorial and cross-sectorial interventions to reduce the burden of human campylobacteriosis in Switzerland.

  12. Projected Lifetime Healthcare Costs Associated with HIV Infection

    DEFF Research Database (Denmark)

    Nakagawa, Fumiyo; Miners, Alec; Smith, Colette J

    2015-01-01

    computer simulation model to project the distribution of lifetime outcomes and costs of men-who-have-sex-with-men (MSM) infected with HIV in 2013 aged 30, over 10,000 simulations. We assumed a resource-rich setting with no loss to follow-up, and that standards and costs of healthcare management remain...

  13. LEAN HEALTHCARE SUPPLY CHAIN MANAGEMENT: MINIMIZING WASTE AND COSTS

    Directory of Open Access Journals (Sweden)

    Catia M L Machado

    2014-12-01

    Full Text Available The purpose of this research is to investigate the management models applied in the supply chain providing services in healthcare organizations, considering the lenses of lean. The aim of this is to develop a model of supply chain management focusing on the identification and minimization of waste, assisting in decision making and contributing to the quality of services and as a consequence the reduction of the costs involved in healthcare supply chain. The philosophies of continuous improvement and lean techniques have a role to play in helping healthcare to provide quality service and support to reduce costs in the current budget constraints. In the supply chain of hospitals the financial costs can be around 40% of its budget (MASOUMI et al. 2012; SOUZA et al., 2013. This article sheds light on the improvement in decision making and the effect of reducing costs in the healthcare supply chain. In this sense, the research intend to expand knowledge related to supply chain management in the area of ​​provision of healthcare services through the use of the philosophy of continuous improvement and lean principles, helping healthcare to provide quality service within their current budget constraints.

  14. Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia.

    Science.gov (United States)

    Dua, Anahita; Desai, Sapan S; Patel, Bhavin; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian; Rossi, Peter J; Malinowski, Michael; Lee, Cheong J

    2016-05-01

    This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients. Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index. From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The impact of diabetes mellitus on healthcare costs in Italy.

    Science.gov (United States)

    Giorda, Carlo B; Manicardi, Valeria; Diago Cabezudo, Jesús

    2011-12-01

    Diabetes mellitus is an increasingly common chronic disease that has a great impact not only in terms of clinical effects, but also in terms of economic burden worldwide. Expenditures due to diabetes derive essentially from direct and indirect costs. Current estimates of global healthcare expenditures due to diabetes are US$376 billion and are expected to increase to US$490 billion by 2030. In particular, costs associated with diabetes-related complications represent the most relevant part of the national healthcare expenditure for diabetes and are higher than the costs of managing diabetes itself. The major expenditure depends on the type and the number of complications: cardiovascular complications increase direct costs, especially for hospitalization. Moreover, diabetic comorbidity has a greater economic impact on the health expenditure in comparison with those patients without diabetes. In Europe, the CODE-2 study was the first attempt to evaluate the costs of diabetes: the annual costs per patient were estimated at €2384 and the highest value, €2991, was registered in Italy. This indicates an overall annual cost of €5170 million for the whole Italian population with diabetes. Current estimates for 2010 healthcare expenditure for diabetes are US$105 billion (10% of total healthcare expenditure, US$2046 per person) for the whole European region, and US$11 billion (9% of total healthcare expenditure, US$2087 per person) for Italy. More studies are needed in order to better define the real significance of the healthcare costs of diabetes in Italy. An effective therapy with a good metabolic control can reduce the risk of complications and represents a valid strategy from an economic point of view.

  16. Understanding the Effects of Sampling on Healthcare Risk Modeling for the Prediction of Future High-Cost Patients

    Science.gov (United States)

    Moturu, Sai T.; Liu, Huan; Johnson, William G.

    Rapidly rising healthcare costs represent one of the major issues plaguing the healthcare system. Data from the Arizona Health Care Cost Containment System, Arizona's Medicaid program provide a unique opportunity to exploit state-of-the-art machine learning and data mining algorithms to analyze data and provide actionable findings that can aid cost containment. Our work addresses specific challenges in this real-life healthcare application with respect to data imbalance in the process of building predictive risk models for forecasting high-cost patients. We survey the literature and propose novel data mining approaches customized for this compelling application with specific focus on non-random sampling. Our empirical study indicates that the proposed approach is highly effective and can benefit further research on cost containment in the healthcare industry.

  17. Demystifying first-cost green building premiums in healthcare.

    Science.gov (United States)

    Houghton, Adele; Vittori, Gail; Guenther, Robin

    2009-01-01

    This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.

  18. Challenges of healthcare administration: optimizing quality and value at an affordable cost in pediatric cardiology.

    Science.gov (United States)

    Cohen, Mitchell I; Frias, Patricio A

    2018-01-01

    The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient. Physicians and hospitals need to align in a team-based approach that allows physicians to understand current costs and how to strive toward a focus on healthcare outcomes. Pediatric cardiology is a unique discipline that cares for patients with complex congenital conditions that will span their lifetime and also involves not just cardiology but surgery, intensive care, anesthesia, nursing, and a host of inpatient and ambulatory services. Understanding what matters to the patient and his/her family and presenting quality outcomes in a transparent fashion will gradually allow a shift to take place away from physician visits, tests ordered, and procedures performed. This can only be achieved with physicians, given the appropriate tools to understand costs, value, and outcomes and models where the hospitals and physicians are aligned. The transformation to a value-based healthcare system is beginning and pediatric cardiologists need to be educated, given the appropriate resources, receive appropriate feedback, and patients need to be part of the solution so that care providers can understand what matters most to them.

  19. Healthcare costs of burn patients from homes without fire sprinklers.

    Science.gov (United States)

    Banfield, Joanne; Rehou, Sarah; Gomez, Manuel; Redelmeier, Donald A; Jeschke, Marc G

    2015-01-01

    The treatment of burn injuries requires high-cost services for healthcare and society. Automatic fire sprinklers are a preventive measure that can decrease fire injuries, deaths, property damage, and environmental toxins. This study's aim was to conduct a cost analysis of patients with burn or inhalation injuries caused by residential fires and to compare this with the cost of implementing residential automatic fire sprinklers. We conducted a cohort analysis of adult burn patients admitted to our provincial burn center (1995-2012). Patient demographics and injury characteristics were collected from medical records and clinical and coroner databases. Resource costs included average cost per day at our intensive care and rehabilitation program, transportation, and property loss. During the study period, there were 1557 residential fire-related deaths province-wide and 1139 patients were admitted to our provincial burn center as a result of a flame injury occurring at home. At our burn center, the average cost was CAN$84,678 per patient with a total cost of CAN$96,448,194. All resources totaled CAN$3,605,775,200. This study shows the considerable healthcare costs of burn patients from homes without fire sprinklers.

  20. Patients find success haggling as health-care costs climb.

    Science.gov (United States)

    Costello, Daniel

    2002-01-01

    In small but growing numbers, Americans are taking an innovative approach to controlling health-care costs: They're haggling with their doctors. Fed up with mounting health bills, consumers ae getting as much as 30% off everything from eye exams to fertility procedures just by agreeing to pay upfront. Others are holding their doctors over a barrel by waiting a few months to pay the bill. Already, a new cottage industry of middlemen who negotiate healthcare bills for patients report their haggling business is up as much as 25% in the last two years.

  1. Cost Conscious: Incentive and Discount Programs Help Students Meet the Rising Cost of a Community College Education

    Science.gov (United States)

    Ullman, Ellen

    2013-01-01

    Aware that rising costs could force some community colleges to compromise their long-standing open-door policies, administrators have put in place programs and incentives to offset the higher price of the average community college education. This article features ideas and programs to help struggling community colleges cope with rising costs such…

  2. Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost-Effectiveness Analysis.

    Science.gov (United States)

    van Baal, Pieter; Meltzer, David; Brouwer, Werner

    2016-02-01

    Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    Science.gov (United States)

    Savitz, Lucy A; Savitz, Samuel T

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

  4. Opinion Leaders See Rising College Costs as Major Concern.

    Science.gov (United States)

    Chronicle of Higher Education, 1988

    1988-01-01

    A recent survey of federal government officials, corporate leaders in charge of personnel and research, and journalists found dramatically different views in some areas, but agreement in concern about college costs, financing, and lack of government spending for research. Most felt college is a fair value for the cost. (MSE)

  5. Healthcare technology: physician collaboration in reducing the surgical cost.

    Science.gov (United States)

    Olson, Steven A; Obremskey, William T; Bozic, Kevin J

    2013-06-01

    The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

  6. Increased costs to US pavement infrastructure from future temperature rise

    Science.gov (United States)

    Underwood, B. Shane; Guido, Zack; Gudipudi, Padmini; Feinberg, Yarden

    2017-10-01

    Roadway design aims to maximize functionality, safety, and longevity. The materials used for construction, however, are often selected on the assumption of a stationary climate. Anthropogenic climate change may therefore result in rapid infrastructure failure and, consequently, increased maintenance costs, particularly for paved roads where temperature is a key determinant for material selection. Here, we examine the economic costs of projected temperature changes on asphalt roads across the contiguous United States using an ensemble of 19 global climate models forced with RCP 4.5 and 8.5 scenarios. Over the past 20 years, stationary assumptions have resulted in incorrect material selection for 35% of 799 observed locations. With warming temperatures, maintaining the standard practice for material selection is estimated to add approximately US$13.6, US$19.0 and US$21.8 billion to pavement costs by 2010, 2040 and 2070 under RCP4.5, respectively, increasing to US$14.5, US$26.3 and US$35.8 for RCP8.5. These costs will disproportionately affect local municipalities that have fewer resources to mitigate impacts. Failing to update engineering standards of practice in light of climate change therefore significantly threatens pavement infrastructure in the United States.

  7. Modelling the healthcare costs of skin cancer in South Africa.

    Science.gov (United States)

    Gordon, Louisa G; Elliott, Thomas M; Wright, Caradee Y; Deghaye, Nicola; Visser, Willie

    2016-04-02

    Skin cancer is a growing public health problem in South Africa due to its high ambient ultraviolet radiation environment. The purpose of this study was to estimate the annual health system costs of cutaneous melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in South Africa, incorporating both the public and private sectors. A cost-of-illness study was used to measure the economic burden of skin cancer and a 'bottom-up' micro-costing approach. Clinicians provided data on the patterns of care and treatments while national costing reports and clinician fees provided cost estimates. The mean costs per melanoma and per SCC/BCC were extrapolated to estimate national costs using published incidence data and official population statistics. One-way and probabilistic sensitivity analyses were undertaken to address the uncertainty of the parameters used in the model. The estimated total annual cost of treating skin cancers in South Africa were ZAR 92.4 million (2015) (or US$15.7 million). Sensitivity analyses showed that the total costs could vary between ZAR 89.7 to 94.6 million (US$15.2 to $16.1 million) when melanoma-related variables were changed and between ZAR 78.4 to 113.5 million ($13.3 to $19.3 million) when non-melanoma-related variables were changed. The primary drivers of overall costs were the cost of excisions, follow-up care, radical lymph node dissection, cryotherapy and radiation therapy. The cost of managing skin cancer in South Africa is sizable. Since skin cancer is largely preventable through improvements to sun-protection awareness and skin cancer prevention programs, this study highlights these healthcare resources could be used for other pressing public health problems in South Africa.

  8. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Directory of Open Access Journals (Sweden)

    Gafurov Andrey

    2018-01-01

    Full Text Available The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the “Project analysis scenario” flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  9. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Science.gov (United States)

    Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

    2018-03-01

    The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  10. Rising costs call for new European refining strategies

    International Nuclear Information System (INIS)

    Sweeney, B.N.C.

    1993-01-01

    The outlook for the global refining industry is for increased spending and reduced margins, largely because of efforts to improve the environment. A look at these trends through the end of the decade is thus in order. Three major industry thrusts are proposed to see refiners through this uncertain period. Three main thrusts are necessary: fixed costs must be reduced by re-engineering business processes and reexamining noncore business units against total and marginal costs. In this respect the best refiners are well ahead of the good ones. New cooperative ways of meeting regulations must be sought, to avoid wasteful over capacity. Joint ventures and alliances with competitors will be needed. The cooperative principle upstream must be extended and new strategies must be sought to meet product demand changes and reduce feedstock costs. The picture that is presented is tough, largely because of the wish to improve the environment. The question that must be continually reviewed is ''Have governments got the right balance in these regulations between the environment and the downstream industry?''

  11. Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

    Science.gov (United States)

    Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

    2000-07-01

    The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

  12. Healthcare costs of asthma comorbidities: a systematic review protocol.

    Science.gov (United States)

    Ferkh, Karim El; Nwaru, Bright I; Griffiths, Chris; Patel, Anita; Sheikh, Aziz

    2017-05-30

    Asthma is associated with many comorbid conditions that have the potential to impact on its management, control and outcomes. These comorbid conditions have the potential to impact on healthcare expenditure. We plan to undertake a systematic review to synthesise the evidence on the healthcare costs associated with asthma comorbidity. We will systematically search the following electronic databases between January 2000 and January 2017: National Health Service (NHS) Economic Evaluation Database, Google Scholar, Allied and Complementary Medicine Database (AMED), Global Health, PsychINFO, Medline, Embase, Institute for Scientific Information Web of Science and Cumulative Index to Nursing and Allied Health Literature. We will search the references in the identified studies for additional potential papers. Additional literature will be identified by contacting experts in the field and through searching of registers of ongoing studies. The review will include cost-effectiveness and economic modelling/evaluation studies and analytical observational epidemiology studies that have investigated the healthcare costs of asthma comorbidity. Two reviewers will independently screen studies and extract relevant data from included studies. Methodological quality of epidemiological studies will be assessed using the Effective Public Health Practice Project tool, while that of economic evaluation studies will be assessed using the Drummond checklist. This protocol has been published in International Prospective Register of Systematic Reviews (PROSPERO) database (No. CRD42016051005). As there are no primary data collected, formal NHS ethical review is not necessary. The findings of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. CRD42016051005. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  13. Activity-based costing of health-care delivery, Haiti.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

    2018-01-01

    To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

  14. Employee wellness coaching as an interpersonal communication intervention: exploring intervention effects on healthcare costs, risks, and behaviors

    OpenAIRE

    Fedesco, Heather Noel

    2015-01-01

    In order to address the rise in healthcare expenditures, employers are turning to wellness programs as a means to potentially curtail costs. One newly implemented program is wellness coaching, which takes a communicative and holistic approach to helping others make improvements to their health. Wellness coaching is a behavioral health intervention whereby coaches work with clients to help them attain wellness-promoting goals in order to change lifestyle-related behaviors across a range of are...

  15. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level.

    Science.gov (United States)

    Vaccari, Mentore; Tudor, Terry; Perteghella, Andrea

    2018-01-01

    Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day -1 bed -1 ), paediatric and intensive care (3.37 kg day -1 bed -1 ) and gastroenterology-digestive endoscopy (3.09 kg day -1 bed -1 ). Annual overall waste management costs were $US5,079,191, or approximately $US2.36 kg -1 , with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation.

  16. Healthcare utilization and costs for patients initiating Dabigatran or Warfarin.

    Science.gov (United States)

    Reynolds, Shannon L; Ghate, Sameer R; Sheer, Richard; Gandhi, Pranav K; Moretz, Chad; Wang, Cheng; Sander, Stephen; Costantino, Mary E; Annavarapu, Srinivas; Andrews, George

    2017-06-21

    Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population. A retrospective matched-cohort study was conducted using data from administrative health care claims during the study period 01/01/2010-12/31/2012. Cox regression analyses were used to compare all-cause risk of first hospitalizations and emergency room (ER) visits. Medical, pharmacy, and total costs per-patient-per-month (PPPM) were compared between dabigatran and warfarin users. A total of 1110 patients initiated on dabigatran were propensity score-matched with corresponding patients initiated on warfarin. The mean number of hospitalizations (0.92 vs. 1.13, P = 0.012), ER visits (1.32 vs. 1.56, P warfarin users. Patients initiated on dabigatran had significantly lower risk of first all-cause ER visits [hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.73-0.98] compared to those initiated on warfarin. Adjusted mean pharmacy costs PPPM were significantly greater for dabigatran users ($510 vs. $250, P warfarin users. Dabigatran users had significantly lower HCRU compared to warfarin users. In addition, dabigatran users had lower risk of all-cause ER visits. Despite higher pharmacy costs, the two cohorts did not differ significantly in medical or total all-cause costs.

  17. Model of investment appraisal of high-rise construction with account of cost of land resources

    Science.gov (United States)

    Okolelova, Ella; Shibaeva, Marina; Trukhina, Natalya

    2018-03-01

    The article considers problems and potential of high-rise construction as a global urbanization. The results of theoretical and practical studies on the appraisal of investments in high-rise construction are provided. High-rise construction has a number of apparent upsides in modern terms of development of megapolises and primarily it is economically efficient. Amid serious lack of construction sites, skyscrapers successfully deal with the need of manufacturing, office and living premises. Nevertheless, there are plenty issues, which are related with high-rise construction, and only thorough scrutiny of them allow to estimate the real economic efficiency of this branch. The article focuses on the question of economic efficiency of high-rise construction. The suggested model allows adjusting the parameters of a facility under construction, setting the tone for market value as well as the coefficient for appreciation of the construction net cost, that depends on the number of storey's, in the form of function or discrete values.

  18. Wage and Benefit Changes in Response to Rising Health Insurance Costs

    OpenAIRE

    Dana Goldman; Neeraj Sood; Arleen Leibowitz

    2005-01-01

    Many companies have defined-contribution benefit plans requiring employees to pay the full cost (before taxes) of more generous health insurance choices. Research has shown that employee decisions are quite responsive to these arrangements. What is less clear is how the total compensation package changes when health insurance premiums rise. This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly. The data come from a si...

  19. The High Rise Low Cost Housing : Sustainable Neighbourhood Elements (Green Elements) in Malaysia

    Science.gov (United States)

    Wahi, Noraziah; Mohamad, Ismail; Mohamad Zin, Rosli; Munikanan, Vikneswaran; Junaini, Syahrizan

    2018-03-01

    The sustainable development is a vital measure to alleviate the greenhouse gas effect, global warming and any other environment issues. The sustainable neighbourhood concept is not new in Malaysia, However, the concept still needs attention and awareness from the stakeholders. This paper discusses on the sustainable neighbourhood elements specifically green elements application on the high rise low cost housing in Malaysia. Malaysia should have focused sustainable neighbourhood planning and design especially on the high rise low cost housing therefore the future generation can be benefited from this type development.

  20. Quantifying the healthcare costs of treating severely bleeding major trauma patients: a national study for England.

    Science.gov (United States)

    Campbell, Helen E; Stokes, Elizabeth A; Bargo, Danielle N; Curry, Nicola; Lecky, Fiona E; Edwards, Antoinette; Woodford, Maralyn; Seeney, Frances; Eaglestone, Simon; Brohi, Karim; Gray, Alastair M; Stanworth, Simon J

    2015-07-06

    Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40% of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions. In collaboration with the Trauma Audit Research Network (TARN) detailed patient-level data on in-hospital resource use, extended care at hospital discharge, and readmissions up to 12 months post-injury were collected on 441 consecutive adult major trauma patients with severe bleeding presenting at 22 hospitals (21 in England and one in Wales). Resource use data were costed using national unit costs and mean costs estimated for the cohort and for clinically relevant subgroups. Using nationally available data on trauma presentations in England, patient-level cost estimates were up-scaled to a national level. The mean (95% confidence interval) total cost of initial hospital inpatient care was £19,770 (£18,177 to £21,364) per patient, of which 62% was attributable to ventilation, intensive care, and ward stays, 16% to surgery, and 12% to blood component transfusion. Nursing home and rehabilitation unit care and re-admissions to hospital increased the cost to £20,591 (£18,924 to £22,257). Costs were significantly higher for more severely injured trauma patients (Injury Severity Score ≥15) and those with blunt injuries. Cost estimates for England were £148,300,000, with over a third of this cost attributable to patients aged 65 years and over. Severely bleeding major trauma patients are a high cost subgroup of all major trauma patients, and the cost burden is projected to rise further as a consequence of an aging population and as evidence continues to emerge on the benefits of early and simultaneous administration of blood products in pre-specified ratios. The findings from

  1. Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits

    DEFF Research Database (Denmark)

    Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten

    2018-01-01

    OBJECTIVES: Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. METHODS: A longitudinal...... between symptom groups and total healthcare costs were statistically significant. CONCLUSIONS: IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare...... and mental vulnerability. RESULTS: IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two...

  2. Healthcare costs attributable to the treatment of patients with spinal metastases

    DEFF Research Database (Denmark)

    Tipsmark, Line Stjernholm; Bünger, Cody Eric; Wang, Miao

    2015-01-01

    for 65% and outpatient services for 31% of the healthcare costs followed by hospice placements 3% and primary care 1%. Lifetime healthcare costs accounted for €36,616 (95% CI 33,835-39,583) per T1 patients, €49,632 (95% CI 42,287-57,767) per T2 patient, €70997 (95% CI 62,244-82,354) per T3 patient...... with an average of 71% for inpatient hospitalisation and 25% for outpatient services. CONCLUSION: The index treatment accounts for almost half of lifetime health care costs from treatment initiation until death. As expected, lifetime healthcare costs are positively association with invasiveness of treatment.......BACKGROUND: Cancer treatment, and in particular end-of-life treatment, is associated with substantial healthcare costs. The purpose of this study was to analyse healthcare costs attributable to the treatment of patients with spinal metastases. METHODS: The study population (n = 629) was identified...

  3. The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study

    NARCIS (Netherlands)

    Biezen, M.G. van der; Adang, E.M.; Burgt, R. Van Der; Wensing, M.; Laurant, M.G.

    2016-01-01

    BACKGROUND: The pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a

  4. Estimating the cost of healthcare delivery in three hospitals in ...

    African Journals Online (AJOL)

    Objective: The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Methods: Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were ...

  5. Understanding the rise of Yinao in China: A commentary on the little known phenomenon of healthcare violence.

    Science.gov (United States)

    Zhang, Liuyi; Stone, Teresa E; Zhang, Jingping

    2017-06-01

    Yinao (healthcare disturbance) refers to violent incidents directed against healthcare staff and facilities for financial benefit. In China, incidences of Yinao are widespread and increasing, but little is known of this phenomenon in the wider global community. This commentary investigates the factors behind Yinao to achieve a deeper understanding. Causes include a lack of trust in medical staff, fueled by costly medical expenses; difficulties in accessing treatment; poor treatment outcomes; high patient expectations; a misunderstanding or rejection of medical ethics; misleading media reports; and a complex appeals process. Both doctors and nurses have been the targets of violent and distressing Yinao events, resulting in emotional pain, physical injury, and even death. In response, hospitals have established a series of preventative measures and and the government has increased the penalties for perpetrators of acts of Yinao. The situation is a salient reminder to policymakers worldwide of the importance of an accessible, affordable, and equitable health system. © 2016 John Wiley & Sons Australia, Ltd.

  6. Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study

    NARCIS (Netherlands)

    W.J. Meerding (Willem Jan); L.G.A. Bonneux (Luc); J.J. Polder (Johan); M.A. Koopmanschap (Marc); P.J. van der Maas (Paul)

    1998-01-01

    textabstractOBJECTIVES: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. DESIGN: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors

  7. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    ... can get there by utilizing the resources we already have. The author provides a comprehensive, positive, and intriguing vision of the future of healthcare for professionals, employers and investors...

  8. Global cost analysis on adaptation to sea level rise based on RCP/SSP scenarios

    Science.gov (United States)

    Kumano, N.; Tamura, M.; Yotsukuri, M.; Kuwahara, Y.; Yokoki, H.

    2017-12-01

    Low-lying areas are the most vulnerable to sea level rise (SLR) due to climate change in the future. In order to adapt to SLR, it is necessary to decide whether to retreat from vulnerable areas or to install dykes to protect them from inundation. Therefore, cost- analysis of adaptation using coastal dykes is one of the most essential issues in the context of climate change and its countermeasures. However, few studies have globally evaluated the future costs of adaptation in coastal areas. This study tries to globally analyze the cost of adaptation in coastal areas. First, global distributions of projected inundation impacts induced by SLR including astronomical high tide were assessed. Economic damage was estimated on the basis of the econometric relationship between past hydrological disasters, affected population, and per capita GDP using CRED's EM-DAT database. Second, the cost of adaptation was also determined using the cost database and future scenarios. The authors have built a cost database for installed coastal dykes worldwide and applied it to estimating the future cost of adaptation. The unit costs of dyke construction will increase with socio-economic scenario (SSP) such as per capita GDP. Length of vulnerable coastline is calculated by identifying inundation areas using ETOPO1. Future cost was obtained by multiplying the length of vulnerable coastline and the unit cost of dyke construction. Third, the effectiveness of dyke construction was estimated by comparing cases with and without adaptation.As a result, it was found that incremental adaptation cost is lower than economic damage in the cases of SSP1 and SSP3 under RCP scenario, while the cost of adaptation depends on the durability of the coastal dykes.

  9. Prevalence and cost of imaging in inpatient falls: the rising cost of falling

    Directory of Open Access Journals (Sweden)

    Fields J

    2015-06-01

    Full Text Available Jessica Fields,1 Tahani Alturkistani,2 Neal Kumar,3 Arjun Kanuri,3 Deeb N Salem,1 Samson Munn,2 Deborah Blazey-Martin1 1Department of Medicine, Tufts Medical Center, Boston, MA, USA; 2Department of Radiology, Tufts Medical Center, Boston, MA, USA; 3Tufts University School of Medicine, Boston, MA, USA Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design: Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting: Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010. Patients: All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results: Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98. More than half of falls were men (55% and patients considered at risk of falls (56%. Falls were evenly distributed across morning (33%, evening (34%, and night (33% shifts. Of 530 falls, 178 (34% patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700 from head computed tomography (CT. Conclusion: Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward

  10. Construction Costs Assessment of Structural Systems for Low-Rise and Social Welfare Housing

    Directory of Open Access Journals (Sweden)

    Carrillo Julián

    2015-09-01

    Full Text Available A comparative analysis of the costs related to the construction of low-rise, low-cost and social welfare housing was carried out. The study included three of the most commonly used structural systems for low-rise housing in Latin America, such as the traditional system of confined masonry walls, concrete walls conventionally reinforced with welded-wire meshes and concrete walls reinforced with steel fiber. The cost comparison was carried out by budgets analysis, which were performed based on construction quantities, unit prices and particular items for each structural system. It was found in the study that, from an economic point of view, the systems of concrete walls reinforced with welded-wire meshes or steel fibers are more advantageous than confined masonry systems. In addition, the integral comparison of the three structural systems demonstrates that the industrialized system of steel fiber reinforced concrete walls allows obtaining greater advantages of cleaning and sustainability, faster construction, lower cost and a more attractive scenario for builders investing in such projects.

  11. Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology

    Science.gov (United States)

    Vilamovska, Anna-Marie

    2010-01-01

    The study investigated whether an upcoming class of health information technology (HIT) can be used to address currently outstanding issues in the quality and cost of healthcare delivery. Expert interviews and a literature review were used to describe the 2009 universe of in- and outpatient healthcare RFID applications and to identify those…

  12. Cost escalation in health-care technology - possible solutions

    African Journals Online (AJOL)

    and its application to rural health care is cited as an exaIllple ofa ... other sources of information in our health-care planning process. ... chances with unproven devices from unknown manufac- turers. ... ment, and the high training level and relatively large number of ... would provide jobs and also stimulate the economy. It.

  13. Economic impact of hand and wrist injuries: Health-care costs and productivity costs in a population-based study

    NARCIS (Netherlands)

    C.E. de Putter (Dennis); R.W. Selles (Ruud); S. Polinder (Suzanne); M.J.M. Panneman (Martien); S.E.R. Hovius (Steven); E.F. van Beeck (Ed)

    2012-01-01

    textabstractBackground: Injuries to the hand and wrist account for approximately 20% of patient visits to emergency departments and may impose a large economic burden. The purpose of this study was to estimate the total health-care costs and productivity costs of injuries to the hand and wrist and

  14. US healthcare costs attributable to type A and type B influenza.

    Science.gov (United States)

    Yan, Songkai; Weycker, Derek; Sokolowski, Stefania

    2017-09-02

    While the overall healthcare burden of seasonal influenza in the United States (US) has been well characterized, the proportion of influenza burden attributable to type A and type B illness warrants further elucidation. The aim of this study was to estimate numbers of healthcare encounters and healthcare costs attributable to influenza viral strains A and B in the US during the 2001/2002 - 2008/2009 seasons. Healthcare encounters and costs in the US during the 2001/2002 - 2008/2009 seasons for influenza type A and influenza type B were estimated separately and collectively, by season and age group, based on data from published literature and secondary sources for: rates of influenza-related encounters requiring formal healthcare, unit costs of influenza-related healthcare encounters, and estimates of population size. Across 8 seasons, projected annual numbers of influenza-related healthcare encounters ranged from 11.3-25.6 million, and healthcare costs, from $2.0-$5.8 billion. While the majority of influenza illness was attributable to type A strains, type B strains accounted for 37% of healthcare costs across all seasons, and as much as 66% in a single season. The outpatient burden of type B disease was considerable among persons aged 18-64 y while the hospital cost burden was highest in young children. Influenza viral strain B was associated with considerable health system burden each year during the period of interest. Increasing influenza vaccine coverage, especially with the recently approved quadrivalent products including an additional type B strain, could potentially reduce overall annual influenza burden in the US.

  15. Cost awareness among healthcare professionals at a South African ...

    African Journals Online (AJOL)

    [9,10] A survey of internal medicine ... the brain. Participants also indicated that they would like to improve their cost information knowledge. ... The use of percentage deviation from true cost as a method of assessing cost awareness creates a ...

  16. Policy options to contain healthcare costs: a review and classification

    NARCIS (Netherlands)

    Stadhouders, N.W.; Koolman, X.; Tanke, M.A.C.; Maarse, H.; Jeurissen, P.P.T.

    2016-01-01

    Containing health care costs has been a challenge for most OECD member states. We classify 2250 cost containment policies in forty-one groups of policy options. This conceptual framework might act as a toolkit for policymakers that seek to develop strategies for cost control; and for researchers

  17. Our winters of discontent : addressing the problem of rising home heating costs

    International Nuclear Information System (INIS)

    Hughes, L.; Wysocki, A.

    2006-03-01

    The cost of space heating may soon increase due to rising fuel prices in international energy markets and the absence of federal and provincial energy security policies. This report examined the benefits and disadvantages of 2 approaches to assist those with limited incomes to meet heating requirements: (1) offering Low Income Fuel Assistance (LIFA) as a one-time payment during the heating season; and (2) the elimination of taxes for home heating fuels. The cost of home heating fuels and their impacts on consumers and governments were considered. A review of the Nova Scotia government's Keep the Heat program noted that the program was not responsive to increases in the price of home heating fuel, particularly if increases in a year exceeded the level of assistance. It was suggested that the removal of heating sales taxes could provide unnecessary windfalls to households with large homes, as well as windfall profits for landlords if savings were not passed on to tenants. Using Nova Scotia as a case study, an alternative support system was considered that guaranteed a set price for heating fuel for those in need. It was suggested that this approach could cost less than a lump-sum payment or the elimination of taxes on home-heating fuel. In addition, the approach would provide low-income consumers with predictable and affordable prices. It was concluded that as space heating energy costs continue to rise, all government fuel assistance programs run the risk of becoming larger and more costly. Other solutions included reducing Canada's dependence on fossil fuels through the use of solar energy; the reduction of residential energy demand; and the promotion of district heating. 26 refs., 9 tabs., 3 figs

  18. Using time-driven activity-based costing to identify value improvement opportunities in healthcare.

    Science.gov (United States)

    Kaplan, Robert S; Witkowski, Mary; Abbott, Megan; Guzman, Alexis Barboza; Higgins, Laurence D; Meara, John G; Padden, Erin; Shah, Apurva S; Waters, Peter; Weidemeier, Marco; Wertheimer, Sam; Feeley, Thomas W

    2014-01-01

    As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches.

  19. Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

    Science.gov (United States)

    Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

    2016-04-01

    The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

  20. The emergence of rural transport strategies in response to rising fuel costs

    International Nuclear Information System (INIS)

    Shapiro, Dana; Pearlmutter, David; Schwartz, Moshe

    2012-01-01

    Rising and sometimes volatile fuel prices pose a challenge for rural organizations reliant on long distance transport. To understand the coping mechanisms used by such organizations, we survey rural business strategies in Israel, where fuel prices are high and urban development is concentrated in the country's geographic center. The businesses surveyed are operated by kibbutzim, historically collective communities that are now in various stages of privatization. Analysis of the ‘transport strategies’ employed by nearly 100 organizations in three regions of varying remoteness and isolation shows that firms rely on distinct strategies such as localization and high value density. Localization was found to be prevalent in all regions, as it requires little capital investment. Strategies exploiting high value density, including information-based services, were prevalent in remote and isolated regions where sensitivity to transport costs is acute. Non-remote firms were less inclined toward strategic adaptation, preferring non-disruptive changes such as cheaper shipping modes. The development implications of these transport strategies are consistent with rural economic trends observed throughout the developed world. If transport costs continue to rise, rural firms may shrink the radius of their sales and labor pools, or search for more lucrative products to reduce their relative transport costs. - Highlights: ► We survey transport strategies used by rural businesses in Israeli kibbutzim. ► The seven distinct strategies identified include localization and value density. ► Localization is used in all regions and value density in remote and isolated regions. ► Development implications are consistent with economic trends in other rural regions. ► Rural firms will likely respond to high fuel costs by strategic transport adaptation.

  1. 20 CFR 404.272 - Indexes we use to measure the rise in the cost-of-living.

    Science.gov (United States)

    2010-04-01

    ... cost-of-living. 404.272 Section 404.272 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.272 Indexes we use to measure the rise in the cost-of-living. (a) The bases. To measure...

  2. Economic justification of costs at inspection of industrial safety of high-rise marine structures

    Science.gov (United States)

    Garibin, Pavel; Ol'khovik, Evgeniy; Rastorguev, Igor

    2018-03-01

    The task of technical and economic regulation within mutual international recognition of testing laboratories are considered. Codes and procedures within requirements of international ISO/IEC standards of a series 17000 for elimination of non-tariff barriers and interlaboratory exchange of experts in the field of high-rise marine construction are considered. In paper, the methods of assessment of formation of economically justified cost of works at inspection and monitoring of technical condition of high-rise marine wharf engineering port structure based on settlement and actual labor input were applied. For the countries of EU, data on the average cost of works of testing laboratory within a week have been taken as a basis. Such approach will be objective as considers only expenses on obligatory actions in the course of inspection of technical condition of port engineering constructions. The analysis of public results of financial activities of the accredited organizations allowed to calculate the main indicators of the size of necessary profit and overheads at observance of all requirements imposed to test laboratories including taking into account their future technical development. The offered practice corresponds to the general direction by mutual international recognition of independent testing laboratories and can be use in the future.

  3. Rising food costs & global food security: Key issues & relevance for India

    Science.gov (United States)

    Gustafson, Daniel J.

    2013-01-01

    Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers’ incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country's reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all. PMID:24135190

  4. Rising food costs & global food security: Key issues & relevance for India

    Directory of Open Access Journals (Sweden)

    Daniel J Gustafson

    2013-01-01

    Full Text Available Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers′ incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country′s reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all.

  5. Rising food costs & global food security: key issues & relevance for India.

    Science.gov (United States)

    Gustafson, Daniel J

    2013-09-01

    Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers' incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country's reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all.

  6. Efficiency and cost effectiveness of retrofitting ventilation in low-rise housing

    International Nuclear Information System (INIS)

    Bowser, D.; Fugler, D.

    2000-01-01

    Effective and inexpensive ventilation systems that can be retrofitted to existing low-rise housing to improve indoor air quality in existing housing stock is discussed. In a project by CMHC ten retrofit ventilation systems in single family residential buildings were tested in an effort to identify homes with specific indoor air quality concerns and to evaluate the performance of these retrofit systems by monitoring air quality before and after installation. Measurements were taken over a two-to-three day period with normal occupancy. In one case radon contamination was also measured directly before and after the retrofit. Cost estimates were based on capital, operating and maintenance expenses. This paper describes the results of three sample case studies. One of these involved a home with high concentration of radon gas. The recommended solution was fan-assisted removal of soil gases as the only way to ensure substantial reductions in concentration. Cost of the system was $2,450, plus $79 annual operating expenses. The second case involved a basement apartment with odour and moisture build-up. To solve the problem, an exhaust-only ventilation system with multiple pick-up points was installed at a cost of $750. Annual operating costs are estimated at $171. The third case study described a dwelling with windows and exhaust ducts showing condensation and mold on the bathroom ceiling. Balanced mechanical ventilation via an HRV was installed to exhaust the moist air from the house and to supply fresh dry air. In this case cost of the system was $1,345 installed, plus annual operating costs of $117. It was stressed that different houses have different requirements. Therefore it is important to be fully aware of the amount of natural ventilation a house has, prior to determining whether the solution demands additional ventilation requirements or simply redistribution. 1 ref., 3 figs

  7. 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.

  8. Long-term impact of war on healthcare costs: an eight-country study

    NARCIS (Netherlands)

    Sabes-Figuera, R.; McCrone, P.; Bogic, M.; Ajdukovic, D.; Franciskovic, T.; Colombini, N.; Kucukalic, A.; Lecic-Tosevski, D.; Morina, N.; Popovski, M.; Schützwohl, M.; Priebe, S.

    2012-01-01

    Objective Exposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the

  9. Estimating the unit costs of public hospitals and primary healthcare centers.

    Science.gov (United States)

    Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

    2013-01-01

    Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

  10. [The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality].

    Science.gov (United States)

    Naranjo-Gil, David; Ruiz-Muñoz, David

    2015-01-01

    Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  11. Direct healthcare costs of selected diseases primarily or partially transmitted by water.

    Science.gov (United States)

    Collier, S A; Stockman, L J; Hicks, L A; Garrison, L E; Zhou, F J; Beach, M J

    2012-11-01

    Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.

  12. Rising labor costs, earnings management, and financial performance of health care providers around the world.

    Science.gov (United States)

    Dong, Gang Nathan

    2015-01-01

    Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

  13. A Study on the Cost of Issuing Social Healthcare Corporation Bonds.

    Science.gov (United States)

    Fukunaga, Hajime; Yamauchi, Kazunobu

    2015-07-01

    The "Social Healthcare Corporation" system was established on 1 April 2007 as a result of the revised Japanese Medical Care Law. As of 1 October 2014, 234 corporations are certified Social Healthcare Corporations. These corporations are allowed to issue public bonds. However, to this day (1 December 2014), no bonds have been issued. In this paper, we focus on cost analysis with respect to issuing public bonds.

  14. Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis.

    Science.gov (United States)

    DeLoach Walworth, Darcy

    2005-08-01

    This comparative analysis examined the cost-effectiveness of music therapy as a procedural support in the pediatric healthcare setting. Many healthcare organizations are actively attempting to reduce the amount of sedation for pediatric patients undergoing various procedures. Patients receiving music therapy-assisted computerized tomography scans ( n = 57), echocardiograms ( n = 92), and other procedures ( n = 17) were included in the analysis. Results of music therapy-assisted procedures indicate successful elimination of patient sedation, reduction in procedural times, and decrease in the number of staff members present for procedures. Implications for nurses and music therapists in the healthcare setting are discussed.

  15. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  16. Healthcare costs in psoriasis and psoriasis sub-groups over time following psoriasis diagnosis.

    Science.gov (United States)

    Al Sawah, Sarah; Foster, Shonda A; Goldblum, Orin M; Malatestinic, William N; Zhu, Baojin; Shi, Nianwen; Song, Xue; Feldman, Steven R

    2017-09-01

    To quantify healthcare costs in patients with psoriasis overall and in psoriasis patient sub-groups, by level of disease severity, presence or absence of psoriatic arthritis, or use of biologics. Administrative data from Truven Health Analytics MarketScan Research Database were used to select adult patients with psoriasis from January 2009 to January 2014. The first psoriasis diagnosis was set as the index date. Patients were required to have ≥6 months of continuous enrollment with medical and pharmacy benefits pre-index and ≥12 months post-index. Patients were followed from index until the earliest of loss to follow-up or study end. All-cause healthcare costs and outpatient pharmacy costs were calculated for the overall psoriasis cohort and for the six different psoriasis patient sub-groups: (a) patients with moderate-to-severe disease and mild disease, (b) patients with psoriatic arthritis and those without, and (c) patients on biologics and those who are not. Costs are presented per-patient-per-year (PPPY) and by years 1, 2, 3, 4, and 5 of follow-up, expressed in 2014 US dollars. A total of 108,790 psoriasis patients were selected, with a mean age of 46.0 years (52.7% females). Average follow-up was 962 days. All-cause healthcare costs were $12,523 PPPY. Outpatient pharmacy costs accounted for 38.6% of total costs. All-cause healthcare costs were highest for patients on biologics ($29,832), then for patients with psoriatic arthritis ($23,427) and those with moderate-to-severe disease ($21,481). Overall, all-cause healthcare costs and outpatient pharmacy costs presented an upward trend over a 5-year period. Psoriasis is associated with significant economic burden, which increases over time as the disease progresses. Patients with moderate-to-severe psoriasis, those with psoriatic arthritis, or use of biologics contributes to higher healthcare costs. Psoriasis-related pharmacy expenditure is the largest driver of healthcare costs in patients with psoriasis.

  17. Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs.

    Science.gov (United States)

    MacBean, Victoria; Drysdale, Simon B; Yarzi, Muska N; Peacock, Janet L; Rafferty, Gerrard F; Greenough, Anne

    2018-03-01

    To determine the impact of viral lower respiratory tract infections (LRTIs) in infancy including rhinovirus (RV) and infancy respiratory syncytial virus (RSV), on school age pulmonary function and healthcare utilization in prematurely born children. School age respiratory outcomes would be worse and healthcare utilization greater in children who had viral LRTIs in infancy. Prospective study. A cohort of prematurely born children who had symptomatic LRTIs during infancy documented, was recalled. Pulmonary function was assessed at 5 to 7 years of age and health related costs of care from aged one to follow-up determined. Fifty-one children, median gestational age 33 +6 weeks, were assessed at a median (IQR) age 7.03 (6.37-7.26) years. Twenty-one children had no LRTI, 14 RV LRTI, 10 RSV LRTI, and 6 another viral LRTI (other LRTI). Compared to the no LRTI group, the RV group had a lower FEV 1 (P = 0.033) and the other LRTI group a lower FVC (P = 0.006). Non-respiratory medication costs were higher in the RV (P = 0.018) and RSV (P = 0.013) groups. Overall respiratory healthcare costs in the RV (£153/year) and RSV (£27/year) groups did not differ significantly from the no LRTI group (£56/year); the other LRTI group (£431/year) had higher respiratory healthcare costs (P = 0.042). In moderately prematurely born children, RV and RSV LRTIs in infancy were not associated with higher respiratory healthcare costs after infancy. Children who experienced LRTIs caused by other respiratory viruses (including RV) had higher respiratory healthcare costs and greater pulmonary function impairment. © 2018 Wiley Periodicals, Inc.

  18. Healthcare costs attributable to secondhand smoke exposure at home for U.S. adults.

    Science.gov (United States)

    Yao, Tingting; Sung, Hai-Yen; Wang, Yingning; Lightwood, James; Max, Wendy

    2018-03-01

    To estimate healthcare costs attributable to secondhand smoke (SHS) exposure at home among nonsmoking adults (18+) in the U.S. We analyzed data on nonsmoking adults (N=67,735) from the 2000, 2005, and 2010 (the latest available data on SHS exposure at home) U.S. National Health Interview Surveys. This study was conducted from 2015 to 2017. We examined hospital nights, home care visits, doctor visits, and emergency room (ER) visits. For each, we analyzed the association of SHS exposure at home with healthcare utilization with a Zero-Inflated Poisson regression model controlling for socio-demographic and other risk characteristics. Excess healthcare utilization attributable to SHS exposure at home was determined and multiplied by unit costs derived from the 2014 Medical Expenditures Panel Survey to determine annual SHS-attributable healthcare costs. SHS exposure at home was positively associated with hospital nights and ER visits, but was not statistically associated with home care visits and doctor visits. Exposed adults had 1.28 times more hospital nights and 1.16 times more ER visits than non-exposed adults. Annual SHS-attributable healthcare costs totaled $4.6 billion (including $3.8 billion for hospital nights and $0.8 billion for ER visits, 2014 dollars) in 2000, $2.1 billion (including $1.8 billion for hospital nights and $0.3 billion for ER visits) in 2005, and $1.9 billion (including $1.6 billion for hospital nights and $0.4 billion for ER visits) in 2010. SHS-attributable costs remain high, but have fallen over time. Tobacco control efforts are needed to further reduce SHS exposure at home and associated healthcare costs. Copyright © 2017. Published by Elsevier Inc.

  19. Formation of costs of high-rise objects of housing and civil purpose based on enlarged norms

    Science.gov (United States)

    Vorotyntseva, Anna; Ovsiannikov, Andrei; Bolgov, Vladimir

    2018-03-01

    When determining the cost of capital construction objects, for purposes of pre-design workings out and purposes of initial maximum initial price determination on tenders, construction price norms are used (CPNs). Modern CPNs are not designed to determine the value of high-rise buildings. It is necessary to adapt modern CPNs to get opportunity for the possibility to take into account special cost factors in determining the cost of high-rise buildings. The main ways can be: selection of new representative objects or application of additional correction factors.

  20. The rise of low-cost sensing for managing air pollution in cities.

    Science.gov (United States)

    Kumar, Prashant; Morawska, Lidia; Martani, Claudio; Biskos, George; Neophytou, Marina; Di Sabatino, Silvana; Bell, Margaret; Norford, Leslie; Britter, Rex

    2015-02-01

    Ever growing populations in cities are associated with a major increase in road vehicles and air pollution. The overall high levels of urban air pollution have been shown to be of a significant risk to city dwellers. However, the impacts of very high but temporally and spatially restricted pollution, and thus exposure, are still poorly understood. Conventional approaches to air quality monitoring are based on networks of static and sparse measurement stations. However, these are prohibitively expensive to capture tempo-spatial heterogeneity and identify pollution hotspots, which is required for the development of robust real-time strategies for exposure control. Current progress in developing low-cost micro-scale sensing technology is radically changing the conventional approach to allow real-time information in a capillary form. But the question remains whether there is value in the less accurate data they generate. This article illustrates the drivers behind current rises in the use of low-cost sensors for air pollution management in cities, while addressing the major challenges for their effective implementation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Printable low-cost sensor systems for healthcare smart textiles

    Science.gov (United States)

    Rai, Pratyush; Kumar, Prashanth S.; Oh, Sechang; Kwon, Hyeokjun; Mathur, Gyanesh N.; Varadan, Vijay K.

    2011-04-01

    Smart textiles-based wearable health monitoring systems (ST-HMS) have been presented as elegant solutions to the requirements of individuals across a wide range of ages. They can be used to monitor young or elderly recuperating /convalescent patients either in hospital or at home, or they can be used by young athletes to monitor important physiological parameters to better design their training or fitness program. Business and academic interests, all over the world, have fueled a great deal of work in the development of this technology since 1990. However, two important impediments to the development of ST-HMS are:-integration of flexible electrodes, flexible sensors, signal conditioning circuits and data logging or wireless transmission devices into a seamless garment and a means to mass manufacture the same, while keeping the costs low. Roll-to-roll printing and screen printing are two low cost methods for large scale manufacturing on flexible substrates and can be extended to textiles as well. These two methods are, currently, best suited for planar structures. The sensors, integrated with wireless telemetry, facilitate development of a ST-HMS that allows for unobtrusive health monitoring. In this paper, we present our results with planar screen printable sensors based on conductive inks which can be used to monitor EKG, abdominal respiration effort, blood pressure, pulse rate and body temperature. The sensor systems were calibrated, and tested for sensitivity, reliability and robustness to ensure reuse after washing cycles.

  2. Healthcare resource use and costs of multiple sclerosis patients in Germany before and during fampridine treatment.

    Science.gov (United States)

    Ziemssen, Tjalf; Prosser, Christine; Haas, Jennifer Scarlet; Lee, Andrew; Braun, Sebastian; Landsman-Blumberg, Pamela; Kempel, Angela; Gleißner, Erika; Patel, Sarita; Huang, Ming-Yi

    2017-03-27

    Multiple sclerosis (MS) patients often suffer from gait impairment and fampridine is indicated to medically improve walking ability in this population. Patient characteristics, healthcare resource use, and costs of MS patients on fampridine treatment for 12 months in Germany were analyzed. A retrospective claims database analysis was conducted including MS patients who initiated fampridine treatment (index date) between July 2011 and December 2013. Continuous insurance enrollment during 12 months pre- and post-index date was required, as was at least 1 additional fampridine prescription in the fourth quarter after the index date. Patient characteristics were evaluated and pre- vs post-index MS-related healthcare utilization and costs were compared. A total of 562 patients were included in this study. The mean (standard deviation [SD]) age was 50.5 (9.8) years and 63% were female. In the treatment period, almost every patient had at least 1 MS-related outpatient visit, 24% were hospitalized due to MS, and 79% utilized MS-specific physical therapy in addition to the fampridine treatment. Total MS-related healthcare costs were significantly higher in the fampridine treatment period than in the period prior to fampridine initiation (€17,392 vs €10,960, P treatment (€1,333 vs €1,565, P treatment. While healthcare costs were higher during fampridine treatment compared to the pre-treatment period, inpatient costs were lower. Further research is necessary to better understand the fampridine influence.

  3. Comparing VA and private sector healthcare costs for end-stage renal disease.

    Science.gov (United States)

    Hynes, Denise M; Stroupe, Kevin T; Fischer, Michael J; Reda, Domenic J; Manning, Willard; Browning, Margaret M; Huo, Zhiping; Saban, Karen; Kaufman, James S

    2012-02-01

    Healthcare for end-stage renal disease (ESRD) is intensive, expensive, and provided in both the public and private sector. Using a societal perspective, we examined healthcare costs and health outcomes for Department of Veterans Affairs (VA) ESRD patients comparing those who received hemodialysis care at VA versus private sector facilities. Dialysis patients were recruited from 8 VA medical centers from 2001 through 2003 and followed for 12 months in a prospective cohort study. Patient demographics, clinical characteristics, quality of life, healthcare use, and cost data were collected. Healthcare data included utilization (VA), claims (Medicare), and patient self-report. Costs included VA calculated costs, Medicare dialysis facility reports and reimbursement rates, and patient self-report. Multivariable regression was used to compare costs between patients receiving dialysis at VA versus private sector facilities. The cohort comprised 334 patients: 170 patients in the VA dialysis group and 164 patients in the private sector group. The VA dialysis group had more comorbidities at baseline, outpatient and emergency visits, prescriptions, and longer hospital stays; they also had more conservative anemia management and lower baseline urea reduction ratio (67% vs. 72%; Pprivate sector dialysis group (Pprivate sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.

  4. Double Relapsed and/or Refractory Multiple Myeloma: Clinical Outcomes and Real World Healthcare Costs.

    Directory of Open Access Journals (Sweden)

    Sarah Gooding

    Full Text Available Double relapsed and/or refractory multiple myeloma (DRMM, MM that is relapsed and/or refractory to bortezomib and lenalidomide, carries a poor prognosis. The healthcare costs of DRMM have not previously been reported. We analyzed detailed medical resource utilization (MRU costs, drug costs and outcomes for 39 UK patients receiving standard DRMM therapy. Median OS in this cohort was 5.6 months. The mean cost of DRMM treatment plus MRU until death was £23,472 [range: £1,411-£90,262], split between drug costs £11,191 and other resource use costs £12,281. The cost per assumed quality-adjusted life year (QALY during DRMM was £66,983. These data provide a standard of care comparison when evaluating the cost-effectiveness of new drugs in DRMM.

  5. Individual responsibility, solidarity and differentiation in healthcare

    NARCIS (Netherlands)

    Stegeman, I.; Willems, D. L.; Dekker, E.; Bossuyt, P. M.

    2014-01-01

    Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. A vignette study was

  6. Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial

    DEFF Research Database (Denmark)

    Rasmussen, J.F.; Siersma, V.; Pedersen, Jesper H.

    2014-01-01

    : This registry study was nested in a randomised controlled trial (DLCST). 4104 participants, current or former heavy smokers, aged 50-70 years were randomised to five annual low dose CT scans or usual care during 2004-2010. Total healthcare costs and healthcare utilisation data for both the primary...... and the secondary healthcare sector were retrieved from public registries from randomisation - September 2011 and compared between (1) the CT-screening group and the control group and, (2) the control group and each of the true-positive, false-positive and true-negative groups. RESULTS: The median annual costs per...... participant were significantly higher in the CT-screening group (Euros [EUR] 1342, interquartile range [IQR] 750-2980) compared with the control group (EUR 1190, IQR 590-2692) (pcost of the CT-screening programme was excluded, there was no longer a statistically significant difference...

  7. Improving the delivery of care and reducing healthcare costs with the digitization of information.

    Science.gov (United States)

    Noffsinger, R; Chin, S

    2000-01-01

    In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

  8. Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

    Directory of Open Access Journals (Sweden)

    Mohammad M. H. Abdullah

    2017-07-01

    Full Text Available Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D and incidence of cardiovascular disease (CVD following a low glycemic index (GI or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1 estimate the proportions of individuals who are likely to consume pulses; (2 evaluate the reductions in established risk factors for T2D and CVD; (3 assess the percent reduction in incidences or complications of the diseases of interest; and (4 calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9 to Can$62.4 (95% CI $26–$98.8 and Can$31.6 (95% CI $11.1–$52 to Can$315.5 (95% CI $110.6–$520.4 million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term.

  9. [Characteristics and healthcare utilization of patients with highest costs of care

    NARCIS (Netherlands)

    Wammes, J.J.G.; Tanke, M.A.C.; Jonkers, W.; Westert, G.P.; Wees, P.J. van der; Jeurissen, P.P.T.

    2017-01-01

    OBJECTIVE: To determine characteristics and healthcare utilization of high-cost patients in the Netherlands. DESIGN: Cross-sectional study, using claim data for 2013 from one Dutch health insurer. Analyses were limited to the curative health system (care that falls under the Health Insurance Act),

  10. The importance of epidemiological predictors for healthcare costs for chronic patients

    DEFF Research Database (Denmark)

    Hansen, Louise

    SUMMARY Healthcare systems around the world continue to see their expenditures increase, measured as a percentage of gross domestic product. Within health economics, the need for models that can predict healthcare costs is of substantial importance, as decisions to introduce as well as to decommi......SUMMARY Healthcare systems around the world continue to see their expenditures increase, measured as a percentage of gross domestic product. Within health economics, the need for models that can predict healthcare costs is of substantial importance, as decisions to introduce as well...... to consider, and lastly choosing the most appropriate statistical model. This framework was developed as a result of five quantitative studies, of which four were based on patient specific data from registers, and one on cost of illness theory. The framework was applied for predicting the cost for all...... which these patients are treated, as different resources were affected differently by the clinical and behavioural predictors included. In conclusion, the results from this dissertation highlight the importance being familiar with the population of interest, identifying the relevant resources, including...

  11. Targeting Environmental Quality to Improve Population Health and Lower Healthcare Costs

    Science.gov (United States)

    Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Ye...

  12. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

    Science.gov (United States)

    Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

    Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

  13. Estimating the cost of healthcare delivery in three hospitals in southern ghana.

    Science.gov (United States)

    Aboagye, A Q Q; Degboe, A N K; Obuobi, A A D

    2010-09-01

    The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were computed by taking into account cash and non-cash expenses and allocating overhead costs to intermediate and final patient care centres. The full costs of running the mission hospital in 2002 and 2003 were US$600,295 and US$758,647 respectively; for the district hospital, the respective costs were US$496,240 and US$487,537; and for the referral hospital, the respective costs were US$1,160,535 and US$1,394,321. Of these, overhead costs ranged between 20% and 42%, while salaries made up between 45% and 60%. Based on healthcare utilization data, in 2003 the estimated cost per outpatient attendance was US$ 2.25 at the mission hospital, US$ 4.51 at the district hospital and US$8.5 at the referral hospital; inpatient day costs were US$ 6.05, US$ 9.95 and US$18.8 at the respective hospitals. User fees charged at service delivery points were generally below cost. However, some service delivery points have the potential to recover their costs. Salaries are the major cost component of the three hospitals. Overhead costs constitute an important part of hospital costs and must be noted in efforts to recover costs. Cost structures are different at different types of hospitals. Unit costs at service delivery points can be estimated and projected into the future.

  14. The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

    DEFF Research Database (Denmark)

    de Kok, I M C M; Polder, J J; Habbema, J D F

    2009-01-01

    life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by 4040 euro...... in women, and by 4100 euro in men. Of these, 660 euro in women, and 890 euro in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase......, with approximately 4000 euro. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications....

  15. Analysis of Anterior Cervical Discectomy and Fusion Healthcare Costs via the Value-Driven Outcomes Tool.

    Science.gov (United States)

    Reese, Jared C; Karsy, Michael; Twitchell, Spencer; Bisson, Erica F

    2018-04-11

    Examining the costs of single- and multilevel anterior cervical discectomy and fusion (ACDF) is important for the identification of cost drivers and potentially reducing patient costs. A novel tool at our institution provides direct costs for the identification of potential drivers. To assess perioperative healthcare costs for patients undergoing an ACDF. Patients who underwent an elective ACDF between July 2011 and January 2017 were identified retrospectively. Factors adding to total cost were placed into subcategories to identify the most significant contributors, and potential drivers of total cost were evaluated using a multivariable linear regression model. A total of 465 patients (mean, age 53 ± 12 yr, 54% male) met the inclusion criteria for this study. The distribution of total cost was broken down into supplies/implants (39%), facility utilization (37%), physician fees (14%), pharmacy (7%), imaging (2%), and laboratory studies (1%). A multivariable linear regression analysis showed that total cost was significantly affected by the number of levels operated on, operating room time, and length of stay. Costs also showed a narrow distribution with few outliers and did not vary significantly over time. These results suggest that facility utilization and supplies/implants are the predominant cost contributors, accounting for 76% of the total cost of ACDF procedures. Efforts at lowering costs within these categories should make the most impact on providing more cost-effective care.

  16. Peripartum hysterectomy: an economic analysis of direct healthcare costs using routinely collected data.

    Science.gov (United States)

    Achana, F A; Fleming, K M; Tata, L J; Sultan, A A; Petrou, S

    2017-10-03

    To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service. Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data. Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls. Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators. Primary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices). The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5380 (95% CI £4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs. Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered. A large amount of NHS data on peripartum hysterectomy suggests active community follow up could reduce costs, #HealthEconomics. © 2017 Royal College of Obstetricians and Gynaecologists.

  17. [Predicting individual risk of high healthcare cost to identify complex chronic patients].

    Science.gov (United States)

    Coderch, Jordi; Sánchez-Pérez, Inma; Ibern, Pere; Carreras, Marc; Pérez-Berruezo, Xavier; Inoriza, José M

    2014-01-01

    To develop a predictive model for the risk of high consumption of healthcare resources, and assess the ability of the model to identify complex chronic patients. A cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years (88,795 people). The dependent variable consisted of healthcare costs above the 95th percentile (P95), including all services provided by the organization and pharmaceutical consumption outside of the institution. The predictive variables were age, sex, morbidity-based on clinical risk groups (CRG)-and selected data from previous utilization (use of hospitalization, use of high-cost drugs in ambulatory care, pharmaceutical expenditure). A univariate descriptive analysis was performed. We constructed a logistic regression model with a 95% confidence level and analyzed sensitivity, specificity, positive predictive values (PPV), and the area under the ROC curve (AUC). Individuals incurring costs >P95 accumulated 44% of total healthcare costs and were concentrated in ACRG3 (aggregated CRG level 3) categories related to multiple chronic diseases. All variables were statistically significant except for sex. The model had a sensitivity of 48.4% (CI: 46.9%-49.8%), specificity of 97.2% (CI: 97.0%-97.3%), PPV of 46.5% (CI: 45.0%-47.9%), and an AUC of 0.897 (CI: 0.892 to 0.902). High consumption of healthcare resources is associated with complex chronic morbidity. A model based on age, morbidity, and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype.

    Science.gov (United States)

    Goolsby Hunter, Alyssa; Rosenblatt, Lisa; Patel, Chad; Blauer-Peterson, Cori; Anduze-Faris, Beatrice

    2017-05-01

    In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored. In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics. Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity. The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs. Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients. These results suggest that liver disease progression varies by genotype and

  19. Inequality in healthcare costs between residing and non-residing patients: evidence from Vietnam.

    Science.gov (United States)

    Nguyen, Hieu M

    2017-05-12

    Place of residence has been shown to impact health. To date, however, previous studies have only focused on the variability in health outcomes and healthcare costs between urban and rural patients. This study takes a different approach and investigates cost inequality facing non-residing patients - patients who do not reside in the regions in which the hospitals are located. Understanding the sources for this inequality is important, as they are directly related to healthcare accessibility in developing countries. The causal impact of residency status on individual healthcare spending is documented with a quasi-experimental design. The propensity score matching method is applied to a unique patient-level dataset (n = 900) collected at public general and specialist hospitals across North Vietnam. Propensity score matching shows that Vietnamese patients who do not reside in the regions in which the hospitals are located are expected to pay about 15 million Vietnamese dongs (approximately 750 USD) more than those who do, a sizable gap, given the distribution of total healthcare costs for the overall sample. This estimate is robust to alternative matching specifications. The obtained discrepancy is empirically attributable to the differences in three potential contributors, namely spending on accompanying relatives, "courtesy funds," and days of hospitalization. The present study finds that there is significant inequality in healthcare spending between residing and non-residing patients at Vietnamese hospitals and that this discrepancy can be partially explained by both institutional and non-institutional factors. These factors signal practical channels through which policymakers can improve healthcare accessibility.

  20. Investigation on the Factors Influencing Construction Time and Cost Overrun for High-Rise Building Projects In Penang

    Science.gov (United States)

    Nor Haslinda, A.; Xian, T. Wei; Norfarahayu, K.; Muhamad Hanafi, R.; Fikri, H. Muhammad

    2018-04-01

    Time and cost overruns have become one prominent issue for most construction projects around the world. Project costing and timeframe extension had been causing a lot of wastage and loss of opportunity for many parties involved. Therefore, this research was carried out to investigate the factors influencing time and cost overruns for high-rise construction projects in Penang, Malaysia. A set of questionnaires survey was distributed to the project managers who had been or currently involved in the high-rise building projects in Penang to get their input and perceptions for each factor identified as well as its frequency of occurrence. In order to rank all the factors gathered, the mean index of the most distinguishing factors and its frequency of occurrence were multiplied to get the severity index. The results revealed that for time overrun, the most predominant causes were due to design changes, inadequate planning and scheduling and poor labor productivity. Meanwhile, the predominant causes of cost overrun were poor pre-construction budget and material cost planning, inaccurate quantity take-off and materials cost increased by inflation. The significance of establishing the issues related to time and cost overruns for the high-rise building construction project is to provide a greater insight and understanding on the causes of delays, particularly among the main project players: contractors, client, and consultants.

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

    Science.gov (United States)

    Danielsen, Anne Kjærgaard; Rosenberg, Jacob

    2014-04-01

    Researchers are urged to include health-economic assessments when exploring the benefits and drawbacks of a new treatment. The aim of the study was to assess the costs associated with the establishment of a new patient education programme for patients with a stoma. Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment Scale six months after surgery. The secondary outcome was generic health-related quality of life measured with Short Form (SF)-36. In this secondary analysis, we calculated direct health-care costs for the first six months post-operatively from the perspective of the health-care system, including costs related to the hospital as well as primary health care. The overall cost related to establishing a patient education programme showed no significant increase in the overall average costs. However, we found a significant reduction in costs related to unplanned readmissions (p = 0.01) as well as a reduction in visits to the general practitioner (p = 0.05). Establishing a patient education programme - which increased quality of life - will probably not increase the overall costs associated with the patient course. The study received financial support from Søster Inge Marie Dahlgaards Fond, Diakonissestiftelsen, Denmark, and from Aase and Ejnar Danielsens Foundation, Denmark. NCT01154725.

  2. Crowdsourcing healthcare costs: Opportunities and challenges for patient centered price transparency.

    Science.gov (United States)

    Meisel, Zachary F; VonHoltz, Lauren A Houdek; Merchant, Raina M

    2016-03-01

    Efforts to improve health care price transparency have garnered significant attention from patients, policy makers, and health insurers. In response to increasing consumer demand, state governments, insurance plans, and health care providers are reporting health care prices. However, such data often do not provide consumers with the most salient information: their own actual out-of-pocket cost for medical care. Although untested, crowdsourcing, a mechanism for the public to help answer complex questions, represents a potential solution to the problem of opaque hospital costs. This article explores, the challenges and potential opportunities for crowdsourcing out-of-pocket costs for healthcare consumers. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Real-world healthcare costs of ipilimumab in patients with advanced cutaneous melanoma in The Netherlands.

    Science.gov (United States)

    Franken, Margreet G; Leeneman, Brenda; Jochems, Anouk; Schouwenburg, Maartje G; Aarts, Maureen J B; van Akkooi, Alexander C J; van den Berkmortel, Franchette W P J; van den Eertwegh, Alfonsus J M; de Groot, Jan Willem B; van der Hoeven, Koos J M; Hospers, Geke A P; Kapiteijn, Ellen; Koornstra, Rutger; Kruit, Wim H J; Louwman, Marieke W J; Piersma, Djura; van Rijn, Rozemarijn S; Suijkerbuijk, Karijn P M; Ten Tije, Albert J; Vreugdenhil, Gerard; Wouters, Michel W J M; van Zeijl, Michiel; Haanen, John B A G; Uyl-de Groot, Carin A

    2018-07-01

    There is limited evidence on the costs associated with ipilimumab. We investigated healthcare costs of all Dutch patients with advanced cutaneous melanoma who were treated with ipilimumab. Data were retrieved from the nation-wide Dutch Melanoma Treatment Registry. Costs were determined by applying unit costs to individual patient resource use. A total of 807 patients who were diagnosed between July 2012 and July 2015 received ipilimumab in Dutch practice. The mean (median) episode duration was 6.27 (4.61) months (computed from the start of ipilimumab until the start of a next treatment, death, or the last date of follow-up). The average total healthcare costs amounted to &OV0556;81 484, but varied widely (range: &OV0556;18 131-&OV0556;160 002). Ipilimumab was by far the most important cost driver (&OV0556;73 739). Other costs were related to hospital admissions (&OV0556;3323), hospital visits (&OV0556;1791), diagnostics and imaging (&OV0556;1505), radiotherapy (&OV0556;828), and surgery (&OV0556;297). Monthly costs for resource use other than ipilimumab were &OV0556;1997 (SD: &OV0556;2629). Treatment-naive patients (n=344) had higher total costs compared with previously-treated patients (n=463; &OV0556;85 081 vs. &OV0556;78 811). Although patients with colitis (n=106) had higher costs for resource use other than ipilimumab (&OV0556;11 426) compared with patients with other types of immune-related adverse events (n=90; &OV0556;9850) and patients with no immune-related adverse event (n=611; &OV0556;6796), they had lower total costs (&OV0556;76 075 vs. &OV0556;87 882 and &OV0556;81 480, respectively). In conclusion, this nation-wide study provides valuable insights into the healthcare costs of advanced cutaneous melanoma patients who were treated with ipilimumab in clinical practice. Most of the costs were attributable to ipilimumab, but the costs and its distribution varied considerably across subgroups.

  4. Health-care costs of underweight, overweight and obesity: Australian population-based study.

    Science.gov (United States)

    Clifford, Susan A; Gold, Lisa; Mensah, Fiona K; Jansen, Pauline W; Lucas, Nina; Nicholson, Jan M; Wake, Melissa

    2015-12-01

    Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. biennial BMI measurements over the same period. Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  5. Duloxetine compliance and its association with healthcare costs among patients with diabetic peripheral neuropathic pain.

    Science.gov (United States)

    Wu, N; Chen, S; Boulanger, L; Fraser, K; Bledsoe, S L; Zhao, Y

    2009-09-01

    Duloxetine is approved to treat diabetic peripheral neuropathic pain (DPNP) in the US. The study objective was to examine the predictors of duloxetine compliance, and its association with healthcare costs among DPNP patients. The study used administrative claims databases to identify non-depressed DPNP patients with a duloxetine prescription dispensed between October 1, 2004 and December 31, 2006. Two cohorts of patients were constructed based on compliance to duloxetine therapy over 1-year follow-up with high compliance defined as a medication possession ratio (MPR) > or =0.80. All-cause, diabetes-, and DPNP-related healthcare costs during 1-year follow-up were estimated. Logistic regressions were performed to examine how average daily dose (ADD) of duloxetine and other factors may influence compliance. Multivariate regressions were estimated to examine the association between compliance and healthcare costs. The study included 1,380 commercially insured (mean age 55 years) and 974 patients with employer-sponsored Medicare supplemental insurance (mean age 75 years). In both populations, patients with an ADD >30 mg were more likely to be compliant with the therapy compared with those with an ADD of compliance patients had greater all-cause ($5,334, pcosts ($3,414, pcompliance patients, with the biggest difference from inpatient costs (all-cause: $7,508; diabetes-related: $3,785, all pcosts were not significant. DPNP patients with a higher ADD of duloxetine over a 1-year follow-up period were more compliant with the therapy. Duloxetine patients with high compliance were also associated with lower healthcare costs. Due to the use of a retrospective cohort design on administrative claims database, limitations of this analysis include a lack of formal diagnostic testing of patients, and inability to infer causality or measure factors such as DPNP severity that are not captured in such database.

  6. Precision oncology in advanced cancer patients improves overall survival with lower weekly healthcare costs

    Science.gov (United States)

    Haslem, Derrick S.; Chakravarty, Ingo; Fulde, Gail; Gilbert, Heather; Tudor, Brian P.; Lin, Karen; Ford, James M.; Nadauld, Lincoln D.

    2018-01-01

    The impact of precision oncology on guiding treatment decisions of late-stage cancer patients was previously studied in a retrospective analysis. However, the overall survival and costs were not previously evaluated. We report the overall survival and healthcare costs associated with precision oncology in these patients with advanced cancer. Building on a matched cohort study of 44 patients with metastatic cancer who received all of their care within a single institution, we evaluated the overall survival and healthcare costs for each patient. We analyzed the outcomes of 22 patients who received genomic testing and targeted therapy (precision oncology) between July 1, 2013 and January 31, 2015, and compared to 22 historically controlled patients (control) who received standard chemotherapy (N = 17) or best supportive care (N = 5). The median overall survival was 51.7 weeks for the targeted treatment group and 25.8 weeks for the control group (P = 0.008) when matching on age, gender, histological diagnosis and previous treatment lines. Average costs over the entire period were $2,720 per week for the targeted treatment group and $3,453 per week for the control group, (P = 0.036). A separate analysis of 1,814 patients with late-stage cancer diagnoses found that those who received a targeted cancer treatment (N = 93) had 6.9% lower costs in the last 3 months of life compared with those who did not. These findings suggest that precision oncology may improve overall survival for refractory cancer patients while lowering average per-week healthcare costs, resource utilization and end-of-life costs. PMID:29552312

  7. Designing an activity-based costing model for a non-admitted prisoner healthcare setting.

    Science.gov (United States)

    Cai, Xiao; Moore, Elizabeth; McNamara, Martin

    2013-09-01

    To design and deliver an activity-based costing model within a non-admitted prisoner healthcare setting. Key phases from the NSW Health clinical redesign methodology were utilised: diagnostic, solution design and implementation. The diagnostic phase utilised a range of strategies to identify issues requiring attention in the development of the costing model. The solution design phase conceptualised distinct 'building blocks' of activity and cost based on the speciality of clinicians providing care. These building blocks enabled the classification of activity and comparisons of costs between similar facilities. The implementation phase validated the model. The project generated an activity-based costing model based on actual activity performed, gained acceptability among clinicians and managers, and provided the basis for ongoing efficiency and benchmarking efforts.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    INTRODUCTION: The present study compared health carerelated costs and the use of social benefits and transfer payments in participants with and without chronic obstructive pulmonary disease (COPD), and related the costs to the severity of the COPD. MATERIAL AND METHODS: Spirometry data from...... a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio ....7 following bronchodilator administration] and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. RESULTS: Health care-related costs were 4,779 (2,404- 7,154) Danish kroner (DKK...

  9. BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth.

    Science.gov (United States)

    Sonneville, Kendrin R; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Wang, Y Claire; Pomeranz, Jennifer L; Moodie, Marj L; Carter, Rob; Sacks, Gary; Swinburn, Boyd A; Gortmaker, Steven L

    2015-07-01

    Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.

    Science.gov (United States)

    Robinson, Rebecca L; Grabner, Michael; Palli, Swetha Rao; Faries, Douglas; Stephenson, Judith J

    2016-06-01

    To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; pcosts/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both pcosts in patients with depression. Copyright © 2016 Eli Lilly and Company. Published by Elsevier Inc. All rights reserved.

  11. Long-term impact of war on healthcare costs: an eight-country study.

    Directory of Open Access Journals (Sweden)

    Ramon Sabes-Figuera

    Full Text Available Exposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the former-Yugoslavia on average 8 years previously, and to identify characteristics associated with the use and costs of healthcare.War-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, and Serbia were recruited through a random walk technique. Refugees in Germany, Italy and the UK were contacted through registers, organisations and networking. Current service use was measured for the previous three months and combined with unit costs for each country for the year 2006/7. A two-part approach was used, to identify predictors of service use with a multiple logistic regression model and predictors of cost with a generalised linear regression model.3,313 participants were interviewed in Balkan countries and 854 refugees in Western European countries. In the Balkan countries, traumatic events and mental health status were related to greater service use while in Western countries these associations were not found. Participants in Balkan countries with post traumatic stress disorder (PTSD had costs that were 63% higher (p = 0.005 than those without PTSD. Distress experienced during the most traumatic war event was associated with higher costs (p = 0.013. In Western European countries costs were 76% higher if non-PTSD anxiety disorders were present (0.027 and 63% higher for mood disorders (p = 0.006.War experiences and their effects on mental health are associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. Focussing on the mental health impact of war is important for many reasons including those of an economic nature.

  12. Tax-Assisted Approaches for Helping Canadians Meet Out-of-Pocket Health-Care Costs

    Directory of Open Access Journals (Sweden)

    J.C. Herbert Emery

    2016-06-01

    Full Text Available Canadians are not saving for the inevitable costs of drugs and long-term care which they will have to pay for out of pocket in their old age, and these costs could potentially be financially devastating for them. Later in life, when out-of-pocket health-care costs mount, those who previously enjoyed the security of a workplace insurance plan to cover such expenses will face a grim financial reality. Many aspects of care for older Canadians aren’t covered by this country’s single-payer health-care system. Besides prescription drugs, these include management of chronic conditions by ancillary health professionals, home care, long-term care, and dental and vision care. Statistics show that in 2012, Canadians’ private spending on health care totaled $60 billion, with private health insurance covering $24.5 billion of that amount. Coverage of health-care costs that don’t fall under Medicare’s purview is at present rather piecemeal. The non-refundable federal Medical Expense Tax Credit covers expenses only after the three-per-cent minimum, or first $2,171, of out-of-pocket costs have been paid by the individual. The Disability Tax Credit is available to those with a certified chronic disability, and these individuals are eligible for further support via the Registered Disability Savings Plan. A Caregiver Tax Credit is also available. The federal government has a golden opportunity to provide an incentive for Canadians to set aside money to pay not only for the often catastrophic medical and drug costs that can come with aging, but also to save so they can afford long-term care, or purchase private health insurance. Too many Canadians, unfortunately, believe that the federal government picks up the tab for long-term care. In fact, provincial subsidies are provided on a means-testing basis, thus leaving many better-off Canadians in the lurch when they can no longer live alone and must make the transition to long-term care. Providing more

  13. Patented drug extension strategies on healthcare spending: a cost-evaluation analysis.

    Science.gov (United States)

    Vernaz, Nathalie; Haller, Guy; Girardin, François; Huttner, Benedikt; Combescure, Christophe; Dayer, Pierre; Muscionico, Daniel; Salomon, Jean-Luc; Bonnabry, Pascal

    2013-01-01

    Drug manufacturers have developed "evergreening" strategies to compete with generic medication after patent termination. These include marketing of slightly modified follow-on drugs. We aimed to estimate the financial impact of these drugs on overall healthcare costs and also to examine the impact of listing these drugs in hospital restrictive drug formularies (RDFs) on the healthcare system as a whole ("spillover effect"). We used hospital and community pharmacy invoice office data in the Swiss canton of Geneva to calculate utilisation of eight follow-on drugs in defined daily doses between 2000 and 2008. "Extra costs" were calculated for three different scenarios assuming replacement with the corresponding generic equivalent for prescriptions of (1) all brand (i.e., initially patented) drugs, (2) all follow-on drugs, or (3) brand and follow-on drugs. To examine the financial spillover effect we calculated a monthly follow-on drug market share in defined daily doses for medications prescribed by hospital physicians but dispensed in community pharmacies, in comparison to drugs prescribed by non-hospital physicians in the community. Estimated "extra costs" over the study period were €15.9 (95% CI 15.5; 16.2) million for scenario 1, €14.4 (95% CI 14.1; 14.7) million for scenario 2, and €30.3 (95% CI 29.8; 30.8) million for scenario 3. The impact of strictly switching all patients using proton-pump inhibitors to esomeprazole at admission resulted in a spillover "extra cost" of €330,300 (95% CI 276,100; 383,800), whereas strictly switching to generic cetirizine resulted in savings of €7,700 (95% CI 4,100; 11,100). Overall we estimated that the RDF resulted in "extra costs" of €503,600 (95% CI 444,500; 563,100). Evergreening strategies have been successful in maintaining market share in Geneva, offsetting competition by generics and cost containment policies. Hospitals may be contributing to increased overall healthcare costs by listing follow-on drugs in

  14. Patented drug extension strategies on healthcare spending: a cost-evaluation analysis.

    Directory of Open Access Journals (Sweden)

    Nathalie Vernaz

    Full Text Available BACKGROUND: Drug manufacturers have developed "evergreening" strategies to compete with generic medication after patent termination. These include marketing of slightly modified follow-on drugs. We aimed to estimate the financial impact of these drugs on overall healthcare costs and also to examine the impact of listing these drugs in hospital restrictive drug formularies (RDFs on the healthcare system as a whole ("spillover effect". METHODS AND FINDINGS: We used hospital and community pharmacy invoice office data in the Swiss canton of Geneva to calculate utilisation of eight follow-on drugs in defined daily doses between 2000 and 2008. "Extra costs" were calculated for three different scenarios assuming replacement with the corresponding generic equivalent for prescriptions of (1 all brand (i.e., initially patented drugs, (2 all follow-on drugs, or (3 brand and follow-on drugs. To examine the financial spillover effect we calculated a monthly follow-on drug market share in defined daily doses for medications prescribed by hospital physicians but dispensed in community pharmacies, in comparison to drugs prescribed by non-hospital physicians in the community. Estimated "extra costs" over the study period were €15.9 (95% CI 15.5; 16.2 million for scenario 1, €14.4 (95% CI 14.1; 14.7 million for scenario 2, and €30.3 (95% CI 29.8; 30.8 million for scenario 3. The impact of strictly switching all patients using proton-pump inhibitors to esomeprazole at admission resulted in a spillover "extra cost" of €330,300 (95% CI 276,100; 383,800, whereas strictly switching to generic cetirizine resulted in savings of €7,700 (95% CI 4,100; 11,100. Overall we estimated that the RDF resulted in "extra costs" of €503,600 (95% CI 444,500; 563,100. CONCLUSIONS: Evergreening strategies have been successful in maintaining market share in Geneva, offsetting competition by generics and cost containment policies. Hospitals may be contributing to increased

  15. The Rise and Fall in Out-of-Pocket Costs in Australia: An Analysis of the Strengthening Medicare Reforms.

    Science.gov (United States)

    Wong, Chun Yee; Greene, Jessica; Dolja-Gore, Xenia; van Gool, Kees

    2017-08-01

    After a period of steady decline, out-of-pocket (OOP) costs for general practitioner (GP) consultations in Australia began increasing in the mid-1990s. Following the rising community concerns about the increasing costs, the Australian Government introduced the Strengthening Medicare reforms in 2004 and 2005, which included a targeted incentive for GPs to charge zero OOP costs for consultations provided to children and concession cardholders (older adults and the poor), as well as an increase in the reimbursement for all GP visits. This paper examines the impact of those reforms using longitudinal survey and administrative data from a large national sample of women. The findings suggest that the reforms were effective in reducing OOP costs by an average of $A0.40 per visit. Decreases in OOP costs, however, were not evenly distributed. Those with higher pre-reform OOP costs had the biggest reductions in OOP costs, as did those with concession cards. However, results also reveal increases in OOP costs for most people without a concession card. The analysis suggests that there has been considerable heterogeneity in GP responses to the reforms, which has led to substantial changes in the fees charged by doctors and, as a result, the OOP costs incurred by different population groups. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

    NARCIS (Netherlands)

    I.M.C.M. de Kok (Inge); J.J. Polder (Johan); J.D.F. Habbema (Dik); L.M. Berkers (Louise Maria); W.J. Meerding (Willem Jan); M. Rebolj (Matejka); M. van Ballegooijen (Marjolein)

    2009-01-01

    textabstractIt is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health

  17. Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

    Science.gov (United States)

    Malmartel, A; Dutron, M; Ghasarossian, C

    2017-09-01

    About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

  18. A direct healthcare cost analysis of the cryopreserved versus fresh transfer policy at the blastocyst stage.

    Science.gov (United States)

    Papaleo, Enrico; Pagliardini, Luca; Vanni, Valeria Stella; Delprato, Diana; Rubino, Patrizia; Candiani, Massimo; Viganò, Paola

    2017-01-01

    A cost analysis covering direct healthcare costs relating to IVF freeze-all policy was conducted. Normal- and high- responder patients treated with a freeze-all policy (n = 63) compared with fresh transfer IVF (n = 189) matched by age, body mass index, duration and cause of infertility, predictive factors for IVF (number of oocytes used for fertilization) and study period, according to a 1:3 ratio were included. Total costs per patient (€6952 versus €6863) and mean costs per live birth were similar between the freeze-all strategy (€13,101, 95% CI 10,686 to 17,041) and fresh transfer IVF (€15,279, 95% CI 13,212 to 18,030). A mean per live birth cost-saving of €2178 (95% CI -1810 to 6165) resulted in a freeze-all strategy owing to fewer embryo transfer procedures (1.29 ± 0.5 versus 1.41 ± 0.7); differences were not significant. Sensitivity analysis revealed that the freeze-all strategy remained cost-effective until the live birth rate is either higher or only slightly lower (≥-0.59%) in the freeze-all group compared with fresh cycles. A freeze-all policy does not increase costs compared with fresh transfer, owing to negligible additional expenses, i.e. vitrification, endometrial priming and monitoring, against fewer embryo transfer procedures required to achieve pregnancy. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  19. An Enterprise Model of Rising Ship Costs: Loss of Learning Due to Time between Ships and Labor Force Instability

    OpenAIRE

    Summerville, Jessica R.; Cullis, Bethia L.; Druker, Eric R.; Rutledge, Gabriel B.; Braxton, Peter J.; Coleman, Richard L.

    2007-01-01

    Proceedings Paper (for Acquisition Research Program) Since the end of the Cold War, the perceived need for Navy ships has dropped, and so the shipbuilding budget has dropped. Seemingly coincidental with this budgetary pressure, and perversely aggravating the problem, ship costs began to rise steeply. We will set aside that ships have grown in weight by about three percent per year since World War II and that ever-more weapon systems are being put into them, and confine ourselves to discu...

  20. An economic evaluation of the healthcare cost of tinnitus management in the UK.

    Science.gov (United States)

    Stockdale, David; McFerran, Don; Brazier, Peter; Pritchard, Clive; Kay, Tony; Dowrick, Christopher; Hoare, Derek J

    2017-08-22

    There is no standard treatment pathway for tinnitus patients in the UK. Possible therapies include education and reassurance, cognitive behavioural therapies, modified tinnitus retraining therapy (education and sound enrichment), or amplification of external sound using hearing aids. However, the effectiveness of most therapies is somewhat controversial. As health services come under economic pressure to deploy resources more effectively there is an increasing need to demonstrate the value of tinnitus therapies, and how value may be continuously enhanced. The objective of this project was to map out existing clinical practice, estimate the NHS costs associated with the management approaches used, and obtain initial indicative estimates of cost-effectiveness. Current treatment pathways, costs and health outcomes were determined from the tinnitus literature, national statistics, a patient survey, and expert opinion. These were used to create an Excel-based economic model of therapy options for tinnitus patients. The probabilities associated with the likelihood of an individual patient receiving a particular combination of therapies was used to calculate the average cost of treatment per patient, average health outcome per patient measured in QALYs gained, and cost-effectiveness, measured by the average cost per QALY gained. The average cost of tinnitus treatment per patient per year is GB£717, equating to an NHS healthcare bill of GB£750 million per year. Across all pathways, tinnitus therapy costs £10,600 per QALY gained. Results were relatively insensitive to restrictions on access to cognitive behaviour therapy, and a subsequent reliance on other therapies. NHS provisions for tinnitus are cost-effective against the National Institute for Health and Care Excellence cost-effective threshold. Most interventions help, but education alone offers very small QALY gains. The most cost-effective therapies in the model were delivered within audiology.

  1. Is cost-effective healthcare compatible with publicly financed academic medical centres?

    Science.gov (United States)

    Chia, Whay Kuang; Toh, Han Chong

    2013-01-01

    Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

  2. Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities.

    Science.gov (United States)

    Asaria, Miqdad; Grasic, Katja; Walker, Simon

    2016-02-01

    This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis.

  3. Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

    Science.gov (United States)

    Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

    2015-01-01

    To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

  4. Comparison of cost determination of both resource consumption accounting and time-driven activity-based costing systems in a healthcare setting.

    Science.gov (United States)

    Özyapıcı, Hasan; Tanış, Veyis Naci

    2017-05-01

    Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.

  5. Trouble Sleeping Associated with Lower Work Performance and Greater Healthcare Costs: Longitudinal Data from Kansas State Employee Wellness Program

    Science.gov (United States)

    Hui, Siu-kuen Azor; Grandner, Michael A.

    2015-01-01

    Objective To examine the relationships between employees’ trouble sleeping and absenteeism, work performance, and healthcare expenditures over a two year period. Methods Utilizing the Kansas State employee wellness program (EWP) dataset from 2008–2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and healthcare costs as the outcomes. Results EWP participants (N=11,698 in 2008; 5,636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all p performance ratings (all p performance, and healthcare costs. PMID:26461857

  6. Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

    Science.gov (United States)

    Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

    2016-01-01

    To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

  7. Analysis of actual healthcare costs of early versus interval cholecystectomy in acute cholecystitis.

    Science.gov (United States)

    Tan, Cheryl H M; Pang, Tony C Y; Woon, Winston W L; Low, Jee Keem; Junnarkar, Sameer P

    2015-03-01

    Healthcare cost modeling have favored early (ELC) over interval laparoscopic cholecystectomy (ILC) for acute cholecystitis (AC). However, actual costs of treatment have never been studied. The aim of the present study was to compare actual hospital costs involved in ELC and ILC in patients with AC. Retrospective study of patients who underwent laparoscopic cholecystectomy for AC was conducted. Demographic, clinical, operative data and costs were extracted and analyzed. Between 2011 and 2013, 201 had laparoscopic surgery for AC at Tan Tock Seng Hospital, Singapore. One hundred and thirty-four (67%) patients underwent ELC (≤7 days of presentation, within index admission). Median total length of stay (LOS) was 4.6 and 6.8 days for ELC and ILC groups, respectively (P = 0.006). Patients who had ELC also had significantly lesser total number of admissions (P < 0.001). The median (IQR) total inpatient costs were €4.4 × 10(3) (3.6-5.6) and €5.5 × 10(3) (4.0-7.5) for ELC and ILC patients, respectively (P < 0.007). Costs associated with investigations were significantly higher in the ILC group (P = 0.039), of which serological costs made most difference (P < 0.005). The ward costs were also significantly higher in the ILC group. The cost differences reflect the significantly increased total LOS, and repeat presentations associated with ILC. Therefore, ELC should be the preferred management strategy for AC. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  8. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Science.gov (United States)

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-05-01

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

  9. Food Insecurity and Healthcare Costs: Research Strategies Using Local, State, and National Data Sources for Older Adults12

    Science.gov (United States)

    Lee, Jung Sun

    2013-01-01

    Food insecurity in older adults is a clinically relevant problem with important implications for healthcare costs; however, few studies have examined the relationship between food insecurity and the healthcare cost burden in older adults. It may be due in part to lack of appropriate data and methods to examine these issues in the existing datasets. It is critical to identify and obtain the data necessary for estimating healthcare costs associated with food insecurity and to explore specific mechanisms by which food insecurity is related to adverse health outcomes and associated healthcare costs. This paper discusses how to best utilize and link available, nationally representative datasets and develop infrastructure and procedures to establish state and local datasets. As an example, an innovative approach tested in Georgia to establish a state-level dataset in a sample of low-income, older adults in need of food assistance is discussed. In this approach, data from the state aging services client database and the Centers for Medicare and Medicaid Services data were linked. Such efforts are essential to estimate the healthcare cost burden of food-insecure older adults who have a particularly higher burden of chronic diseases and direct future research, program, and policy decisions to improve the food and healthcare security of low-income, older adults. PMID:23319122

  10. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

    Science.gov (United States)

    Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

    2015-10-01

    Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

  11. Let the bleeding begin: rising costs are starting to crush oilpatch profits

    International Nuclear Information System (INIS)

    Koch, G.

    1997-01-01

    Reasons for the increase in the cost and decrease in profits in the oil industry were investigated. The most likely cause for the cost increase and hence the diminishing profit margin, was identified as a simple supply and demand increase in the cost of exploration and drilling: seismic crews, drilling rigs, well servicing and labour have all increased by an average of some 10 per cent as a result of the heavy demand for these services to support the growth that companies seek. Concentrated ownership in the drilling sector is partially to blame. A severe shortage of skilled labour, and an increase in land prices are some of the other possible causes. While some industry observers expect the worst, others are confident that gradually falling profits will prompt a market correction. The tightening of investment capital will slow down rates of drilling and land acquisition, gradually easing prices downward. Volume contracting ahead of time, booking seismic crews and rigs for an entire season at a fixed cost, and technological improvements also offer hope of forcing costs down. Heavy investment by industry majors in new oilsands and heavy oil developments is yet another promise of maintaining profit margins in the oil patch while reducing the industry''s reliance on conventional light crude

  12. Patented Drug Extension Strategies on Healthcare Spending: A Cost-Evaluation Analysis

    Science.gov (United States)

    Vernaz, Nathalie; Haller, Guy; Girardin, François; Huttner, Benedikt; Combescure, Christophe; Dayer, Pierre; Muscionico, Daniel; Salomon, Jean-Luc; Bonnabry, Pascal

    2013-01-01

    Background Drug manufacturers have developed “evergreening” strategies to compete with generic medication after patent termination. These include marketing of slightly modified follow-on drugs. We aimed to estimate the financial impact of these drugs on overall healthcare costs and also to examine the impact of listing these drugs in hospital restrictive drug formularies (RDFs) on the healthcare system as a whole (“spillover effect”). Methods and Findings We used hospital and community pharmacy invoice office data in the Swiss canton of Geneva to calculate utilisation of eight follow-on drugs in defined daily doses between 2000 and 2008. “Extra costs” were calculated for three different scenarios assuming replacement with the corresponding generic equivalent for prescriptions of (1) all brand (i.e., initially patented) drugs, (2) all follow-on drugs, or (3) brand and follow-on drugs. To examine the financial spillover effect we calculated a monthly follow-on drug market share in defined daily doses for medications prescribed by hospital physicians but dispensed in community pharmacies, in comparison to drugs prescribed by non-hospital physicians in the community. Estimated “extra costs” over the study period were €15.9 (95% CI 15.5; 16.2) million for scenario 1, €14.4 (95% CI 14.1; 14.7) million for scenario 2, and €30.3 (95% CI 29.8; 30.8) million for scenario 3. The impact of strictly switching all patients using proton-pump inhibitors to esomeprazole at admission resulted in a spillover “extra cost” of €330,300 (95% CI 276,100; 383,800), whereas strictly switching to generic cetirizine resulted in savings of €7,700 (95% CI 4,100; 11,100). Overall we estimated that the RDF resulted in “extra costs” of €503,600 (95% CI 444,500; 563,100). Conclusions Evergreening strategies have been successful in maintaining market share in Geneva, offsetting competition by generics and cost containment policies. Hospitals may be contributing to

  13. Association of obesity with healthcare resource utilization and costs in a commercial population.

    Science.gov (United States)

    Kamble, Pravin S; Hayden, Jennifer; Collins, Jenna; Harvey, Raymond A; Suehs, Brandon; Renda, Andrew; Hammer, Mette; Huang, Joanna; Bouchard, Jonathan

    2018-05-10

    To examine the association of obesity with healthcare resource utilization (HRU) and costs among commercially insured individuals. This retrospective observational cohort study used administrative claims from 1 January 2007 to 1 December 2013. The ICD-9-CM status codes (V85 hierarchy) from 2008 to 2012 classified body mass index (BMI) into the World Health Organizations' BMI categories. The date of first observed BMI code was defined as the index date and continuous eligibility for one year pre- and post- index date was ensured. Post-index claims determined individuals' HRU and costs. Sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data ensured representation of the US adult commercially insured population. Baseline characteristics were described across BMI classes and associations between BMI categories, and outcomes were examined using multivariable regression. The cohort included 9651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%) and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department and outpatient utilization, and higher total healthcare, medical and pharmacy costs. Increasing BMI was associated with higher prevalence of cardiometabolic conditions and higher HRU and costs. There is an urgent need to address the epidemic of obesity and its clinical and economic impacts.

  14. Decision makers' experiences of prioritisation and views about how to finance healthcare costs.

    Science.gov (United States)

    Werntoft, Elisabet; Edberg, Anna-Karin

    2009-10-01

    Prioritisation in healthcare is an issue of growing importance due to scarcity of resources. The aims of this study were firstly to describe decision makers' experience of prioritisation and their views concerning willingness to pay and how to finance healthcare costs. An additional aim was to compare the views of politicians and physicians. The study was a cross-sectional study based on a questionnaire administered to 700 Swedish politicians and physicians. This was analysed using both quantitative and qualitative methods. A majority of the decision makers (55%) suggested that increasing costs should be financed through higher taxation but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety; politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions. This study do not answer the question about how to make prioritisation in health care but the result highlights the different ways that the decision makers view the subject and thereby elicit that publicly elected politicians and physicians perhaps not always work with the same goal ahead. There are needs for more research but also more media focus on the subject so the citizens will be aware and take part in the debate.

  15. Ranking of healthcare programmes based on health outcome, health costs and safe delivery of care in hospital pharmacy practice.

    Science.gov (United States)

    Brisseau, Lionel; Bussières, Jean-François; Bois, Denis; Vallée, Marc; Racine, Marie-Claude; Bonnici, André

    2013-02-01

    To establish a consensual and coherent ranking of healthcare programmes that involve the presence of ward-based and clinic-based clinical pharmacists, based on health outcome, health costs and safe delivery of care. This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programmes at five sites that involved the provision of ward-based and clinic-based pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient (clinic-based) or outpatient (ward-based) healthcare programme. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare programme on three fields: health outcome, health costs and safe delivery of care. They agreed by consensus on the final ranking of healthcare programmes. A ranking was assigned for each of the 18 healthcare programmes for outpatient care and the 17 healthcare programmes for inpatient care involving the presence of pharmacists, based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from a 2007-2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. Given the often limited human and financial resources, managers should consider the best evidence available on a profession's impact to plan healthcare services within an organization. Data are few on ranking healthcare programmes in order to prioritize which healthcare programme would mostly benefit from the delivery of pharmaceutical care by ward-based and clinic-based pharmacists. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  16. Colleges Struggle to Dispose of Hazardous Wastes in Face of Rising Costs and Increased Regulation.

    Science.gov (United States)

    Magner, Denise K.

    1989-01-01

    After years of being ignored by federal regulators because of the low volume of hazardous waste in question, colleges and universities are facing increased enforcement of environmental laws concerning waste disposal and storage, at great cost in money, facilities, and personnel. (MSE)

  17. Healthcare and wider societal implications of stillbirth: a population-based cost-of-illness study.

    Science.gov (United States)

    Campbell, H E; Kurinczuk, J J; Heazell, Aep; Leal, J; Rivero-Arias, O

    2018-01-01

    To extend previous work and estimate health and social care costs, litigation costs, funeral-related costs, and productivity losses associated with stillbirth in the UK. A population-based cost-of-illness study using a synthesis of secondary data. The National Health Service (NHS) and wider society in the UK. Stillbirths occurring within a 12-month period and subsequent events occurring over the following 2 years. Costs were estimated using published data on events, resource use, and unit costs. Mean health and social care costs, litigation costs, funeral-related costs, and productivity costs for 2 years, reported for a single stillbirth and at a national level. Mean health and social care costs per stillbirth were £4191. Additionally, funeral-related costs were £559, and workplace absence (parents and healthcare professionals) was estimated to cost £3829 per stillbirth. For the UK, the annual health and social care costs were estimated at £13.6 million, and total productivity losses amounted to £706.1 million (98% of this cost was attributable to the loss of the life of the baby). The figures for total productivity losses were sensitive to the perspective adopted about the loss of life of the baby. This work expands the current intelligence on the costs of stillbirth beyond the health service to costs for parents and society, and yet these additional findings must still be regarded as conservative estimates of the true economic costs. The costs of stillbirth are significant, affecting the health service, parents, professionals, and society. Why and how was the study carried out? The personal, social, and emotional consequences of stillbirth are profound. Placing a monetary value on such consequences is emotive, yet necessary, when deciding how best to invest limited healthcare resources. We estimated the average costs associated with a single stillbirth and the costs for all stillbirths occurring in the UK over a 1-year period. What were the main

  18. Characteristics and healthcare utilisation patterns of high-cost beneficiaries in the Netherlands: a cross-sectional claims database study

    NARCIS (Netherlands)

    Wammes, J.J.G.; Tanke, M.A.C.; Jonkers, W.; Westert, G.P.; Wees, P.J. van der; Jeurissen, P.P.T.

    2017-01-01

    OBJECTIVE: To determine medical needs, demographic characteristics and healthcare utilisation patterns of the top 1% and top 2%-5% high-cost beneficiaries in the Netherlands. DESIGN: Cross-sectional study using 1 year claims data. We broke down high-cost beneficiaries by demographics, the most

  19. Assessment of healthcare measures, healthcare resource use, and cost of care among severe hemophilia A patients in Mumbai region of India.

    Science.gov (United States)

    Jadhav, U; Mukherjee, K

    2017-10-23

    In India, the low public health priority given to rare disorders such as hemophilia hinders their management and optimal care, leading to relatively poor health outcomes. This study aims to profile the multidimensional health status of patients with severe hemophilia A, and its association with the use of healthcare resources and the cost of care in Mumbai region of India. A cross-sectional, single-center study was conducted during January-May 2011, among 160 patients diagnosed with severe hemophilia A in Mumbai region of India. Their health status was documented using the Hemophilia Utilization Group Study's validated instrument of Functional Health Status Measure (FHS) and a single item of Self-care Measure. Of 160 patients, 55% (n = 88) scored on the lower side on the FHS, with an average score of 6.65 ± 2.85. The use of healthcare resources and cost of treatment were considerable for patients with a lower mean rank score on the FHS and a higher mean rank score on the self-care measure. The consumption of clotting factor concentrates (CFCs), number of visits to a health facility and incidence of inpatient episodes were significantly associated with a relatively low score on the FHS. Similarly, a higher cost of treatment, in terms of the cost of CFCs, direct cost, emergency room cost, and indirect cost, were significantly associated with a lower score on the FHS. The health status of patients with severe hemophilia A is compromised and has a significant impact on the use of healthcare resources and the cost of treatment.

  20. Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

    Science.gov (United States)

    Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

    2015-10-01

    This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

  1. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.

    Science.gov (United States)

    Lokkerbol, Joran; Adema, Dirk; Cuijpers, Pim; Reynolds, Charles F; Schulz, Richard; Weehuizen, Rifka; Smit, Filip

    2014-03-01

    Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.

    Science.gov (United States)

    Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

    2015-04-29

    Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children. Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group. The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

  3. Identifying critical success factors (CSFs) of Facilities Management (FM) in non-low cost high-rise residential buildings

    Science.gov (United States)

    Dahlan, F. M.; Zainuddin, A.

    2018-02-01

    Critical success factors (CSFs) are important key areas of activity that must be performed well in any Facilities Management (FM) organisation to achieve its missions, objectives or goals. Before implementing CSFs, an FM organisation must identify the key areas where things must be done properly to enable the business to flourish. Although many performance measurements in FM organisation have been discussed in previous research, not much research has been done on CSFs from the perspective of FM business in non-low cost high-rise residential buildings. The purpose of this study is to develop a methodology in developing the CSFs group and CSFs for FM organisation in non-low cost residential buildings. This research will involve three (3) phases of research strategy to achieve the objective of this research.

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

    Directory of Open Access Journals (Sweden)

    Oliván-Blázquez Bárbara

    2009-11-01

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

  5. Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

    Science.gov (United States)

    Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten; Hastrup, Lene H; Eliasen, Marie; Dantoft, Thomas M; Schröder, Andreas; Jørgensen, Torben

    2018-05-01

    Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population ( n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

  6. Proactive Approach for Safe Use of Antimicrobial Coatings in Healthcare Settings: Opinion of the COST Action Network AMiCI

    Directory of Open Access Journals (Sweden)

    Merja Ahonen

    2017-03-01

    Full Text Available Infections and infectious diseases are considered a major challenge to human health in healthcare units worldwide. This opinion paper was initiated by EU COST Action network AMiCI (AntiMicrobial Coating Innovations and focuses on scientific information essential for weighing the risks and benefits of antimicrobial surfaces in healthcare settings. Particular attention is drawn on nanomaterial-based antimicrobial surfaces in frequently-touched areas in healthcare settings and the potential of these nano-enabled coatings to induce (ecotoxicological hazard and antimicrobial resistance. Possibilities to minimize those risks e.g., at the level of safe-by-design are demonstrated.

  7. Emergency department visits of Syrian refugees and the cost of their healthcare.

    Science.gov (United States)

    Gulacti, Umut; Lok, Ugur; Polat, Haci

    2017-07-01

    The aim of this study was to evaluate the demographic and clinical characteristics of Emergency Department (ED) visits made by Syrian refugees and to assess the cost of their healthcare. This retrospective study was conducted in adult Syrians who visited the ED of Adiyaman University Training and Research Hospital, Adiyaman Province, Turkey, between 01 January and 31 December 2015. We evaluated 10,529 Syrian refugees who visited the ED, of whom 9,842 were included in the study. The number of ED visits significantly increased in 2015 compared with 2010; the increase in the proportion of total ED visits was 8% (n = 11,275, dif: 8%, CI 95%: 7.9- 8.2, p refugees and the remaining 1.5% accounted for the visits made by other individuals. Upper respiratory tract infections (URTI) were the diseases most frequently presented (n = 4,656; 47.3%), and 68.5% of ED visits were inappropriate (n = 6,749). The median ED length of stay (LOS) of the Syrian refugees was significantly longer than that of the other individuals visiting the ED (p refugees who visited the ED was calculated as US$ 773,374.63. This study showed that Syrian refugees have increased the proportion of ED visits and the financial healthcare burden. The majority of ED visits made by Syrian refugees were inappropriate. In addition, their ED LOS was longer than that of other individuals making ED visits.

  8. Caring for healthcare entrepreneurs - Towards successful entrepreneurial strategies for sustainable innovations in Dutch healthcare

    NARCIS (Netherlands)

    Janssen, M.; Moors, E.H.M.

    The sustainability of current healthcare systems is threatened by several societal developments, including an aging population, an increase of unmet medical needs and rising healthcare costs. A transition is needed in order to meet these threats and to achieve a proper balance between the demand for

  9. Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections.

    Science.gov (United States)

    Mukerji, Shohini; MacIntyre, C Raina; Seale, Holly; Wang, Quanyi; Yang, Peng; Wang, Xiaoli; Newall, Anthony T

    2017-07-03

    There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.

  10. Towards a tipping point in responding to change: rising costs, fewer options for Arctic and global societies.

    Science.gov (United States)

    Huntington, Henry P; Goodstein, Eban; Euskirchen, Eugénie

    2012-02-01

    Climate change incurs costs, but government adaptation budgets are limited. Beyond a certain point, individuals must bear the costs or adapt to new circumstances, creating political-economic tipping points that we explore in three examples. First, many Alaska Native villages are threatened by erosion, but relocation is expensive. To date, critically threatened villages have not yet been relocated, suggesting that we may already have reached a political-economic tipping point. Second, forest fires shape landscape and ecological characteristics in interior Alaska. Climate-driven changes in fire regime require increased fire-fighting resources to maintain current patterns of vegetation and land use, but these resources appear to be less and less available, indicating an approaching tipping point. Third, rapid sea level rise, for example from accelerated melting of the Greenland ice sheet, will create a choice between protection and abandonment for coastal regions throughout the world, a potential global tipping point comparable to those now faced by Arctic communities. The examples illustrate the basic idea that if costs of response increase more quickly than available resources, then society has fewer and fewer options as time passes.

  11. Hospital treatment, mortality and healthcare costs in relation to socioeconomic status among people with bipolar affective disorder

    Science.gov (United States)

    Yeh, Ling-Ling; Chen, Yu-Chun; Kuo, Kuei-Hong; Chang, Chin-Kuo

    2016-01-01

    Background Evidence regarding the relationships between the socioeconomic status and long-term outcomes of individuals with bipolar affective disorder (BPD) is lacking. Aims We aimed to estimate the effects of baseline socioeconomic status on longitudinal outcomes. Method A national cohort of adult participants with newly diagnosed BPD was identified in 2008. The effects of personal and household socioeconomic status were explored on outcomes of hospital treatment, mortality and healthcare costs, over a 3-year follow-up period (2008–2011). Results A total of 7987 participants were recruited. The relative risks of hospital treatment and mortality were found elevated for the ones from low-income households who also had higher healthcare costs. Low premium levels did not correlate with future healthcare costs. Conclusions Socioeconomic deprivation is associated with poorer outcome and higher healthcare costs in BPD patients. Special care should be given to those with lower socioeconomic status to improve outcomes with potential benefits of cost savings in the following years. Declaration of interest None. Copyright and usage © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703748

  12. Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

    Science.gov (United States)

    Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

    2016-01-01

    Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation

  13. Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

    Science.gov (United States)

    Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

    2011-03-01

    Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare

  14. Rapid, low cost prototyping of transdermal devices for personal healthcare monitoring

    Directory of Open Access Journals (Sweden)

    Sanjiv Sharma

    2017-04-01

    Full Text Available The next generation of devices for personal healthcare monitoring will comprise molecular sensors to monitor analytes of interest in the skin compartment. Transdermal devices based on microneedles offer an excellent opportunity to explore the dynamics of molecular markers in the interstitial fluid, however good acceptability of these next generation devices will require several technical problems associated with current commercially available wearable sensors to be overcome. These particularly include reliability, comfort and cost. An essential pre-requisite for transdermal molecular sensing devices is that they can be fabricated using scalable technologies which are cost effective.We present here a minimally invasive microneedle array as a continuous monitoring platform technology. Method for scalable fabrication of these structures is presented. The microneedle arrays were characterised mechanically and were shown to penetrate human skin under moderate thumb pressure. They were then functionalised and evaluated as glucose, lactate and theophylline biosensors. The results suggest that this technology can be employed in the measurement of metabolites, therapeutic drugs and biomarkers and could have an important role to play in the management of chronic diseases. Keywords: Microneedles, Minimally invasive sensors, Continuous glucose monitoring (CGM, Continuous lactate monitoring (CLM, Interstitial therapeutic drug monitoring (iTDM

  15. Tele-healthcare for diabetes management: A low cost automatic approach.

    Science.gov (United States)

    Benaissa, M; Malik, B; Kanakis, A; Wright, N P

    2012-01-01

    In this paper, a telemedicine system for managing diabetic patients with better care is presented. The system is an end to end solution which relies on the integration of front end (patient unit) and backend web server. A key feature of the system developed is the very low cost automated approach. The front-end of the system is capable of reading glucose measurements from any glucose meter and sending them automatically via existing networks to the back-end server. The back-end is designed and developed using n-tier web client architecture based on model-view-controller design pattern using open source technology, a cost effective solution. The back-end helps the health-care provider with data analysis; data visualization and decision support, and allows them to send feedback and therapeutic advice to patients from anywhere using a browser enabled device. This system will be evaluated during the trials which will be conducted in collaboration with a local hospital in phased manner.

  16. Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs.

    Science.gov (United States)

    Baldissera-Aradas, J V; Rodríguez-Villamil, L; Blanco-Fernández, R; Pérez-García, C; Viejo de la Guerra, G; González-Rodríguez, I; Mosquera-Madera, J

    2018-01-10

    Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-12-01

    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  18. Changing Job Satisfaction, Absenteeism, and Healthcare Claims Costs In a Hospital Culture

    Science.gov (United States)

    Newsome, Misty; Pearsall, Cynthia; Ryan, Teresa; Starlin, Pamela

    2014-01-01

    Introduction: Fairfield Medical Center is a 222-bed community hospital located in Lancaster, Ohio. Organizational leadership chose to invest in the Transforming Stress Workshop, a 6-hour workshop with a 2-hour follow-up workshop, in order to improve the well-being of its staff and physicians. Special thought and consideration were given to being able to sustain any benefits and/or improvements long-term. As a result, strategies were developed to integrate the program into our culture. Methods: Four staff members from a variety of disciplines were selected and sent to HeartMath Train-the-Trainer to gain proficiency in HeartMath methodology and tools, expanding their duties to deliver the classes. Biweekly workshops were offered from August 2007 through December 2010, educating a total of 975 employees, or 48% of the staff. Other tactics providing a sustainable program included senior leadership support and championing, management team training, positive employee comments published internally, use of tools in committee and department meetings, incorporation into orientation and on-boarding processes, part of major initiative roll-outs, element in clinical ladder, expansion to include Transforming Team Workshops, sharing of Participant and Organizational Quality Assessment-Revised data, a lead HeartMath instructor who provides consulting to other organizations, provision of classes to local educators, and open workshops for employee family members. Results: Three metrics were selected to measure the success of the program: employee satisfaction, absenteeism rates, and healthcare claims cost. Statistically significant cultural and financial return on investment were demonstrated. Employees who received HeartMath training experienced a 2:1 savings on healthcare claims as compared to employees who had not received training. Employee Opinion Survey results demonstrated that employees who had HeartMath training had higher overall satisfaction scores than those who had not

  19. ‘A Medical Doctor in Politics’. Els Borst-Eilers and the Rise of Evidence-Based Healthcare in the Netherlands

    Directory of Open Access Journals (Sweden)

    Nele Beyens

    2017-03-01

    Full Text Available This article examines how Els Borst-Eilers, Dutch minister of Health between 1994 and 2002, pursued the cause of Evidence-Based Medicine (EBM – an influential movement in the medical field that gained a particularly firm foothold in the Netherlands. It focusses on the way Borst-Eilers operated within the nexus between healthcare and politics, discussing whether or not this made her a boundary person (analogous to the notion of boundary concepts. In particular, the paper analyses how she deliberately cultivated her persona as a specialist minister (‘a doctor, not a politician’ and how she pragmatically utilised EBM as a tool for depoliticising the thorny political issue of cost containment in healthcare. It was not so much the notion of EBM itself, but rather its specific translation into efficient and appropriate healthcare of which Els Borst-Eilers became the foremost advocate in the Netherlands. 'Een dokter in de politiek'. Els Borst-Eilers en de opkomst van de empirisch onderbouwde gezondheidszorg in Nederland.Dit artikel onderzoekt de wijze waarop Els-Borst Eilers, minister vanVolksgezondheid tussen 1994 en 2002, zich heeft ingezet voor ‘evidence-based medicine’ (EBM – een invloedrijke beweging in de geneeskunde die een sterke stempel heeft gedrukt op de huidige Nederlandse gezondheidszorg. Het artikel richt zich op de manier waarop Borst-Eilers manoeuvreerde op het snijvlak tussen gezondheidszorg en politiek, waarbij de vraag aan de orde komt of zij beschouwd kan worden als een boundary person (analoog aan de notie van boundary concepts. Centraal in de analyse staat de door Borst gecultiveerde ‘persona’ van vakminister (‘een dokter, geen politicus’, evenals de wijze waarop zij EBM gebruikte als middel om het vraagstuk van kostenbeheersing in de gezondheidszorg te depolitiseren. In dat opzicht was Borst-Eilers niet zozeer de grote voorvechter van EBM als zodanig, als wel van de specifieke vertaling ervan tot doelmatige

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

    Science.gov (United States)

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

    2016-04-01

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

  1. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  2. Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada.

    Science.gov (United States)

    Schurer, Janna M; Rafferty, Ellen; Schwandt, Michael; Zeng, Wu; Farag, Marwa; Jenkins, Emily J

    2016-07-06

    Toxoplasma gondii and Toxocara spp. are zoonotic parasites with potentially severe long-term consequences for those infected. We estimated incidence and investigated distribution, risk factors, and costs associated with these parasites by examining hospital discharge abstracts submitted to the Canadian Institute for Health Information (2002-2011). Annual incidence of serious toxoplasmosis and toxocariasis was 0.257 (95% confidence interval [CI]: 0.254-0.260) and 0.010 (95% CI: 0.007-0.014) cases per 100,000 persons, respectively. Median annual health-care costs per serious case of congenital, adult-acquired, and human immunodeficiency virus (HIV)-associated toxoplasmosis were $1,971, $763, and $5,744, respectively, with an overall cost of C$1,686,860 annually (2015 Canadian dollars). However, the total economic burden of toxoplasmosis is likely much higher than these direct health-care cost estimates. HIV was reported as a comorbidity in 40% of toxoplasmosis cases and accounted for over half of direct health-care costs associated with clinical toxoplasmosis. A One Health approach, integrating physician and veterinary input, is recommended for increasing public awareness and decreasing the economic burden of these preventable zoonoses. © The American Society of Tropical Medicine and Hygiene.

  3. Rumble over jailhouse healthcare. As states broaden outsourcing to private vendors, critics question quality of care and cost savings.

    Science.gov (United States)

    Kutscher, Beth; Meyer, Harris

    2013-09-02

    The trend for states to outsource prison healthcare has met opposition from inmate advocates and legal aid groups. They fear quality of care will suffer, while others debate whether outsourcing care saves any money. Corizon, the largest U.S. private prison healthcare provider, says it definitely delivers savings. "We are the model because we've been doing capitated rates since we've been in business. Our cost per individual is significantly less than in the 'free world,' "says Corizon CEO Rich Hallworth.

  4. Quantity Surveying Undergraduates’ Awareness on Cost Significant of High-Rise Condominium Projects in Malaysia: The Case of a Private University in Malaysia

    OpenAIRE

    Peng Lee Wah; Seng Ng See; Choon Toh Tien; Sim Lim Cheng; Khian Yong Ching; Chen Goh Kai

    2016-01-01

    Recent developments in quantity surveying (QS) emphasised the importance of identifying cost significant elements (CSE). The knowledge on CSE of high-rise condominium projects (HRCP) is essential as high-rise residential multi-unit projects are the next option in building construction due to limited land areas in urban areas. This study aims to determine the levels of awareness among QS undergraduates of a private university in Malaysia on CSE of HRCP in Malaysia. The respondents’ knowledge o...

  5. Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

    Science.gov (United States)

    de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

    2015-01-01

    Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

  6. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

    Science.gov (United States)

    Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

    2017-09-19

    Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

  7. Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

    Science.gov (United States)

    Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

    2017-05-15

    To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

    Science.gov (United States)

    Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

    2015-04-27

    In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal

  9. Measuring Healthcare Providers' Performances Within Managed Competition using Multidimensional Quality and Cost Indicators

    NARCIS (Netherlands)

    Portrait, F.R.M.; van den Berg, B.

    2015-01-01

    Background and objectives: The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare

  10. Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

    Directory of Open Access Journals (Sweden)

    Toni Meier

    Full Text Available Non-communicable diseases (NCDs represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA, salt and sugar (mono- & disaccharides, MDS were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR in the year 2008, which represents 7% (CI95% 2%-10% of the total treatment costs in Germany (254 billion EUR. This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1; salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3 and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion. Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

  11. Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

    Science.gov (United States)

    Meier, Toni; Senftleben, Karolin; Deumelandt, Peter; Christen, Olaf; Riedel, Katja; Langer, Martin

    2015-01-01

    Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

  12. Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis.

    Science.gov (United States)

    Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

    2018-06-01

    Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.

  13. Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls.

    Science.gov (United States)

    Broder, Michael S; Neary, Maureen P; Chang, Eunice; Ludlam, William H

    2015-12-01

    Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Using 2008-2012 MarketScan® database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p < .001) or controls (5.6 %, p < .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p < .001) or controls (14.3 %, p < .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p < .001) or controls (7.1, p < .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p < .001) or controls (20.5, p < .001). Mean total healthcare costs for CD patients were $26,269 versus $12,282 for DM patients (p < .001) and $5869 for controls (p < .001). CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls.

  14. Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder.

    Science.gov (United States)

    Karve, Sudeep; Markowitz, Michael; Fu, Dong-Jing; Lindenmayer, Jean-Pierre; Wang, Chi-Chuan; Candrilli, Sean D; Alphs, Larry

    2014-06-01

    Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication

  15. [Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people].

    Science.gov (United States)

    Lutomski, Jennifer E; Baars, Maria A E; Boter, Han; Buurman, Bianca M; den Elzen, Wendy P J; Jansen, Aaltje P D; Kempen, Gertrudis I J M; Steunenberg, Bas; Steyerberg, Ewout W; Olde Rikkert, Marcel G M; Melis, René J F

    2014-01-01

    To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

  16. Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States.

    Science.gov (United States)

    Zhang, Dongmu; Prabhu, Vimalanand S; Marcella, Stephen W

    2018-04-17

    The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01-5.39) and 1.95 days (95% CI, 1.48-2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436-$25013) and $10580 (95% CI, $8849-$12446), respectively. The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.

  17. Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Johnson BH

    2016-02-01

    Full Text Available Barbara H Johnson,1 Machaon M Bonafede,1 Crystal Watson2 1Outcomes Research, Truven Health Analytics, Cambridge, MA, USA; 2Health Economics and Outcomes Research, Biogen, Cambridge, MA, USA Objectives: The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS.Methods: This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS were described in the year postindex.Results: The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6% of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days and Medicare beneficiaries (4.0 vs 10.8 days

  18. Healthcare Services Expenditure: A Case Study in Isfahan Province, Iran

    Directory of Open Access Journals (Sweden)

    Ferdosi

    2015-01-01

    Full Text Available Background Determining and understanding of healthcare costs and its financing method is one of the most important subjects understatement of which can cause such major problems as excessive health costs for households due to the high rate of out-of-pocket expenses. Objectives The current study aimed to analyze the healthcare costs and determine the share of Isfahan province, Iran, from the total healthcare costs of the country from 2006 to 2011. Materials and Methods It was a retrospective and descriptive-analytical study. The required statistical data were gathered from statistical yearbooks of the country and the province, the website of the World Bank, the statistics provided by the Healthcare Department of Isfahan and Kashan Universities of Medical Sciences and the statistical data provided by Iran Statistics Center in 2011, all covering the period of six years from 2006 to 2011. Excel software was used for data analysis and computations of the research. Results During this period, the annual growth average of healthcare and treatment costs were 12% and 20%, respectively. The share of the healthcare sector declined from 33% in 2006 to 25.4% in 2011. In other words, healthcare cost per capita, being about one second of the treatment cost per capita, reduced to a third of treatment per capita in 2011. Conclusions Efficient allocation of financial resources in the healthcare system based on specific goals and strategies, coordination of public and private sectors in providing healthcare services, the rising share of the healthcare sector in GDP of the province and the country, and the preference of prevention over treatment measures can affect achieving the healthcare system goals and surmount challenges such as pay-out-of-pocket and rising healthcare costs, particularly the costs of integrated treatment with full performance.

  19. Quantity Surveying Undergraduates’ Awareness on Cost Significant of High-Rise Condominium Projects in Malaysia: The Case of a Private University in Malaysia

    Directory of Open Access Journals (Sweden)

    Peng Lee Wah

    2016-01-01

    Full Text Available Recent developments in quantity surveying (QS emphasised the importance of identifying cost significant elements (CSE. The knowledge on CSE of high-rise condominium projects (HRCP is essential as high-rise residential multi-unit projects are the next option in building construction due to limited land areas in urban areas. This study aims to determine the levels of awareness among QS undergraduates of a private university in Malaysia on CSE of HRCP in Malaysia. The respondents’ knowledge on CSE has not achieved a satisfactory level. Both male and female respondents have the same levels of awareness on CSE. Remedial strategies to improve this situation are recommended.

  20. Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs

    DEFF Research Database (Denmark)

    Græsholt-Knudsen, Troels; Skovgaard, Anne Mette; Jensen, Jens Søndergaard

    2017-01-01

    medical services outside the hospital during a 4.5-year follow-up period from the day of assessment. Regression with bootstrap bias-corrected and accelerated CIs were performed. Results: 1018 (76.8%) children had no FSS with primary healthcare use adjusted for other child health problems, maternal...... is a predictor for the child's future primary healthcare use. More research on complex predictive models is needed to further explore the clinical significance of these results, and to contribute to the underpinning of early interventions towards impairing FSS in children....

  1. Impact of five years of rotavirus vaccination in Finland - And the associated cost savings in secondary healthcare.

    Science.gov (United States)

    Leino, Tuija; Baum, Ulrike; Scott, Peter; Ollgren, Jukka; Salo, Heini

    2017-10-09

    This study aimed to estimate the impact of the national rotavirus (RV) vaccination programme, starting 2009, on the total hospital-treated acute gastroenteritis (AGE) and severe RV disease burden in Finland during the first five years of the programme. This study also evaluated the costs saved in secondary healthcare by the RV vaccination programme. The RV related outcome definitions were based on ICD10 diagnostic codes recorded in the Care Register for Health Care. Incidences of hospitalised and hospital outpatient cases of AGE (A00-A09, R11) and RVGE (A08.0) were compared prior (1999-2005) and after (2010-2014) the start of the programme among children less than five years of age. The reduction in disease burden in 2014, when all children under five years of age have been eligible for RV vaccination, was 92.9% (95%CI: 91.0%-94.5%) in hospitalised RVGE and 68.5% (66.6%-70.3%) in the total hospitalised AGE among children less than five years of age. For the corresponding hospital outpatient cases, there was a reduction of 91.4% (82.4%-96.6%) in the RVGE incidence, but an increase of 6.3% (2.7%-9.9%) in the AGE incidence. The RV vaccination programme prevented 2206 secondary healthcare AGE cases costing €4.5 million annually. As the RV immunisation costs were €2.3 million, the total net savings just in secondary healthcare costs were €2.2 million, i.e. €33 per vaccinated child. The RV vaccination programme clearly controlled the severe, hospital-treated forms of RVGE. The total disease burden is a more valuable end point than mere specifically diagnosed cases as laboratory confirmation practises usually change after vaccine introduction. The RV vaccination programme annually pays for itself at least two times over. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    Science.gov (United States)

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

  3. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  4. Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

    Science.gov (United States)

    Rognoni, Carla; Tarricone, Rosanna

    2017-01-17

    This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent

  5. Costs of Medically Attended Acute Gastrointestinal Infections: The Polish Prospective Healthcare Utilization Survey.

    Science.gov (United States)

    Czech, Marcin; Rosinska, Magdalena; Rogalska, Justyna; Staszewska, Ewa; Stefanoff, Pawel

    The burden of acute gastrointestinal infections (AGIs) on the society has not been well studied in Central European countries, which prevents the implementation of effective, targeted public health interventions. We investigated patients of 11 randomly selected general practices and 8 hospital units. Each patient meeting the international AGI case definition criteria was interviewed on costs incurred related to the use of health care resources. Follow-up interview with consenting patients was conducted 2 to 4 weeks after the general practitioner (GP) visit or discharge from hospital, collecting information on self-medication costs and indirect costs. Costs were recalculated to US dollars by using the purchasing power parity exchange rate for Poland. Weighting the inpatient costs by age-specific probability of hospital referral by GPs, the societal cost of a medically attended AGI case was estimated to be US $168. The main cost drivers of direct medical costs were cost of hospital bed days (US $28), cost of outpatient pharmacotherapy (US $20), and cost of GP consultation (US $10). Patients covered only the cost of outpatient pharmacotherapy. Considering the AGI population GP consultation rate, the age-adjusted societal cost of medically attended AGI episodes was estimated at US $2222 million, of which 53% was attributable to indirect costs. Even though AGIs generate a low cost for individuals, they place a high burden on the society, attributed mostly to indirect costs. Higher resources could be allocated to the prevention and control of AGIs. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  6. Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study.

    Science.gov (United States)

    Errando-Smet, Carlos; Müller-Arteaga, Carlos; Hernández, Marta; Lenero, Enrique; Roset, Montse

    2018-01-01

    To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (used more healthcare resources compared with patients with BSAQ symptom scores used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost. © 2017 Wiley Periodicals, Inc.

  7. Cost analysis of Healthcare in a Private sector Neonatal Intensive Care Unit in India.

    Science.gov (United States)

    Karambelkar, Geeta; Malwade, Sudhir; Karambelkar, Rajendra

    2016-09-08

    To study the actual cost of care per patient in private-sector level IIIa Neonatal Intensive Care Unit (NICU). Prospective cost-analysis study. Cost incurred by the family on the treatment of baby, separately for every newborn for entire length of hospitalization, was calculated. 126 newborns were enrolled; High level of intervention was needed for 25.4% babies. The mean cost of care was US $ 90.7 per patient per day. Bulk of the cost of care was the hospital bill.

  8. [Deinstitutionalization of long-stay psychiatric patients in upper Austria -- utilization of healthcare resources and costs of outpatient care].

    Science.gov (United States)

    Haberfellner, Egon Michael; Grausgruber, Alfred; Grausgruber-Berner, Rosemarie; Ortmair, Margarethe; Schöny, Werner

    2006-03-01

    The study was intended to evaluate the therapeutic and healthcare services utilized by 116 former long-stay patients after an average of 42.9 months of deinstitutionalization during a follow-up time of (1/2) year and to calculate the costs thus incurred. 116 patients and their caregivers were interviewed during a period of 6 months using the German version of the Client Sociodemographic and Service Receipt Inventory. On average, 3.3 institutions/facilities were contacted per patient, most often by younger patients living in group homes and least often by patients in psychiatric nursing homes. During the 6-month follow-up time costs of euro 14,665 were incurred per patient. Of these costs, 87.2 % were for the residential facilities. The costs of outpatient care accounted for 41.4 % of the costs that would have been incurred for inpatient care in a psychiatric hospital. Deinstitutionalization of psychiatric long-stay patients in Upper Austria provided for considerable reductions in costs while maintaining a high quality of care.

  9. Healthcare Rationing by Proxy: Cost-Effectiveness Analysis and the Misuse of the $50 000 Threshold in the US

    OpenAIRE

    John F.P. Bridges; Eberechukwu Onukwugha; C. Daniel. Mullins

    2010-01-01

    The application of cost-effectiveness analysis in healthcare has become commonplace in the US, but the validity of this approach is in jeopardy unless the proverbial $US50 000 per QALY benchmark for determining value for money is updated for the 21st century. While the initial aim of this article was to review the arguments for abandoning the $US50 000 threshold, it quickly turned to questioning whether we should maintain a fixed threshold at all. Our consideration of the releva...

  10. The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study).

    Science.gov (United States)

    Massa, Ilaria; Balzi, William; Burattini, Costanza; Gentili, Nicola; Bucchi, Lauro; Nanni, Oriana; Gallegati, Davide; Pierini, Andrea; Amadori, Dino; Falcini, Fabio; Altini, Mattia

    2017-08-01

    In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. State trends in premiums and deductibles, 2003-2009: how building on the Affordable Care Act will help stem the tide of rising costs and eroding benefits.

    Science.gov (United States)

    Schoen, Cathy; Stremikis, Kristof; How, Sabrina K H; Collins, Sara R

    2010-12-01

    Rapidly rising health insurance costs have strained U.S. families and employers in recent years. This issue brief examines data for all states on changes in private employer premiums and deductibles for 2003 and 2009. The analysis finds that premiums for businesses and their employees increased 41 percent across states from 2003 to 2009, while per-person deductibles jumped 77 percent in large as well as small firms. If these trends continue at the rate prior to enactment of the Affordable Care Act, the average premium for family coverage will rise 79 percent by 2020, to more than $23,000. The authors describe how health reform offers the potential to reduce insurance cost growth while improving value and protection. If reforms succeed in slowing premium growth by 1 percentage point annually in all states, by 2020 employers and families together will save $2,323 annually for family coverage, compared with projected trends.

  12. Construction cost impact analysis of the U.S. Department of Energy mandatory performance standards for new federal commercial and multi-family, high-rise residential buildings

    International Nuclear Information System (INIS)

    Di Massa, F.V.; Hadley, D.L.; Halverson, M.A.

    1993-12-01

    In accordance with federal legislation, the U.S. Department of Energy (DOE) has conducted a project to demonstrate use of its Energy Conservation Voluntary Performance Standards for Commercial and Multi-Family High-Rise Residential Buildings; Mandatory for New Federal Buildings; Interim Rule (referred to in this report as DOE-1993). A key requisite of the legislation requires DOE to develop commercial building energy standards that are cost effective. During the demonstration project, DOE specifically addressed this issue by assessing the impacts of the standards on (1) construction costs, (2) builders (and especially small builders) of multi-family, high-rise buildings, and (3) the ability of low-to moderate-income persons to purchase or rent units in such buildings. This document reports on this project

  13. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

    Science.gov (United States)

    Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J

    2016-03-09

    Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p Health-care costs were reduced by 65.6% (p nutritional parameters were improved at one year (albumin: +10.6%, p nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.

  14. Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

    Science.gov (United States)

    Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

    2010-11-01

    Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on

  15. Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider.

    Science.gov (United States)

    Waters, H; Abdallah, H; Santillán, D

    2001-01-01

    This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.

  16. Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization: The 2012 Medical Expenditure Panel Survey.

    Science.gov (United States)

    Valero-Elizondo, Javier; Salami, Joseph A; Ogunmoroti, Oluseye; Osondu, Chukwuemeka U; Aneni, Ehimen C; Malik, Rehan; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

    2016-03-01

    The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD. © 2016 American Heart Association, Inc.

  17. [Bayesian approach for the cost-effectiveness evaluation of healthcare technologies].

    Science.gov (United States)

    Berchialla, Paola; Gregori, Dario; Brunello, Franco; Veltri, Andrea; Petrinco, Michele; Pagano, Eva

    2009-01-01

    The development of Bayesian statistical methods for the assessment of the cost-effectiveness of health care technologies is reviewed. Although many studies adopt a frequentist approach, several authors have advocated the use of Bayesian methods in health economics. Emphasis has been placed on the advantages of the Bayesian approach, which include: (i) the ability to make more intuitive and meaningful inferences; (ii) the ability to tackle complex problems, such as allowing for the inclusion of patients who generate no cost, thanks to the availability of powerful computational algorithms; (iii) the importance of a full use of quantitative and structural prior information to produce realistic inferences. Much literature comparing the cost-effectiveness of two treatments is based on the incremental cost-effectiveness ratio. However, new methods are arising with the purpose of decision making. These methods are based on a net benefits approach. In the present context, the cost-effectiveness acceptability curves have been pointed out to be intrinsically Bayesian in their formulation. They plot the probability of a positive net benefit against the threshold cost of a unit increase in efficacy.A case study is presented in order to illustrate the Bayesian statistics in the cost-effectiveness analysis. Emphasis is placed on the cost-effectiveness acceptability curves. Advantages and disadvantages of the method described in this paper have been compared to frequentist methods and discussed.

  18. Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

    Science.gov (United States)

    Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

    2017-08-01

    We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

  19. Student Loan Programs. As Federal Costs of Loan Consolidation Rise, Other Options Should be Examined. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    In this report GAO recommends that the Secretary of Education assess the advantages of consolidation loans for borrowers and the government in light of program costs and identify options for reducing federal costs. Options could include targeting the program to borrowers at risk of default and extending existing consolidation alternatives to more…

  20. Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

    Science.gov (United States)

    Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

    2015-12-01

    The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

  1. The cost of bariatric medical tourism on the Canadian healthcare system.

    Science.gov (United States)

    Sheppard, Caroline E; Lester, Erica L W; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

    2014-05-01

    Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed. Between February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return. Conservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD. The absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

    Science.gov (United States)

    Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

    2008-10-01

    Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

  3. Cost-Effectiveness of Endovascular Stroke Therapy: A Patient Subgroup Analysis From a US Healthcare Perspective.

    Science.gov (United States)

    Kunz, Wolfgang G; Hunink, M G Myriam; Sommer, Wieland H; Beyer, Sebastian E; Meinel, Felix G; Dorn, Franziska; Wirth, Stefan; Reiser, Maximilian F; Ertl-Wagner, Birgit; Thierfelder, Kolja M

    2016-11-01

    Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location. A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with both strategies applied in a US setting. Model input parameters were obtained from the literature, including recently pooled outcome data of 5 randomized controlled trials (ESCAPE [Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke], EXTEND-IA [Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial], MR CLEAN [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], REVASCAT [Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within 8 Hours of Symptom Onset], and SWIFT PRIME [Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment]). Probabilistic sensitivity analysis was performed to estimate uncertainty of the model results. Net monetary benefits, incremental costs, incremental effectiveness, and incremental cost-effectiveness ratios were derived from the probabilistic sensitivity analysis. The willingness-to-pay was set to $50 000/QALY. Overall, EVT+SC was cost-effective compared with SC (incremental cost: $4938, incremental effectiveness: 1.59 QALYs, and incremental cost-effectiveness ratio: $3110/QALY) in 100% of simulations. In all patient subgroups, EVT+SC led to gained QALYs (range: 0.47-2.12), and mean incremental cost-effectiveness ratios were considered cost

  4. Data scan. With access to a newly available trove of private insurers' claims data, new institute aims to study what's driving spiraling healthcare costs.

    Science.gov (United States)

    Evans, Melanie

    2011-09-26

    A new research initiative aims to delve into private-insurer claims data to study utilization and what's driving healthcare costs. The Health Care Cost Institute will help researchers, who have been limited to Medicare data or limited private claims. "We're optimistic. We have nothing to hide here," says Michael Richards, left, of Gundersen Lutheran Medical Center.

  5. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.

    Science.gov (United States)

    Klatt, Maryanna D; Sieck, Cynthia; Gascon, Gregg; Malarkey, William; Huerta, Timothy

    2016-08-01

    To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group. We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n=84) and the diet/exercise intervention (n=86) to a retrospectively matched control group (n=258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study. Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention. Significantly fewer primary care visits (porganization health cost savings that such programs can generate. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The impact of federalism on the healthcare system in terms of efficiency, equity, and cost containment: the case of Switzerland.

    Science.gov (United States)

    Crivelli, Luca; Salari, Paola

    2014-01-01

    According to the economic theory of federalism (Oates 1999), a decentralized decision to collectively fund and supply the quantity and quality of public services will increase economic welfare as long as three conditions are fulfilled: preferences and production costs of the different local constituencies are heterogeneous; local governments are better informed than the central agency because of their proximity to the citizens; and the competition between local governments exerts a significant impact on the performance of the local administration and on the ability of public agencies to implement policy innovation. Federalism also presents some negative aspects, including the opportunity costs of decentralization, which materialize in terms of unexploited economies of scale; the emergence of spillover effects among jurisdictions; and the risk of cost-shifting exercises from one layer of the government to the other. Finally, competition between fiscal regimes can affect the level of equity. The literature considers fiscal federalism as a mechanism for controlling the size of the public sector and for constraining the development of redistributive measures. The present paper reviews the impact that federalism has on the efficiency, equity, and cost containment of the healthcare system in Switzerland, a country with a strongly decentralized political system that is based on federalism and the institutions of direct democracy, a liberal economic culture, and a well-developed tradition of mutualism and social security (generous social expenditure and welfare system). By analyzing the empirical evidence available for Switzerland, we expect to draw some general policy lessons that might also be useful for other countries.

  7. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition.

    Science.gov (United States)

    Rosen, Barry S; Maddox, P J; Ray, Nancy

    2013-11-01

    Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

  8. Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

    Science.gov (United States)

    Park, Claire Su-Yeon

    2017-08-01

    To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

  9. Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States.

    Science.gov (United States)

    Li, Qian; Blume, Steven W; Huang, Joanna C; Hammer, Mette; Ganz, Michael L

    2015-01-01

    This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels. The Geisinger Health System provided electronic medical records and claims between January 2004 and May 2013 for a sample of 153,561 adults (50% males and 97% white). Adults with A total of 21 chronic conditions, with established association with obesity in the literature, were identified by diagnosis codes and/or lab test results. The total healthcare costs were measured in each year. The association between annual costs and ORCs was assessed by a regression, which jointly considered all the ORCs. The per-person incremental costs of a single comorbidity, without any of the other ORCs, were calculated. The population-level economic burden was the product of each ORC's incremental costs and the annual prevalence of the ORC among 100,000 individuals. The prevalence of ORCs was stratified by obesity status to estimate the economic burden among 100,000 individuals with obesity and among those without. This study identified 56,895 adults (mean age = 47 years; mean BMI = 29.6 kg/m(2)). The annual prevalence of ORCs ranged from 0.5% for pulmonary embolism (PE) to 41.8% for dyslipidemia. The per-person annual incremental costs of a single ORC ranged from $120 for angina to $1665 for PE. Hypertensive diseases (HTND), dyslipidemia, and osteoarthritis were the three most expensive ORCs at the population level; each responsible for ≥$18 million annually among 100,000 individuals. HTND and osteoarthritis were much more costly among individuals with obesity than those without obesity. Data were from a small geographic region. ORCs are associated with substantial economic burden, especially for those requiring continuous treatments.

  10. 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

  11. Effects of Vascular and Nonvascular Adverse Events and of Extended-Release Niacin With Laropiprant on Health and Healthcare Costs.

    Science.gov (United States)

    Kent, Seamus; Haynes, Richard; Hopewell, Jemma C; Parish, Sarah; Gray, Alastair; Landray, Martin J; Collins, Rory; Armitage, Jane; Mihaylova, Borislava

    2016-07-01

    Extended-release niacin with laropiprant did not significantly reduce the risk of major vascular events and increased the risk of serious adverse events in Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE), but its net effects on health and healthcare costs are unknown. 25 673 participants aged 50 to 80 years with previous cardiovascular disease were randomized to 2 g of extended-release niacin with 40 mg of laropiprant daily versus matching placebo, in addition to effective statin-based low-density lipoprotein cholesterol-lowering treatment. The net effects of niacin-laropiprant on quality-adjusted life years and hospital care costs (2012 UK £; converted into US $ using purchasing power parity index) during 4 years in HPS2-THRIVE were evaluated using estimates of the impact of serious adverse events on health-related quality of life and hospital care costs. During the study, participants assigned niacin-laropiprant experienced marginally but not statistically significantly lower survival (0.012 fewer years [standard error (SE) 0.007]), fewer quality-adjusted life years (0.023 [SE 0.007] fewer using UK EQ-5D scores; 0.020 [SE 0.006] fewer using US EQ-5D scores) and accrued greater hospital costs (UK £101 [SE £37]; US $145 [SE $53]). Stroke, heart failure, musculoskeletal events, gastrointestinal events, and infections were associated with significant decreases in health-related quality of life in both the year of the event and in subsequent years. All serious vascular and nonvascular events were associated with substantial increases in hospital care costs. In HPS2-THRIVE, the addition of extended-release niacin-laropiprant to statin-based therapy reduced quality of life-adjusted survival and increased hospital costs. URL: http://clinicaltrials.gov. Unique identifier: NCT00461630. © 2016 American Heart Association, Inc.

  12. Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.

    Science.gov (United States)

    Pettoello-Mantovani, Massimo; Namazova-Baranova, Leyla; Ehrich, Jochen

    2016-02-24

    Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth. On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to "deliver more for less" often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales. The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional

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

    DEFF Research Database (Denmark)

    Danielsen, Anne Kjærgaard; Rosenberg, Jacob

    2014-01-01

    AND METHODS: Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment...

  14. Effects of Health-Care Services and Commodities Cost on the ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... services and commodities cost on the patients at the primary health facilities in Zaria .... This is a social security system that guarantees the provision of needed ..... tourism to India, Dubai, London, America, and even to some other ..... Mudyarabikwa O. An examination of public sector subsidies to the private ...

  15. Quantifying the hidden healthcare cost of diabetes mellitus in Australian hospital patients.

    Science.gov (United States)

    Karahalios, Amalia; Somarajah, Gowri; Hamblin, Peter S; Karunajeewa, Harin; Janus, Edward D

    2018-03-01

    Diabetes mellitus in hospital inpatients is most commonly present as a comorbidity rather than as the primary diagnosis. In some hospitals, the prevalence of comorbid diabetes mellitus across all inpatients exceeds 30%, which could add to complexity of care and resource utilisation. However, whether and to what extent comorbid diabetes mellitus contributes indirectly to greater hospitalisation costs is ill-defined. To determine the attributable effect of comorbid diabetes mellitus on hospital resource utilisation in a General Internal Medical service in Melbourne, Australia. We extracted data from a database of all General Internal Medical discharge episodes from July 2012 to June 2013. We fitted multivariable regression models to compare patients with diabetes mellitus to those without diabetes mellitus with respect to hospitalisation cost, length of stay, admissions per year and inpatient mortality. Of 4657 patients 1519 (33%) had diabetes mellitus, for whom average hospitalisation cost (AUD9910) was higher than those without diabetes mellitus (AUD7805). In multivariable analysis, this corresponded to a 1.22-fold (95% confidence interval (CI) 1.12-1.33, P diabetes was 8.2 days versus 6.8 days for those without diabetes, with an adjusted 1.19-fold greater odds (95% CI 1.06-1.33, P = 0.001) of staying an additional day. Number of admissions and mortality were similar. Comorbid diabetes mellitus adds significantly to hospitalisation duration and costs in medical inpatients. Moreover, diabetes mellitus patients with chronic complications had a greater-still cost and hospitalisation duration compared to those without diabetes mellitus. © 2017 Royal Australasian College of Physicians.

  16. A case-mix classification system for explaining healthcare costs using administrative data in Italy.

    Science.gov (United States)

    Corti, Maria Chiara; Avossa, Francesco; Schievano, Elena; Gallina, Pietro; Ferroni, Eliana; Alba, Natalia; Dotto, Matilde; Basso, Cristina; Netti, Silvia Tiozzo; Fedeli, Ugo; Mantoan, Domenico

    2018-03-04

    The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity. Copyright © 2018. Published by Elsevier B.V.

  17. Romanian healthcare system at a glance

    Directory of Open Access Journals (Sweden)

    Christiana Balan

    2013-04-01

    Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

  18. How to design the cost-effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework.

    Science.gov (United States)

    Johannesen, Kasper M; Claxton, Karl; Sculpher, Mark J; Wailoo, Allan J

    2018-02-01

    This paper presents a conceptual framework to analyse the design of the cost-effectiveness appraisal process of new healthcare technologies. The framework characterises the appraisal processes as a diagnostic test aimed at identifying cost-effective (true positive) and non-cost-effective (true negative) technologies. Using the framework, factors that influence the value of operating an appraisal process, in terms of net gain to population health, are identified. The framework is used to gain insight into current policy questions including (a) how rigorous the process should be, (b) who should have the burden of proof, and (c) how optimal design changes when allowing for appeals, price reductions, resubmissions, and re-evaluations. The paper demonstrates that there is no one optimal appraisal process and the process should be adapted over time and to the specific technology under assessment. Optimal design depends on country-specific features of (future) technologies, for example, effect, price, and size of the patient population, which might explain the difference in appraisal processes across countries. It is shown that burden of proof should be placed on the producers and that the impact of price reductions and patient access schemes on the producer's price setting should be considered when designing the appraisal process. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Effect of an evidence-based website on healthcare usage: an interrupted time-series study.

    NARCIS (Netherlands)

    Spoelman, W.A.; Bonten, T.N.; Waal, M.W.M. de; Drenthen, T.; Smeele, I.J.M.; Nielen, M.M.; Chavannes, N.

    2016-01-01

    Objectives: Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in

  20. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy

    DEFF Research Database (Denmark)

    Søndergaard, Jens; Christensen, Helene Nordahl; Ibsen, Rikke

    2017-01-01

    -based cohort study including patients ≥18 years of age initiating ≥4 weeks opioid therapy (1998–2012) in Denmark. A measure of OIC was constructed based on data from Danish national health registries, and defined as ≥1 diagnosis of constipation, diverticulitis, mega colon, ileus/subileus, abdominal pain....../acute abdomen or haemorrhoids and/or ≥2 subsequent prescription issues of laxatives. Total healthcare resource utilization and costs (including pharmacy dispense, inpatient-, outpatient-, emergency room- and primary care) were estimated according to OIC status, opioid treatment dosage and length, gender, age...... characteristics of non-cancer OIC patients showed a higher frequency of strong opioid treatment (69% versus 41%), long-term opioid treatment (1189 days versus 584 days), advanced age (73 years versus 61 years), and cardiovascular disease (31% versus 19%) compared to those without OIC (P 

  1. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review.

    Science.gov (United States)

    Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G

    2016-08-18

    Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  2. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    2016-08-01

    Full Text Available Sleep disorders are frequent (18%–23% and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  3. Impact of initiation of asenapine on patterns of utilization and cost of healthcare resources associated with the treatment of bipolar I disorder.

    Science.gov (United States)

    Chitnis, Abhishek; Wang, Rosa; Sun, Shawn X; Dixit, Shailja; Tawah, Alie; Boulanger, Luke

    2015-01-01

    To assess the impact of initiation of asenapine on "real-world" levels of utilization and cost of healthcare services for the treatment of bipolar I disorder (BPD) in the US. Using two large US healthcare claims databases that collectively included commercially insured patients aged a BPD diagnosis, plus psychiatric medications and the costs thereof (2012 dollars) were deemed 'BPD-related'. Differences in BPD-related utilization and cost of healthcare services were compared between the pre- and post-index periods. A total of 1403 patients met all selection criteria; the mean age was 42.8 years and 70.6% were women. Relative to pre-index, significant decreases were noted in post-index use of BPD-related healthcare services, most notably admissions (from 24.0% to 12.3% during the post-index period) and emergency department visits (from 4.6% to 2.6%) (both p levels of utilization of BPD-related healthcare services and costs decreased during the 6-month period immediately following initiation of asenapine therapy.

  4. U.S. Dental School Deans’ Perceptions of the Rising Cost of Dental Education and Borrowing Pressures on Dental Students: Report of Survey Results.

    Science.gov (United States)

    McAllister, Dora Elías; Garrison, Gwen E; Feldman, Cecile A; Anderson, Eugene L; Cook, Bryan J; Valachovic, Richard W

    2015-06-01

    This report presents findings from a survey of U.S. dental school deans designed to capture their perceptions regarding the rising cost of dental education and its impact on borrowing by dental students to finance their education. The survey included questions about factors influencing the cost of dental education, concerns about dental student borrowing, and financial awareness resources for students. The survey was distributed to the deans of all 63 U.S. dental schools in January 2013; 42 deans responded, for a 67% response rate. The results indicate that, according to the responding deans, new clinical technologies, technology costs, and central university taxes are the main factors that contribute to the increasing cost of dental education. Coupled with reduced state appropriations at public dental schools and declines in private giving at all dental schools, dental school deans face a perplexing set of financial management challenges. Tuition and fees are a primary source of revenue for all dental schools; however, many deans do not have total control over the cost of attending their schools since tuition and fees are often tied to mandates and policies from the parent university and the state legislature. The findings of this study indicate that U.S. dental school deans are aware of and concerned about the impact of increases in tuition and fees on dental student debt and that they are using a variety of strategies to address the growth in dental student borrowing.

  5. Illness Mapping: a time and cost effective method to estimate healthcare data needed to establish community-based health insurance

    Directory of Open Access Journals (Sweden)

    Binnendijk Erika

    2012-10-01

    Full Text Available Abstract Background Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the “Illness Mapping” method (IM for data collection (faster and cheaper than household surveys. Methods IM is a modification of two non-interactive consensus group methods (Delphi and Nominal Group Technique to operate as interactive methods. We elicited estimates from “Experts” in the target community on morbidity and healthcare utilization. Interaction between facilitator and experts became essential to bridge literacy constraints and to reach consensus. The study was conducted in Gaya District, Bihar (India during April-June 2010. The intervention included the IM and a household survey (HHS. IM included 18 women’s and 17 men’s groups. The HHS was conducted in 50 villages with1,000 randomly selected households (6,656 individuals. Results We found good agreement between the two methods on overall prevalence of illness (IM: 25.9% ±3.6; HHS: 31.4% and on prevalence of acute (IM: 76.9%; HHS: 69.2% and chronic illnesses (IM: 20.1%; HHS: 16.6%. We also found good agreement on incidence of deliveries (IM: 3.9% ±0.4; HHS: 3.9%, and on hospital deliveries (IM: 61.0%. ± 5.4; HHS: 51.4%. For hospitalizations, we obtained a lower estimate from the IM (1.1% than from the HHS (2.6%. The IM required less time and less person-power than a household survey, which translate into reduced costs. Conclusions We have shown that our Illness Mapping method can be carried out at lower financial and human cost for sourcing essential local data, at acceptably accurate levels. In view of the good fit of

  6. Illness Mapping: a time and cost effective method to estimate healthcare data needed to establish community-based health insurance.

    Science.gov (United States)

    Binnendijk, Erika; Gautham, Meenakshi; Koren, Ruth; Dror, David M

    2012-10-09

    Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the "Illness Mapping" method (IM) for data collection (faster and cheaper than household surveys). IM is a modification of two non-interactive consensus group methods (Delphi and Nominal Group Technique) to operate as interactive methods. We elicited estimates from "Experts" in the target community on morbidity and healthcare utilization. Interaction between facilitator and experts became essential to bridge literacy constraints and to reach consensus.The study was conducted in Gaya District, Bihar (India) during April-June 2010. The intervention included the IM and a household survey (HHS). IM included 18 women's and 17 men's groups. The HHS was conducted in 50 villages with1,000 randomly selected households (6,656 individuals). We found good agreement between the two methods on overall prevalence of illness (IM: 25.9% ±3.6; HHS: 31.4%) and on prevalence of acute (IM: 76.9%; HHS: 69.2%) and chronic illnesses (IM: 20.1%; HHS: 16.6%). We also found good agreement on incidence of deliveries (IM: 3.9% ±0.4; HHS: 3.9%), and on hospital deliveries (IM: 61.0%. ± 5.4; HHS: 51.4%). For hospitalizations, we obtained a lower estimate from the IM (1.1%) than from the HHS (2.6%). The IM required less time and less person-power than a household survey, which translate into reduced costs. We have shown that our Illness Mapping method can be carried out at lower financial and human cost for sourcing essential local data, at acceptably accurate levels. In view of the good fit of results obtained, we assume that the method could work elsewhere

  7. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

    Science.gov (United States)

    de Andrés-Nogales, F; Vivancos Mora, J; Barriga Hernández, F J; Díaz Otero, F; Izquierdo Esteban, L; Ortega-Casarrubios, M Á; Castillo Moreno, L; Ximénez-Carrillo Rico, Á; Martín Torres, M P; Gómez-Escalonilla Escobar, C I; Torres González, C; de Salas-Cansado, M; Casado Gómez, M Á; Soto Álvarez, J; Gil-Núñez, A

    2015-01-01

    Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier Espa

  8. Short- and long-term effects of gestational diabetes mellitus on healthcare cost: a cross-sectional comparative study in the ATLANTIC DIP cohort.

    Science.gov (United States)

    Danyliv, A; Gillespie, P; O'Neill, C; Noctor, E; O'Dea, A; Tierney, M; McGuire, B; Glynn, L G; Dunne, F

    2015-04-01

    This paper examines the association between gestational diabetes mellitus and costs of care during pregnancy and 2-5 years post pregnancy. Healthcare utilization during pregnancy was measured for a sample of 658 women drawn from the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network. Healthcare utilization 2-5 years post pregnancy was assessed for a subsample of 348 women via a postal questionnaire. A vector of unit costs was applied to healthcare activity to calculate the costs of care at both time points. Differences in cost for women with gestational diabetes mellitus compared with those with normal glucose tolerance during the pregnancy were examined using univariate and multivariate regression analyses. Gestational diabetes mellitus was independently associated with an additional €817.60 during pregnancy (€1192.1 in the gestational diabetes mellitus group, €511.6 in the normal glucose tolerance group), in the form of additional delivery and neonatal care costs, and an additional €680.50 in annual healthcare costs 2-5 years after the index pregnancy (€6252.4 in the gestational diabetes mellitus group, €5434.8 in the normal glucose tolerance group). These results suggest that gestational diabetes mellitus is associated with increased costs of care during and post pregnancy. They provide indication of the associated cost that can be avoided or reduced by the screening, prevention and management of gestational diabetes mellitus in pregnancy. These estimates are useful for further studies that examine the cost and cost-effectiveness of such programmes. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  9. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Directory of Open Access Journals (Sweden)

    Oded Vered

    Full Text Available Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU. Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470. Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410. HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391. Before diagnosis (baseline, the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05, however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001. Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001. Additional elevated costs were 3.6 times higher laboratory tests (P<0.001, 2.8 times higher emergency room visits (P<0.001, 1.8 times higher medication (P<0.001 and 1.3 times higher diagnostic procedures (P<0.001. We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  10. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Science.gov (United States)

    Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

    2015-01-01

    Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  11. Quality improvement in hospitals: how much does it reduce healthcare costs?

    Science.gov (United States)

    Jones, S B

    1995-01-01

    The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

  12. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2012-02-01

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 +\\/- 0.41 to 0.8 +\\/- 0.37 and the mean number of bed days occupied was reduced from 16.6 +\\/- 2.94 to 5.3 +\\/- 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 +\\/- 0.27 to 1.2 +\\/- 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  13. Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology.

    Science.gov (United States)

    Falls, Christopher Edward

    2008-01-01

    American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.

  14. Use of Generics—A Critical Cost Containment Measure for All Healthcare Professionals in Europe?

    Directory of Open Access Journals (Sweden)

    F. Cankat Tulunay

    2010-08-01

    Full Text Available Pharmaceutical expenditures in ambulatory care rose rapidly in Europe in the 1990s and early 2000s. This was typically faster than other components of healthcare spending, leading to reforms to moderate future growth. A number of these centered on generic medicines with measures to lower reimbursed prices as well as enhance their prescribing and dispensing. The principal objective of this paper is to review additional measures that some European countries can adopt to further reduce reimbursed prices for generics. Secondly, potential approaches to address concerns with generics when they arise to maximize savings. Measures to enhance the prescribing of generics will also briefly be discussed. A narrative review of the extensive number of publications and associated references from the co-authors was conducted supplemented with known internal or web-based articles. In addition, health authority and health insurance databases, principally from 2001 to 2007, were analyzed to assess the impact of the various measures on price reductions for generic omeprazole and generic simvastatin vs. pre-patent loss prices, as well as overall efficiency in Proton Pump Inhibitor (PPI and statin prescribing. The various initiatives generally resulted in considerable lowering of the prices of generics as well as specifically for generic omeprazole and generic simvastatin vs. pre-patent loss prices. At one stage in the UK, generic simvastatin was just 2% of the originator price. These measures also led to increased efficiency for PPI and statin prescribing with reimbursed expenditure for the PPIs and statins either falling or increasing at appreciably lower rates than increases in utilization. A number of strategies have also been introduced to address patient and physician concerns with generics to maximize savings. In conclusion, whilst recent reforms have been successful, European countries must continue learning from each other to fund increased volumes and new

  15. When renewable energy met sustainable growth. Regulation, cost reduction, and the rise of renewable energy in the United States

    International Nuclear Information System (INIS)

    Stephens, Samantha

    2016-01-01

    Historically and famously fossil-fuel dependent, the U.S. energy and electricity mixes are evolving quickly as costs fall for renewables, regulations mandate their implementation, and fiscal policy incentivizes their installation. The investment and production tax credits (ITC and PTC) as well as power purchase agreements (PPAs) are well-known for their contributions to the development of solar and wind capacity, and the recent extensions of these credits has led to a positive outlook for continued growth in installations and generation. In addition, the green power market is experiencing record participation, as tracking the positive environmental externalities of renewable power has become important to meet renewable portfolio standards, which mandate implementation of renewable energy by state. Cost reduction is further taking place globally due to technological advances and economies of scale, which serves as another key driver for development. Of course, challenges are still present, particularly due to a plentiful and inexpensive domestic fossil fuel supply, uneven application of regulation and incentives state-by-state, and the uncertainty of continued political support. Even so, a progressive lowering of traditional barriers is leading to the potential for widespread deployment of renewables across the American landscape. (author)

  16. A Case Study of Preliminary Cost-Benefit Analysis of Building Levees to Mitigate the Joint Effects of Sea Level Rise and Storm Surge

    Directory of Open Access Journals (Sweden)

    Binbin Peng

    2018-02-01

    Full Text Available Sea-level rise (SLR will magnify the impacts of storm surge; the resulting severe flooding and inundation can cause huge damage to coastal communities. Community leaders are considering implementing adaptation strategies, typically hard engineering projects, to protect coastal assets and resources. It is important to understand the costs and benefits of the proposed project before any decision is made. To mitigate the flooding impact of joint effects of storm surge and SLR, building levee segments is chosen to be a corresponding adaptation strategy to protect the real estate assets in the study area—the City of Miami, FL, USA. This paper uses the classic Cost-Benefit Analysis (CBA to assess the cost efficiency and proposes corresponding improvements in the benefit estimation, by estimating the avoided damages of implementing levee projects. Results show that the city will benefit from implementing levee projects along the Miami River in both a one-time 10 year storm event with SLR and cumulative long-term damage scenarios. This study also suggests that conducting CBA is a critical process before making coastal adaptation planning investment. A more meaningful result of cost effectiveness is estimated by accounting for the appreciation and time value. In addition, a sensitivity analysis is conducted to verify how the choice of discount rate influences the result. Uncertain factors including the rate of SLR, storm intensification, land use changes, and real estate appreciation are further analyzed.

  17. Relations between decision indicators for implementing technology in healthcare logistics – a bed logistics case study

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes; Jacobsen, Peter

    2015-01-01

    The cost of healthcare is rising and reforms have been introduced across Europe to address the cost issue in healthcare. There is potential to improve logistical processes within healthcare to save costs and at the same time provide services that support high quality patient care. Re......-designing processes and implementing technology can improve the efficiency of processes and reduce costs. A relations diagram has been developed that identifies the effects between the constructs Logistics, Technology, Procedure and Structure. Knowledge about how these constructs affect each other is important when...

  18. Impact of the raising immunizations safely and effectively (RISE) program on healthcare worker influenza immunization rates in long term care settings.

    Science.gov (United States)

    Nace, David A; Handler, Steven M; Hoffman, Erika L; Perera, Subashan

    2012-11-01

    National influenza immunization rates for healthcare workers (HCW) in long-term care (LTC) remain unacceptably low. This poses a serious public health threat to residents. Prior work has suggested high staff turnover rates as a contributing factor to low immunization rates. There is a critical need to identify and deploy successful models of HCW influenza immunization programs to LTC facilities. This report describes one potential model that has been successfully initiated in a network of LTC facilities. All facilities served by a single regional LTC pharmacy were invited to participate in a HCW influenza immunization program. This voluntary immunization program began in 2005 and continues to the present. As part of the program, the pharmacy promoted organizational change by assuming oversight and control of HCW immunization policies and processes for all facilities. Primary and secondary outcomes are the number of facilities reaching HCW influenza immunization rates of 60% and 80%. Fourteen of the 16 LTC facilities participated. Facilities were diverse and included both nursing and assisted living facilities; unionized and nonunionized facilities; and urban, suburban, and rural facilities. The pharmacy provided educational and communication materials, centralized data collection using a standardized definition for HCW immunization rates, and facility feedback. All 14 LTC facilities achieved the primary goal of 60% and nearly two thirds reached the secondary goal of 80%. Twenty percent reached the new Healthy People 2020 goal of 90%. It is possible for LTC facilities to improve HCW immunization rates using a pharmacy based, voluntary HCW influenza immunization approach. Such an approach may help attenuate the negative influence of staff turnover on HCW immunizations. Attainment of the new Health People 2020 goals still remains a challenge and may require mandatory programs. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc

  19. Associations of renal function at 1-year after kidney transplantation with subsequent return to dialysis, mortality, and healthcare costs.

    Science.gov (United States)

    Schnitzler, Mark A; Johnston, Karissa; Axelrod, David; Gheorghian, Adrian; Lentine, Krista L

    2011-06-27

    Improved early kidney transplant outcomes limit the contemporary utility of standard clinical endpoints. Quantifying the relationship of renal function at 1 year after transplant with subsequent clinical outcomes and healthcare costs may facilitate cost-benefit evaluations among transplant recipients. Data for Medicare-insured kidney-only transplant recipients (1995-2003) were drawn from the United States Renal Data System. Associations of estimated glomerular filtration rate (eGFR) level at the first transplant anniversary with subsequent death-censored graft failure and patient death in posttransplant years 1 to 3 and 4 to 7 were examined by parametric survival analysis. Associations of eGFR with total health care costs defined by Medicare payments were assessed with multivariate linear regression. Among 38,015 participants, first anniversary eGFR level demonstrated graded associations with subsequent outcomes. Compared with patients with 12-month eGFR more than or equal to 60 mL/min/1.73 m, the adjusted relative risk of death-censored graft failure in years 1 to 3 was 31% greater for eGFR 45 to 59 mL/min/1.73 m (Preturn to dialysis or die attributable to eGFR less than 60 mL/min/1.73 m over 10 years were 23.1% and 9.4%, respectively, and were significantly higher than proportions attributable to delayed graft function or acute rejection. Reduced eGFR was associated with graded and significant increases in health care spending during years 2 and 3 after transplant (P<0.0001). eGFR is strongly associated with clinical and economic outcomes after kidney transplantation.

  20. Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

    Science.gov (United States)

    Flores, Gabriela; Krishnakumar, Jaya; O'Donnell, Owen; van Doorslaer, Eddy

    2008-12-01

    In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.

  1. Prescription copay reduction program for diabetic employees: impact on medication compliance and healthcare costs and utilization.

    Science.gov (United States)

    Nair, Kavita V; Miller, Kerri; Saseen, Joseph; Wolfe, Pamela; Allen, Richard Read; Park, Jinhee

    2009-01-01

    To examine the impact of a value-based benefit design on utilization and expenditures. This benefit design involved all diabetes-related drugs and testing supplies placed on the lowest copay tier for 1 employer group. The sample of diabetic members were enrolled from a 9-month preperiod and for 2 years after the benefit design was implemented. Measured outcomes included prescription drug utilization for diabetes and medical utilization. Generalized measures were used to estimate differences between years 1 and 2 and the preperiod adjusting for age, gender, and comorbidity risk. Diabetes prescription drug use increased by 9.5% in year 1 and by 5.5% in year 2, and mean adherence increased by 7% to 8% in year 1 and fell slightly in year 2 compared with the preperiod. Pharmacy expenditures increased by 47% and 53% and expenditures for diabetes services increased by 16% and 32% in years 1 and 2, respectively. Increases in adherence and use of diabetes medications were observed. There were no compensatory cost-savings for the employer through lower utilization of medical expenditures in the first 2 years. Adherent patients had fewer emergency department visits than nonadherent patients after the implementation of this benefit design.

  2. Rethinking costs of psoriasis: 10% of patients account for nearly 40% of healthcare expenditures among enrollees with psoriasis in a U.S. health plan.

    Science.gov (United States)

    Armstrong, April W; Zhao, Yang; Herrera, Vivian; Li, Yunfeng; Bancroft, Tim; Hull, Michael; Altan, Aylin

    2017-11-01

    To examine characteristics, healthcare utilization and costs among patients with psoriasis who have high medical costs. This is a retrospective study of patients with psoriasis with continuous enrollment from 1 January 2011 to 31 December 2013 in a large US health plan. Total paid 2012 healthcare costs excluding biologics (to identify costliest not due to biologic costs) were used to create cohorts representing the top 10% (T10) and bottom 90% (B90) of expenditures. Demographics, comorbidities, prescriptions, all-cause and psoriasis-related healthcare utilization and costs were compared between cohorts. Logistic regression identified demographic and clinical characteristics associated with the 2012 T10 cohort status. 18,653 patients (mean age 48 years; 49% female) were included. Patients in the T10 group accounted for 26% (2011), 39% (2012) and 26% (2013) of all-cause costs including biologics and 13% (2011), 18% (2012) and 11% (2013) of psoriasis-related costs. Mean 2012 total costs were $58,030 for T10 vs. $10,295 for B90 (all-cause) and $10,475 vs. $5301 (psoriasis-related). T10 patients in 2012 filled more prescriptions and were more likely to use corticosteroids (57% vs. 31%); however, biologic use and costs were similar (any use: 23% vs. 24%; prescriptions: 1.5 vs. 1.7, biologic costs: $4959 vs. $5095). Compared with B90 patients, T10 patients were more likely to have hospitalizations (all-cause: 45% vs. 3%; psoriasis-related: 14% vs. 1%) and ER visits (all-cause: 53% vs. 21%; psoriasis-related: 3% vs. 1%), and more likely to have renal disease (odds ratio (OR) = 2.05), depression (OR =1.96), cardiovascular disease (OR =1.88), psoriatic arthritis (OR =1.57) and diabetes (OR =1.50) (all p psoriasis-related biologic treatment utilization and costs. The T10 patients had significantly more inpatient and emergency utilization, and comorbid medical conditions.

  3. The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial.

    Science.gov (United States)

    Chun, K R Julian; Brugada, Josep; Elvan, Arif; Gellér, Laszlo; Busch, Matthias; Barrera, Alberto; Schilling, Richard J; Reynolds, Matthew R; Hokanson, Robert B; Holbrook, Reece; Brown, Benedict; Schlüter, Michael; Kuck, Karl-Heinz

    2017-07-27

    This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation ( P =0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000. When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. URL: http://www.clinicaltrials.gov. Identifier: NCT01490814. © 2017 The Authors and Medtronic. Published on behalf of the American Heart Association, Inc., by Wiley.

  4. Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings.

    Science.gov (United States)

    Adrion, Emily R; Kocher, Keith E; Nallamothu, Brahmajee K; Ryan, Andrew M

    2017-12-01

    Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectly affect non-Medicare patients, little is known about the use of, and spending associated with, observation care among commercially insured populations. Using multipayer commercial claims for the period 2009-13, we evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In our study period, the use of observation care increased relative to that of short-stay hospitalizations. Total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly-and at rates much higher than spending in the inpatient setting-over the study period. Despite this growth, spending on observation care is unlikely to exceed spending for short-stay hospitalizations. As observation care attracts greater attention, policy makers should be aware that Medicare policies that disincentivize observation may have unintended financial impacts on non-Medicare populations, where observation care may be cost saving.

  5. Cost-Effectiveness Analysis of the Use of Probiotics for the Prevention of Clostridium difficile-Associated Diarrhea in a Provincial Healthcare System.

    Science.gov (United States)

    Leal, Jenine R; Heitman, Steven J; Conly, John M; Henderson, Elizabeth A; Manns, Braden J

    2016-09-01

    OBJECTIVE To conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile-associated diarrhea (CDAD). DESIGN Cost-effectiveness analysis using decision analytic modeling. METHODS A cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results. RESULTS Treatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates. CONCLUSIONS Oral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD. Infect Control Hosp Epidemiol 2016;37:1079-1086.

  6. Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients

    NARCIS (Netherlands)

    van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W.; Pols, Huibert A. P.; van der Cammen, Tischa J. M.

    2008-01-01

    BACKGROUND: Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. METHOD: Within a common geriatric outpatient

  7. The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

    Directory of Open Access Journals (Sweden)

    Steyerberg Ewout W

    2011-09-01

    Full Text Available Abstract Background Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene. Methods/design The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital. Intervention A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback. Variables The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed. Statistical analysis Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of

  8. A Framework for Healthcare Planning and Control

    NARCIS (Netherlands)

    Hans, Elias W.; van Houdenhoven, Mark; Hulshof, P.J.H.; Hall, Randolph

    2012-01-01

    Rising expenditures spur healthcare organizations to organize their processes more efficiently and effectively. Unfortunately, healthcare planning and control lags behind manufacturing planning and control. We analyze existing planning and control concepts or frameworks for healthcare operations

  9. Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia.

    Science.gov (United States)

    Darkow, Theodore; Henk, Henry J; Thomas, Simu K; Feng, Weiwei; Baladi, Jean-Francois; Goldberg, George A; Hatfield, Alan; Cortes, Jorge

    2007-01-01

    Identify treatment interruptions and non-adherence with imatinib; examine the clinical and patient characteristics related to treatment interruptions and non-adherence; and estimate the association between treatment interruptions and non-adherence with imatinib and healthcare costs for US managed care patients with chronic myeloid leukaemia (CML). This retrospective analysis utilised electronic healthcare claims data from a US managed care provider. Adult patients with CML (as determined by International Classification of Diseases, ninth revision, Clinical Modification [ICD-9-CM] diagnosis code) were identified who began treatment with imatinib from 1 June 2001 through 31 March 2004. Treatment interruptions (i.e. failure to refill imatinib within 30 days from the run-out date of the prior prescription) were identified during the 12-month follow-up period. Medication possession ratio (MPR), calculated as total days' supply of imatinib divided by 365, was also examined. Healthcare costs (i.e. paid amounts for all prescription medications and medical services received, including health plan and patient liability) were examined in three ways: (i) total healthcare costs; (ii) total healthcare costs exclusive of imatinib costs; and (iii) total medical costs. All costs were converted to US dollars (2004 values) using the medical component of the Consumer Price Index. MPR was modelled using ordinary least squares regression. Presence of treatment interruptions was modelled using logistic regression. The association between MPR and healthcare costs was estimated using a generalised linear model specified with a gamma error distribution and a log link. All models included adjustment for age, gender, number of concomitant medications, starting dose of imatinib and cancer complexity. A total of 267 patients were identified. Average age was approximately 50 years, and 43% were women. Mean MPR was 77.7%, with 31% of patients having a treatment interruption. However, all of these

  10. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2011-05-11

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 ± 0.41 to 0.8 ± 0.37 and the mean number of bed days occupied was reduced from 16.6 ± 2.94 to 5.3 ± 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 ± 0.27 to 1.2 ± 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  11. Who prefers the 'cost-effectiveness ratio' prioritization approach in health-care decisions? Results of an empirical analysis.

    Science.gov (United States)

    Damm, Kathrin; Prenzler, Anne; Zuchandke, Andy

    2015-12-01

    The problem of resource scarcity has led to an on-going debate about priority setting in the health-care system. Prioritization via the economic-based cost-effectiveness ratio (CER), for example, is controversial and has many advocates as well as opponents. Hence, the aim of our research is to analyse the fairness consideration of the CER approach in comparison with other prioritization approaches and to investigate whether these preferences depend on the field of study. We developed and tested a unique questionnaire. Between October 2011 and January 2012, freshmen and advanced university students of medicine, law, economics, philosophy and religion in Germany were asked to choose among four prioritization approaches (CER, minimum health, random selection and age) using a dichotomous choice technique. The data were analysed by descriptive and microeconometric regression techniques. Data on 913 students were included in the study. A majority of the students prioritized cost-effectiveness second after minimum health. Advanced economics students preferred the CER approach significantly more than did incoming economics students. The attitudes of the advanced philosophy/religion students towards the CER were significantly more negative compared with the respective freshmen. Further, gender had a strong, significant impact on attitudes: women chose the CER less often than men did (P < 0.01). The results of this study indicate that attitudes presented by opinion leaders in the investigated fields of study seem to be in line with the perceptions of the respective fields' advanced students. Because of these differences, the debate on how to deal with scarce resources may remain complicated. © 2014 John Wiley & Sons Ltd.

  12. Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

    Science.gov (United States)

    Suzuki, Cibele; Lopes da Silva, Nilceia; Kumar, Praveen; Pathak, Purnima; Ong, Siew Hwa

    2017-08-01

    Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross

  13. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada

    Science.gov (United States)

    Abdullah, Mohammad M. H.; Gyles, Collin L.; Marinangeli, Christopher P. F.; Carlberg, Jared G.; Jones, Peter J. H.

    2015-01-01

    Background: Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults. Methods: A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step. Results: Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million–$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD. Conclusion: Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers’ general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada. PMID

  14. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

    Science.gov (United States)

    Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.

    2016-01-01

    Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand

  15. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.

    Directory of Open Access Journals (Sweden)

    Nicholas Graves

    Full Text Available The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012.No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.The Australian National Hand Hygiene Initiative was cost

  16. Cost effectiveness of once-daily oral chelation therapy with deferasirox versus infusional deferoxamine in transfusion-dependent thalassaemia patients: US healthcare system perspective.

    Science.gov (United States)

    Delea, Thomas E; Sofrygin, Oleg; Thomas, Simu K; Baladi, Jean-Francois; Phatak, Pradyumna D; Coates, Thomas D

    2007-01-01

    Deferasirox is a recently approved once-daily oral iron chelator that has been shown to reduce liver iron concentrations and serum ferritin levels to a similar extent as infusional deferoxamine. To determine the cost effectiveness of deferasirox versus deferoxamine in patients with beta-thalassaemia major from a US healthcare system perspective. A Markov model was used to estimate the total additional lifetime costs and QALYs gained with deferasirox versus deferoxamine in patients with beta-thalassaemia major and chronic iron overload from blood transfusions. Patients were assumed to be 3 years of age at initiation of chelation therapy and to receive prescribed dosages of deferasirox and deferoxamine that have been shown to be similarly effective in such patients. Compliance with chelation therapy and probabilities of iron overload-related cardiac disease and death by degree of compliance were estimated using data from published studies. Costs ($US, year 2006 values) of deferoxamine administration and iron overload-related cardiac disease were based on analyses of health insurance claims of transfusion-dependent thalassaemia patients. Utilities were based on a study of patient preferences for oral versus infusional chelation therapy, as well as published literature. Probabilistic and deterministic sensitivity analyses were employed to examine the robustness of the results to key assumptions. Deferasirox resulted in a gain of 4.5 QALYs per patient at an additional expected lifetime cost of $US126,018 per patient; the cost per QALY gained was $US28,255. The cost effectiveness of deferasirox versus deferoxamine was sensitive to the estimated costs of deferoxamine administration and the quality-of-life benefit associated with oral versus infusional therapy. Cost effectiveness was also relatively sensitive to the equivalent daily dose of deferasirox, and the unit costs of deferasirox and deferoxamine, and was more favourable in younger patients. Results of this analysis

  17. Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States

    Directory of Open Access Journals (Sweden)

    Kritika Subramanian

    2017-01-01

    Full Text Available Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

  18. Healthcare resource use and costs associated with chronic kidney disease in US private insurance patients with multiple myeloma.

    Science.gov (United States)

    Bhowmik, Debajyoti; Song, Xue; Intorcia, Michele; Kent, Shia T; Shi, Nianwen

    2018-01-01

    Objectives Within a median 1.2 years after patients have an initial diagnosis with multiple myeloma, up to 61% were diagnosed with renal impairment and 50% were diagnosed with chronic kidney disease. This study estimated economic burden associated with chronic kidney disease in multiple myeloma patients in the US. Methods In this retrospective cohort study, patients ≥18 years old with ≥1 inpatient or ≥ 2 outpatient multiple myeloma diagnoses between 1 January 2008 and 31 March 2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. Chronic kidney disease patients had ≥1 diagnosis of chronic kidney disease Stages 1-5 (first chronic kidney disease diagnosis date = index date) on or after the first multiple myeloma diagnosis, and were propensity score matched 1:1 to multiple myeloma patients without chronic kidney disease, end-stage renal disease, dialysis, or other type of chronically impaired renal function. All patients had ≥six-month continuous enrollment prior to index date and were followed for ≥one month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (30 September 2015). The per-patient per-year healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 US dollars. Results A total of 2541 multiple myeloma patients with chronic kidney disease stages 1-5 and 2541 matched controls met the study criteria and were respectively 69.3 and 69.6 years, 54.5% and 55.3% men, and had 572.2 and 533.4 mean days of follow up. Compared to controls, chronic kidney disease patients had significantly (all P chronic kidney disease, end-stage renal disease, or dialysis had $78,455 ( P chronic kidney disease in patients with multiple myeloma was estimated to be between $34,754 and $78,455 per-patient per-year. Given its substantial clinical and economic impact, preservation of renal function is important in

  19. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fibre in Canada

    Directory of Open Access Journals (Sweden)

    Mohammad eAbdullah

    2015-08-01

    Full Text Available Background: Consumption of fibre-rich diets is associated with favourable impacts on type 2 diabetes (T2D and cardiovascular disease (CVD, two of the most costly ailments worldwide, however the economic value of altered fibre intakes remains poorly understood. Methods: A cost-of-illness analysis was conducted to identify the percentage of adults expected to consume fibre-rich diets in Canada, estimate fibre intakes in relation to T2D and CVD reductions, and assess the potential annual savings in healthcare costs with reductions in rates of these two epidemics. Results: Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8-$1,295.7 million in CVD costs were calculated under a scenario where cereal fibre was used to increase current intakes of dietary fibre to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fibre consumption resulted in annual CAD$2.6-$51.1 and $4.6-$92.1 million savings for T2D and CVD, respectively. Conclusions: Strategies to increase consumers’ knowledge of the recommended dietary fibre intakes, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of costs associated with T2D and CVD in Canada.

  20. Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Joëlle Castellani

    Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.

  1. Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

    Science.gov (United States)

    Quach, Jon; Oberklaid, Frank; Gold, Lisa; Lucas, Nina; Mensah, Fiona K; Wake, Melissa

    2014-10-01

    We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  2. Impact of IPDE-SQ personality disorders on the healthcare and societal costs of fibromyalgia patients: a cross-sectional study.

    Science.gov (United States)

    Gumà-Uriel, Laura; Peñarrubia-María, M Teresa; Cerdà-Lafont, Marta; Cunillera-Puertolas, Oriol; Almeda-Ortega, Jesús; Fernández-Vergel, Rita; García-Campayo, Javier; Luciano, Juan V

    2016-06-01

    Data is lacking on comorbid personality disorders (PD) and fibromyalgia syndrome (FMS) in terms of prevalence, and associated healthcare and societal costs. The main aim of this study was to assess the prevalence of PD in FMS patients and to analyse whether the presence of comorbid PD is related to worse functional impairment and greater healthcare (medical visits, drug consumption, and medical tests) and societal costs. A cross-sectional study was performed using the baseline data of 216 FMS patients participating in a randomized, controlled trial carried out in three primary health care centres situated in the region of Barcelona, Spain. Measurement instruments included the International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ), the Fibromyalgia Impact Questionnaire (FIQ), the Client Service Receipt Inventory (CSRI), and a socio-demographic questionnaire. Most patients (65 %) had a potential PD according to the IPDE-SQ. The most prevalent PD were the avoidant (41.4 %), obsessive-compulsive (33.1 %), and borderline (27 %). We found statistically significant differences in functional impairment (FIQ scores) between FMS patients with potential PD vs non-PD (59.2 vs 51.1; p FIQ total scores and the presence of potential PD were related to more healthcare costs (primary and specialised care visits). As expected, PD are frequent comorbid conditions in patients with FMS. Our results suggest that the screening of comorbid PD in patients with FMS might be recommendable in order to detect potential frequent attenders to primary and specialised care.

  3. Exposure to second-hand smoke and direct healthcare costs in children – results from two German birth cohorts, GINIplus and LISAplus

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    Batscheider Ariane

    2012-10-01

    Full Text Available Abstract Background Although the negative health consequences of the exposure to second hand tobacco smoke during childhood are already known, evidence on the economic consequences is still rare. The aim of this study was to estimate excess healthcare costs of exposure to tobacco smoke in German children. Methods The study is based on data from two birth cohort studies of 3,518 children aged 9-11 years with information on healthcare utilisation and tobacco smoke exposure: the GINIplus study (German Infant Study On The Influence Of Nutrition Intervention Plus Environmental And Genetic Influences On Allergy Development and the LISAplus study (Influence of Life-Style Factors On The Development Of The Immune System And Allergies In East And West Germany Plus The Influence Of Traffic Emissions And Genetics. Direct medical costs were estimated using a bottom-up approach (base year 2007. We investigated the impact of tobacco smoke exposure in different environments on the main components of direct healthcare costs using descriptive analysis and a multivariate two-step regression analysis. Results Descriptive analysis showed that average annual medical costs (physician visits, physical therapy and hospital treatment were considerably higher for children exposed to second-hand tobacco smoke at home (indoors or on patio/balcony compared with those who were not exposed. Regression analysis confirmed these descriptive trends: the odds of positive costs and the amount of total costs are significantly elevated for children exposed to tobacco smoke at home after adjusting for confounding variables. Combining the two steps of the regression model shows smoking attributable total costs per child exposed at home of €87 [10–165] (patio/balcony and €144 [6–305] (indoors compared to those with no exposure. Children not exposed at home but in other places showed only a small, but not significant, difference in total costs compared to those with no exposure

  4. Out-of-range international normalized ratio values and healthcare cost among new warfarin patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Nelson, Winnie W; Wang, Li; Baser, Onur; Damaraju, C V; Schein, Jeffrey R

    2015-05-01

    Patients with out-of-range international normalized ratio (INR) values 3.0 have been associated with increased risk of thromboembolic and bleeding events. INR monitoring is costly, because of associated physician and nurse time, laboratory resource use, and dose adjustments. This study assessed the healthcare cost burden associated with out-of-range INR among warfarin initiator patients diagnosed with non-valvular atrial fibrillation (NVAF) in the US Veterans Health Administration (VHA) population. Adult NVAF patients (≥18 years) initiating warfarin were selected from the VHA dataset for the study period October 1, 2007-September 30, 2012. Only valid INR measurements (0.5 ≤ INR ≤ 20) were examined for the follow-up period, from the index date (warfarin initiation date) until the end of warfarin exposure or death. All-cause healthcare costs within 30 days were measured starting from the second month (31 days post-index date) to the end of the study period. Costs for inpatient stays, emergency room, outpatient facility, physician office visits, and other services were computed separately. Multiple regression was performed using the generalized linear model for overall cost analysis. In total, 29,463 patients were included in the study sample. Mean costs for out-of-range INR ranged from $3419 to $5126. Inpatient, outpatient, outpatient pharmacy, and total costs were significantly higher after patients experienced out-of-range results (INR  3), compared with in-range INR (2 ≤ INR ≤ 3). When exposed to out-of-range INR, patients also incurred higher mean total costs within 2-6 months ($3840-$5820) than after the first 6 months ($2789-$3503) of warfarin therapy. In the VHA population, INR measures outside of the 2-3 range were associated with significantly higher healthcare costs. Increased costs were especially apparent when INR values were below 2, although INR measures above 3 were also associated with higher costs relative to in

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

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    Jitender Sodhi

    2016-01-01

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

  6. Rising equity

    International Nuclear Information System (INIS)

    Burr, M.T.

    1992-01-01

    This article reports on the results of a financial rankings survey of the independent energy industry indicating that lenders and investors provided more than five billion dollars in capital for new, private power projects during the first six months of 1992. The topics of the article include rising equity requirements, corporate finance, mergers and acquisitions, project finance investors, revenue bonds, project finance lenders for new projects, project finance lenders for restructurings, and project finance advisors

  7. Use of healthcare resources and costs associated to the start of treatment with injectable drugs in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Morano, Raúl; Ruíz, Lucía

    2016-12-01

    The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogues (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups. A retrospective, non-interventional, observational study was conducted. Patients aged ≥20 years who started treatment with insulin or GLP-1 RAs in the 2010-2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m 2 ), metabolic control (HbA1c), adherence, persistence, and complications (hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered. A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; P<.001) and specialized care (1.0 vs. 1.8; P<.001), hospital stays (0.3 vs. 0.7; P=.030) and less visits to the emergency room (0.8 vs. 1.6; P<.001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; P<.001) and persistence (62.0% vs. 55.9%; P=.046), and had less hypoglycemia episodes (13.4% vs. 18.7%; P=.022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; P=.049), BMI (29.1 vs. 30.9kg/m 2 ), and CVE rate (9.1% vs. 11.5%; P=.330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (P=.046.) CONCLUSIONS: Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment

  8. Drug usage patterns and treatment costs in newly-diagnosed type 2 diabetes mellitus cases, 2007 vs 2012: findings from a large US healthcare claims database analysis.

    Science.gov (United States)

    Weng, W; Liang, Y; Kimball, E S; Hobbs, T; Kong, S; Sakurada, B; Bouchard, J

    2016-07-01

    Objective To explore trends in demographics, comorbidities, anti-diabetic drug usage, and healthcare utilization costs in patients with newly-diagnosed type 2 diabetes mellitus (T2DM) using a large US claims database. Methods For the years 2007 and 2012, Truven Health Marketscan Research Databases were used to identify adults with newly-diagnosed T2DM and continuous 12-month enrollment with prescription benefits. Variables examined included patient demographics, comorbidities, inpatient utilization patterns, healthcare costs (inpatient and outpatient), drug costs, and diabetes drug claim patterns. Results Despite an increase in the overall database population between 2007-2012, the incidence of newly-diagnosed T2DM decreased from 1.1% (2007) to 0.65% (2012). Hyperlipidemia and hypertension were the most common comorbidities and increased in prevalence from 2007 to 2012. In 2007, 48.3% of newly-diagnosed T2DM patients had no claims for diabetes medications, compared with 36.2% of patients in 2012. The use of a single oral anti-diabetic drug (OAD) was the most common diabetes medication-related claim (46.2% of patients in 2007; 56.7% of patients in 2012). Among OAD monotherapy users, metformin was the most commonly used and increased from 2007 (74.7% of OAD monotherapy users) to 2012 (90.8%). Decreases were observed for sulfonylureas (14.1% to 6.2%) and thiazolidinediones (7.3% to 0.6%). Insulin, predominantly basal insulin, was used by 3.9% of patients in 2007 and 5.3% of patients in 2012. Mean total annual healthcare costs increased from $13,744 in 2007 to $15,175 in 2012, driven largely by outpatient services, although costs in all individual categories of healthcare services (inpatient and outpatient) increased. Conversely, total drug costs per patient were lower in 2012 compared with 2007. Conclusions Despite a drop in the rate of newly-diagnosed T2DM from 2007 to 2012 in the US, increased total medical costs and comorbidities per individual patient suggest that

  9. Healthcare Resource Utilization and Costs Associated with Ketosis Events in Pediatric and Adult Patients with Type 1 Diabetes Mellitus in the UK.

    Science.gov (United States)

    Thalange, Nandu; Aldhouse, Natalie Valerie Jane; Kitchen, Helen; Howard, Daniel; Tutkunkardas, Deniz; Håkan-Bloch, Jonas

    2017-10-01

    Ketosis is a metabolic state associated with insulin deficiency. Untreated, it develops into diabetic ketoacidosis, a significant contributor to mortality and morbidity in people with type 1 diabetes mellitus (T1DM). Little is understood about how patients utilize healthcare resources during ketosis events. This study aimed to identify and quantify healthcare resource utilization and provide estimates of associated costs of ketosis events in T1DM, treated unaided or with healthcare professional (HCP) assistance in the UK. Qualitative interviews with adult patients, pediatric carers, and HCPs identified resources used by patients/carers during ketosis events. An online quantitative survey was then used to quantify patients/carers resource use during their/their child's most recent ketosis event, and HCPs estimated patient resource uptake to corroborate the findings. Associated costs estimated from UK data sources were applied to the survey results to calculate the cost of ketosis events in adults and children. Quantitative survey responses from 93 adults, 76 carers, and 52 HCPs were analyzed. Patients and carers monitored ketosis during and following the event with ketone strips and additional glucose strips, and administered treatment comprising insulin and pump set changes where appropriate. Additionally, patients/carers accessed phone services and many received follow-up medical appointments. In total, 70% (n = 65) of adult and 66% (n = 50) of pediatric ketosis events were managed at home, for which resource use costs per event were £23.87 and £38.00 respectively. Remaining events were treated in NHS facilities costing £217.57 per adult and £352.92 per child. Weighted averages identified that ketosis events cost £81.98 per adult and £142.97 per child. Indirect costs from work productivity loss increase these figures to £225.11 per adult and £256.88 per child. Healthcare resource use for ketosis events is high in adults and children with T1DM and

  10. EXAMINING THE BENEFITS OF USING CURRENT HEALTH AND WELLNESS PHILOSOPHIES TO IMPROVE SERVICE MEMBERS HEALTH AND FITNESS AND ALLEVIATE RISING DoD HEALTHCARE COSTS

    Science.gov (United States)

    2016-02-28

    amount of spending has produced a market that has driven the development of technological products that integrate with media devices, cell phones and...of muscle strengthening and activity are important to a service-wide fitness program that would be designed to increase mobility and stamina ...member would be able to participate in daily fitness routines with reduced physical injuries and increased cardiovascular stamina . These would then become

  11. Cost-effectiveness analysis of strategies introducing FDG-PET into the mediastinal staging of non-small-cell lung cancer from the French healthcare system perspective

    International Nuclear Information System (INIS)

    Alzahouri, K.; Lejeune, C.; Woronoff-Lemsi, M.-C.; Arveux, P.; Guillemin, F.

    2005-01-01

    AIM: To determine the most cost-effective strategy using PET for mediastinal staging of potentially operable non-small-cell lung cancer (NSCLC). METHODS: Four decision strategies based on French NSCLC work-up practices for the selection of potential surgical candidates were compared, comprising CT only, PET for negative CT, PET for all with anatomical CT, and CT and PET for all cases. The medical literature was surveyed to obtain values for all variables of interest. Costs were assessed with reimbursements from the French healthcare insurance for the year 1999. Expected cost and life expectancy were calculated for all possible outcomes of each strategy. Sensitivity analysis was performed to determine the effects of changing variables on the expected cost and life expectancy. RESULTS: Compared with the CT only strategy, CT and PET for all resulted in a relative reduction of 70% of surgery for persons with mediastinal lymph node metastasis. PET for all with anatomical CT was shown to be a cost-effective alternative to the CT only, with life expectancy increased by 0.10 years and expected cost savings of 61 euros. This strategy was more favourable than PET for negative CT. Overall, sensitivity analyses showed the robustness of the results. CONCLUSION: The introduction of thoracic PET for NSCLC staging is potentially cost-effective in France. Further clinical investigation might help to validate this result

  12. Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

    Science.gov (United States)

    Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

    2014-01-01

    Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

  13. Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States.

    Science.gov (United States)

    Kumar, Krishna; Bishop, Sharon

    2009-06-01

    Many institutions with spinal cord stimulation (SCS) programs fail to realize that besides the initial implantation cost, budgetary allocation must be made to address annual maintenance costs as well as complications as they arise. Complications remain the major contributing factor to the overall expense of SCS. The authors present a formula that, when applied, provides a realistic representation of the actual costs necessary to implant and maintain SCS systems in Canada and the US. The authors performed a retrospective analysis of 197 cases involving SCS (161 implanted and 36 failed trial stimulations) between 1995 and 2006. The cost of patient workup, initial implantation, annual maintenance, and resources necessary to resolve complications were assessed for each case and a unit cost applied. The total cost allocated for each case was determined by summing across healthcare resource headings. Using the same parameters, the unit cost was calculated in both Canadian (CAD) and US dollars (USD) at 2007 prices. The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136-18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381-28,495) for Medicare and $21,390 (range $573-54,547) for BCBS (both USD). Using these calculations a formula was derived as follows: the annual maintenance cost (a) was added to the average annual cost per complication per patient implanted (b); the sum was then divided by the implantation cost (c); and the result was multiplied by 100 to obtain a percentage (a + b / c x 100). To make this budgetary cap universally applicable, the results from the application of the formula were averaged, resulting in an 18% premium. For budgeting purposes the

  14. Illness Mapping: A time and cost effective method to estimate healthcare data needed to establish community-based health insurance

    NARCIS (Netherlands)

    E. Binnendijk (Erica); M. Gautham (Meenakshi); R. Koren (Ruth); D.M. Dror (David)

    2012-01-01

    textabstractBackground: Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution,

  15. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Retrospective study (multicentres) conducted using computerised medical records. 13 primary care teams in 2008 were included. All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R(2)). The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation.

  16. Do guidelines recommending pharmacogenetic testing of psychiatric patients affect treatment costs and the use of healthcare services?

    DEFF Research Database (Denmark)

    Herbild, Louise; Bech, Mickael; Gyrd-Hansen, Dorte

    2011-01-01

    To identify the effects of local recommendations of pharmacogenetic testing in psychiatry with respect to treatment costs.......To identify the effects of local recommendations of pharmacogenetic testing in psychiatry with respect to treatment costs....

  17. Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology.

    Science.gov (United States)

    Turner-Stokes, Lynne; Sutch, Stephen; Dredge, Robert

    2012-03-01

    To describe the rationale and development of a casemix model and costing methodology for tariff development for specialist neurorehabilitation services in the UK. Patients with complex needs incur higher treatment costs. Fair payment should be weighted in proportion to costs of providing treatment, and should allow for variation over time CASEMIX MODEL AND BAND-WEIGHTING: Case complexity is measured by the Rehabilitation Complexity Scale (RCS). Cases are divided into five bands of complexity, based on the total RCS score. The principal determinant of costs in rehabilitation is staff time. Total staff hours/week (estimated from the Northwick Park Nursing and Therapy Dependency Scales) are analysed within each complexity band, through cross-sectional analysis of parallel ratings. A 'band-weighting' factor is derived from the relative proportions of staff time within each of the five bands. Total unit treatment costs are obtained from retrospective analysis of provider hospitals' budget and accounting statements. Mean bed-day costs (total unit cost/occupied bed days) are divided broadly into 'variable' and 'non-variable' components. In the weighted costing model, the band-weighting factor is applied to the variable portion of the bed-day cost to derive a banded cost, and thence a set of cost-multipliers. Preliminary data from one unit are presented to illustrate how this weighted costing model will be applied to derive a multilevel banded payment model, based on serial complexity ratings, to allow for change over time.

  18. Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

    Science.gov (United States)

    Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

    2017-06-01

    Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

  19. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  20. A retrospective study on the impact of comorbid depression or anxiety on healthcare resource use and costs among diabetic neuropathy patients

    Directory of Open Access Journals (Sweden)

    Bao Yanjun

    2009-06-01

    Full Text Available Abstract Background Diabetic neuropathy (DN is a common complication of diabetes that has significant economic burden, especially for patients with comorbid depression or anxiety. This study examines and quantifies factors associated with healthcare costs among patients diagnosed with diabetic neuropathy (DN with or without a comorbid diagnosis of depression or anxiety (DA using retrospective administrative claims data. No study has examined the differences in economic outcomes depending on the presence of comorbid DA disorders. Methods Over-age-18 individuals with 1+ diagnosis of DN in 2005 were selected. The first observed DN claim was considered the "index date." All individuals had a 12-month pre-index and follow-up period. For both under-age-65 commercially insured and over-age-65 individuals with employer-sponsored Medicare supplemental insurance, we constructed 2 subgroups for individuals with DA (DN-DA or without (DN-only. Patients' clinical characteristics over pre-index period were compared. Multivariate regressions were performed to assess whether DN-DA patients had higher utilization of healthcare resources and costs than DN-only patients, controlling for demographic and clinical characteristics. Results We identified 16,831 DN-only and 1,699 DN-DA patients in the Medicare supplemental cohort, as well as 17,205 and 3,105 in the commercially insured. DN-DA patients had higher prevalence of diabetes-related comorbidities for cardiovascular disease, cerebrovascular/peripheral vascular disease, nephropathy, obesity, and hypoglycemic events than DN-only patients (all p Conclusion These findings indicate that the healthcare costs were significantly higher for DN patients with depression or anxiety relative to those without such comorbid disorders.

  1. Examining quality and efficiency of the U.S. healthcare system.

    Science.gov (United States)

    Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

    2011-01-01

    The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the

  2. Cost-effectiveness of ranibizumab versus aflibercept in the treatment of visual impairment due to diabetic macular edema: a UK healthcare perspective

    Directory of Open Access Journals (Sweden)

    Régnier SA

    2015-05-01

    Full Text Available Stephane A Régnier,1 William Malcolm,2 Jennifer Haig,3 Weiguang Xue41Novartis Pharma AG, Basel, Switzerland; 2Novartis Pharmaceuticals UK Ltd, Frimley Business Park, UK; 3Optum, Burlington, ON, Canada; 4Optum, Uxbridge, UKBackground: Ranibizumab and aflibercept are alternative anti-vascular endothelial growth factor agents approved for the treatment of visual impairment (VI due to diabetic macular edema (DME.Objective: To estimate, from a UK healthcare perspective, the cost-effectiveness of ranibizumab 0.5 mg pro re nata (PRN and ranibizumab 0.5 mg treat and extend (T&E compared with aflibercept 2 mg every 8 weeks after five initial monthly doses (2q8 in the treatment of VI due to DME.Methods: A Markov model previously reviewed by the National Institute for Health and Care Excellence was used to simulate the long-term outcomes and costs of treating DME. Health states were defined by increments of ten letters in best-corrected visual acuity (BCVA, with a 3-month cycle length. Patients could gain (or lose a maximum of two health states between cycles. A 3-year treatment time frame and a lifetime horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Patient baseline characteristics and the efficacy of ranibizumab PRN were derived using data from the RESTORE study. The relative efficacies of ranibizumab PRN, ranibizumab T&E, and aflibercept were assessed with a network meta-analysis. Different utilities were assigned based on BCVA and whether the treated eye was the better- or the worse-seeing eye. Sensitivity analyses tested the robustness of the model.Results: Lifetime costs per patient of treating DME were £20,019 for ranibizumab PRN, £22,930 for ranibizumab T&E, and £25,859 for aflibercept 2q8. Ranibizumab was dominant over aflibercept, with an incremental gain of 0.05 quality-adjusted life-years (QALYs and cost savings of £5,841 (PRN and £2,930 (T&E compared with aflibercept. Ranibizumab PRN and

  3. Viability of healthcare service delivery alternatives for the Australian mining sector.

    Science.gov (United States)

    Williams, Patricia A H; Giles, Margaret

    2012-01-01

    The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities.

  4. Actualización del coste de las inoculaciones accidentales en el personal sanitario hospitalario Update of the cost of needlestick injuries in hospital healthcare personnel

    Directory of Open Access Journals (Sweden)

    Víctor M. Solano

    2005-02-01

    Full Text Available Objetivos: Actualizar el coste medio a que asciende cada seguimiento de la hepatitis B y C, así como la infección por el virus de la inmunodeficiencia humana (VIH, en el personal sanitario que ha experimentado una inoculación accidental, desagregar el coste según el estado serológico de la fuente e identificar los apartados que influyen en mayor grado en la cuantía de este resultado. Métodos: Se realizó una descripción de los costes. El programa postexposición se modelizó en un árbol de decisión que combinaba las probabilidades (porcentaje de cada tipo de fuente en función de su positividad a los 3 virus e inmunización del accidentado frente a la hepatitis B y los costes monetarios (en euros del año 2002 relacionados con los gastos de personal, laboratorio, farmacia (incluida la profilaxis postexposición frente al VIH, energéticos, de limpieza, teléfono, material médico y de oficina, amortización y pérdidas productivas. Resultados: El coste medio de cada inoculación fue de 388 euros, con un rango de 1.502 (fuente positiva a la hepatitis C y el VIH a 172 euros (fuente negativa a los 3 virus. Si la fuente era la hepatitis B positiva, el coste medio fue de 666 euros cuando el accidentado no estaba inmunizado, y de 467 si efectivamente lo estaba. La mayor parte del coste residió en las pruebas serológicas y la administración de profilaxis postexposición. Conclusiones: El alto coste indica una evaluación adecuada del riesgo con el fin de evitar unos seguimientos innecesarios. El modelo permite conocer el coste de cada episodio potencialmente evitable y puede aplicarse en cualquier hospital, con el objetivo de evaluar económicamente los nuevos dispositivos preventivos.Objectives: To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that

  5. Lean six sigma in healthcare.

    Science.gov (United States)

    de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

    2006-01-01

    Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

  6. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases.

    Science.gov (United States)

    Mukherjee, Mome; Stoddart, Andrew; Gupta, Ramyani P; Nwaru, Bright I; Farr, Angela; Heaven, Martin; Fitzsimmons, Deborah; Bandyopadhyay, Amrita; Aftab, Chantelle; Simpson, Colin R; Lyons, Ronan A; Fischbacher, Colin; Dibben, Christopher; Shields, Michael D; Phillips, Ceri J; Strachan, David P; Davies, Gwyneth A; McKinstry, Brian; Sheikh, Aziz

    2016-08-29

    There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma. We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010-11, and routine administrative, health and social care datasets for 2011-12; 2011-12 costs were estimated in pounds sterling using economic modelling. The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7-31.3; n = 18.5 million (m) people) and 15.6 % (14.3-16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9-10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7-5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths. Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs.

  7. Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? – From Chinese healthcare system perspective

    International Nuclear Information System (INIS)

    Wang, Yu-ting; Huang, Gang

    2012-01-01

    Objectives: The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China. Methods: Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis. Results: Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800 RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B–A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B–A), and decrease of palliative therapy cost could reduce both the ICER and overall cost. Conclusions: The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making.

  8. Management and cost analysis of cancer patients treated with G-CSF: a cohort study based on the French national healthcare insurance database.

    Science.gov (United States)

    Tilleul, Patrick; Jacot, William; Emery, Corinne; Lafuma, Antoine; Gourmelen, Julie

    2017-12-01

    To describe the management and costs associated with G-CSF therapy in cancer patients in France. This study analyzed a representative random population sample from the French national healthcare insurance database, focusing on 1,612 patients with hematological or solid malignancies who were reimbursed in 2013 or 2014 for at least one G-CSF treatment dispensed in a retail pharmacy. Patient characteristics and treatment costs were analyzed according to the type of cancer. Then the costs and characteristics of patients associated with the use of different G-CSF products were analyzed in the sub-set of breast cancer patients. The most frequent malignancies in the database population were breast cancer (23.3%), hematological malignancies (22.2%), and lung cancer (12.4%). The reimbursed G-CSF was pegfilgrastim in 34.1% of cases, lenograstim in 26.7%, and filgrastim in 17.9%. More than one G-CSF product was reimbursed to 21.3% of patients. The total annual reimbursed health expenses per patient, according to the type of G-CSF, were €27,001, €24,511, and €20,802 for patients treated with filgrastim, lenograstim, and pegfilgrastim, respectively. Ambulatory care accounted for, respectively, 35%, 38%, and 41% of those costs. In patients with breast cancer, ambulatory care cost was €7,915 with filgrastim, €7,750 with lenograstim, and €6,989 with pegfilgrastim, and the respective cost of G-CSF was €1,733, €1,559, and €3,668. All available G-CSF products have been shown to be effective in cancer patients, and both daily G-CSFs and pegylated G-CSF are recommended in international guidelines. Nevertheless, this analysis of G-CSF reimbursement indicates that the choice of product can markedly affect the total cost of ambulatory care.

  9. Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? - From Chinese healthcare system perspective

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yu-ting, E-mail: wangyuting_330@163.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University, School of Medicine (China); Huang, Gang, E-mail: huang2802@163.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University, School of Medicine (China); Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SJTUSM) and Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences - CAS (China)

    2012-08-15

    Objectives: The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China. Methods: Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis. Results: Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800 RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B-A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B-A), and decrease of palliative therapy cost could reduce both the ICER and overall cost. Conclusions: The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making.

  10. Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? - From Chinese healthcare system perspective.

    Science.gov (United States)

    Wang, Yu-ting; Huang, Gang

    2012-08-01

    The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China. Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis. Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B-A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B-A), and decrease of palliative therapy cost could reduce both the ICER and overall cost. The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.

    Science.gov (United States)

    Greven, Peter; Sikirica, Vanja; Chen, Yaozhu J; Curtice, Tammy G; Makin, Charles

    2017-09-01

    Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy. Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index. No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients. These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.

  12. Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

    Science.gov (United States)

    Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

    2017-03-01

    To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  13. Valuing inter-sectoral costs and benefits of interventions in the healthcare sector: methods for obtaining unit prices.

    Science.gov (United States)

    Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Evers, Silvia M A A

    2017-02-01

    There is a lack of knowledge about methods for valuing health intervention-related costs and monetary benefits in the education and criminal justice sectors, also known as 'inter-sectoral costs and benefits' (ICBs). The objective of this study was to develop methods for obtaining unit prices for the valuation of ICBs. By conducting an exploratory literature study and expert interviews, several generic methods were developed. The methods' feasibility was assessed through application in the Netherlands. Results were validated in an expert meeting, which was attended by policy makers, public health experts, health economists and HTA-experts, and discussed at several international conferences and symposia. The study resulted in four methods, including the opportunity cost method (A) and valuation using available unit prices (B), self-constructed unit prices (C) or hourly labor costs (D). The methods developed can be used internationally and are valuable for the broad international field of HTA.

  14. Comparing the cost-effectiveness of linezolid to trimethoprim/sulfamethoxazole plus rifampicin for the treatment of methicillin-resistant Staphylococcus aureus infection: a healthcare system perspective.

    Science.gov (United States)

    von Dach, E; Morel, C M; Murthy, A; Pagani, L; Macedo-Vinas, M; Olearo, F; Harbarth, S

    2017-09-01

    Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection. We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity. Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin. Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost.

    Science.gov (United States)

    Nguyen, Albert P; Gabriel, Rodney A; Golts, Eugene; Kistler, Erik B; Schmidt, Ulrich

    2017-08-01

    Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. Retrospective. University hospital. Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015. The incidences of AKI and ARF, as defined using the Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria, were measured. Perioperative events were analyzed to identify risk factors for renal compromise. A comparison of ventilator days, intensive care unit (ICU) and hospital lengths of stay (LOS), 1-year readmissions, and emergency department visits was performed among AKI, ARF, and uninjured patients. Ninety-seven patients underwent lung transplantation; 22 patients developed AKI and 35 patients developed ARF. Patients with ARF had significantly longer ICU LOS (12 days v 4 days, p < 0.001); ventilator days (4.5 days v 1 day, p < 0.001); and hospital LOS (22.5 days v 14 days, p < 0.001) compared with uninjured patients. Patients with AKI also had significantly longer ICU and hospital LOS. Patients with ARF had significantly more emergency department visits and hospital readmissions (2 v 1 readmissions, p = 0.002) compared with uninjured patients. A univariable analysis suggested that prolonged surgical time, intraoperative vasopressor use, and cardiopulmonary bypass use were associated with the highest increased risk for AKI. Intraoperative vasopressor use and cardiopulmonary bypass mean arterial pressure <60 mmHg were identified as independent risk factors by multivariable analysis for AKI. The severity of AKI was associated with an increase in the use of healthcare resources after surgery and discharge. Certain risk factors appeared modifiable and may reduce the incidence of AKI and ARF. Copyright © 2017. Published by Elsevier Inc.

  16. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  17. What Are the Most Significant Cost and Value Drivers for Pancreatic Resection in an Integrated Healthcare System?

    Science.gov (United States)

    Vuong, Brooke; Dehal, Ahmed; Uppal, Abhineet; Stern, Stacey L; Mejia, Juan; Weerasinghe, Roshanthi; Kapoor, Vandana; Ong, Evan; Hansen, Paul D; Bilchik, Anton J

    2018-03-23

    An initiative was established to improve value-based care for pancreatic surgery in a large nonprofit health system. Cost data were presented bimonthly to a hepatobiliary clinical performance group via videoconference. The direct costs were calculated for all patients undergoing distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) between January 2014 and July 2017. Median length of stay, 30-day and 90-day mortality rates, readmission rate, and costs were stratified by surgeon volume using 2 published criteria: "volume pledge" criteria (≥5 PDs/year) and Leapfrog criteria (≥11 PDs/year). There were 270 DPs and 526 PDs performed in 14 hospitals spanning 4 states. Median PD costs were lower for high-volume surgeons (≥5 PDs/year), $21,026 vs $24,706 (p = 0.005). High-volume surgeons had a shorter length of stay (9 days vs 11 days; p definition of high volume. The sharing of detailed financial data with HPB surgeons on a regular basis provides an opportunity to evaluate practice patterns and thereby reduce direct costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Potential cost to Western Australia of proposed patient co-payments according to healthcare organisational structure: A preliminary analysis.

    Science.gov (United States)

    Millar, J Alasdair; Millar, Robyn C

    2014-01-01

    The Australian federal government has proposed an AUD $7 patient co-payment for a general practitioner (GP) consultation. One effect of the co-payment may be that patients will seek assistance at public hospital emergency departments (EDs), where currently there is no user charge. We studied the possible financial impact of patient diversion on the Western Australia (WA) health budget. We constructed a spreadsheet model of changes in annual cash flows including the co-payment, GP fees for service, and rates of diversion to emergency departments with additional marginal costs for ED attendance. Changes in WA cash flows are the aggregate of marginal ED costs of treating diverted patients and added expenditure in fees paid to rural doctors who also man local emergency centres. The estimated costs to WA are AUD $6.3 million, $35.9 million and $87.4 million at 1, 5, and 10 per cent diversion, respectively. Commonwealth receipts increase and expenditure on Medicare benefits declines. A diversion of patients from GP surgeries to ED in WA caused by the co-payment will result in increased costs to the state, which may be substantial, and will reduce net costs to the Commonwealth.

  19. Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

    DEFF Research Database (Denmark)

    Wickramasinghe, Kanchana; Steele, Paul; Dawson, Andrew

    2009-01-01

    pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services....... prospectively collected over a one-month period from one general hospital (2005) and five peripheral hospitals (2006) in the Anuradhapura district. Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals. The cost of the inputs in United...... States dollars (US$), using 2005 figures, was derived from hospital accounts. FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital...

  20. Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

    DEFF Research Database (Denmark)

    Wickramasinghe, Kanchana; Steele, Paul; Dawson, Andrew

    2009-01-01

    States dollars (US$), using 2005 figures, was derived from hospital accounts. FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital...... pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services.......OBJECTIVE: To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district. METHODS: Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were...

  1. Primary Care Practice Transformation and the Rise of Consumerism.

    Science.gov (United States)

    Shrank, William H

    2017-04-01

    Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.

  2. Cost-effectiveness of metformin plus vildagliptin compared with metformin plus sulphonylurea for the treatment of patients with type 2 diabetes mellitus: a Portuguese healthcare system perspective.

    Science.gov (United States)

    Viriato, Daniel; Calado, Frederico; Gruenberger, Jean-Bernard; Ong, Siew Hwa; Carvalho, Davide; Silva-Nunes, José; Johal, Sukhvinder; Viana, Ricardo

    2014-07-01

    To evaluate the cost-effectiveness of vildagliptin plus metformin vs generic sulphonylurea plus metformin in patients with type 2 diabetes mellitus, not controlled with metformin, from a Portuguese healthcare system perspective. A cost-effectiveness model was constructed using risk equations from the UK Prospective Diabetes Study Outcomes Model with a 10,000-patient cohort and a lifetime horizon. The model predicted microvascular and macrovascular complications and mortality in yearly cycles. Patients entered the model as metformin monotherapy failures and switched to alternative treatments (metformin plus basal-bolus insulin and subsequently metformin plus intensive insulin) when glycated hemoglobin A1c >7.5% was reached. Baseline patient characteristics and clinical variables were derived from a Portuguese epidemiological study. Cost estimates were based on direct medical costs only. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the model. There were fewer non-fatal diabetes-related adverse events (AEs) in patients treated with metformin plus vildagliptin compared with patients treated with metformin plus sulphonylurea (6752 vs 6815). Addition of vildagliptin compared with sulphonylurea led to increased drug acquisition costs but reduced costs of AEs, managing morbidities, and monitoring patients. Treatment with metformin plus vildagliptin yielded a mean per-patient gain of 0.1279 quality-adjusted life years (QALYs) and a mean per-patient increase in total cost of €1161, giving an incremental cost-effectiveness ratio (ICER) of €9072 per QALY. Univariate analyses showed that ICER values were robust and ranged from €4195 to €16,052 per QALY when different parameters were varied. The model excluded several diabetes-related morbidities, such as peripheral neuropathy and ulceration, and did not model second events. Patients were presumed to enter the model with no diabetes-related complications. Treatment with

  3. Costly energy : why oil and gas prices are rising and what we can do about it : a collection of progressive analysis and policy alternatives

    International Nuclear Information System (INIS)

    Klein, S.

    2001-02-01

    A collection of essays were presented to address the issue of rising oil and gas prices. This issue has significant social and environmental implications and the public wants to know what is driving prices up and who is profiting. The myth that gas taxes are driving price increases was dispelled. It was argued that price hikes are mainly due to crude oil price increases and to refining and marketing price increases. The link between rising prices and free trade was also emphasized. The North American Free Trade Agreement (NAFTA) tied Canada into a North American energy market in which U.S. demand sets prices in Canada. It was suggested that trade rules regarding energy should be changed. Other short and longer-term progressive policy alternatives were also presented in the second part of this report. One possible short-term policy response would be to tax windfall oil and gas profits and direct the resulting revenues to rebates for low-income households and for energy conservation initiatives. It was noted that the environmental benefit of rising prices is that it encourages conservation and improved fuel efficiency. The final part of this report discussed the issue of protecting electricity from deregulation and sited lessons learned from the deregulation of natural gas. 2 tabs., 4 figs

  4. The Rise of the Food Risk Society and the Changing Nature of the Technological Treadmill

    Directory of Open Access Journals (Sweden)

    Lioudmila Chatalova

    2016-06-01

    Full Text Available Economic development of transition and developed countries is associated with increasingly unhealthy dietary habits among low-income population segments. Drawing on Ulrich Beck’s sociological theory of risk society, the present research note calls attention to the positive relation between national economic development and food risks that result in the rise of food-related diseases and healthcare costs. On this basis, we argue that the knowledge-intensive agribusiness may translate Cochrane’s technological treadmill into Beck’s risk treadmill that shifts a growing share of food-related healthcare costs from producers toward consumers, state, and the healthcare system. This argument motivates a novel research program dealing with the “food risk treadmill” that emerges in response to modern farming and agribusiness practices. Awareness of the food risk treadmill may help to streamline the development of agricultural science and to prevent it from being excessively dominated by the agricultural and food industry.

  5. Societal consequences of falls in the older population: Injuries, healthcare costs, and long-term reduced quality of life

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); E.F. van Beeck (Ed); S. Polinder (Suzanne); N. van der Velde (Nathalie); E.M.M. van Lieshout (Esther); M.J.M. Panneman (Martien); T.J.M. van der Cammen (Tischa); P. Patka (Peter)

    2011-01-01

    textabstractBACKGROUND:: Fall incidents are a major cause of morbidity and mortality in older adults. The aim of this cohort study was to determine the incidence, costs, and quality of life for fall-related injuries in the older Dutch population presenting at the emergency department. METHODS:: Data

  6. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction.

    Science.gov (United States)

    Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin

    2015-10-31

    At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Cost-effectiveness analysis of malaria rapid diagnostic test incentive schemes for informal private healthcare providers in Myanmar.

    Science.gov (United States)

    Chen, Ingrid T; Aung, Tin; Thant, Hnin Nwe Nwe; Sudhinaraset, May; Kahn, James G

    2015-02-05

    The emergence of artemisinin-resistant Plasmodium falciparum parasites in Southeast Asia threatens global malaria control efforts. One strategy to counter this problem is a subsidy of malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) within the informal private sector, where the majority of malaria care in Myanmar is provided. A study in Myanmar evaluated the effectiveness of financial incentives vs information, education and counselling (IEC) in driving the proper use of subsidized malaria RDTs among informal private providers. This cost-effectiveness analysis compares intervention options. A decision tree was constructed in a spreadsheet to estimate the incremental cost-effectiveness ratios (ICERs) among four strategies: no intervention, simple subsidy, subsidy with financial incentives, and subsidy with IEC. Model inputs included programmatic costs (in dollars), malaria epidemiology and observed study outcomes. Data sources included expenditure records, study data and scientific literature. Model outcomes included the proportion of properly and improperly treated individuals with and without P. falciparum malaria, and associated disability-adjusted life years (DALYs). Results are reported as ICERs in US dollars per DALY averted. One-way sensitivity analysis assessed how outcomes depend on uncertainty in inputs. ICERs from the least to most expensive intervention are: $1,169/DALY averted for simple subsidy vs no intervention, $185/DALY averted for subsidy with financial incentives vs simple subsidy, and $200/DALY averted for a subsidy with IEC vs subsidy with financial incentives. Due to decreasing ICERs, each strategy was also compared to no intervention. The subsidy with IEC was the most favourable, costing $639/DALY averted compared with no intervention. One-way sensitivity analysis shows that ICERs are most affected by programme costs, RDT uptake, treatment-seeking behaviour, and the prevalence and virulence of non

  8. The Rise of the Low Cost Model in the Airline Industry : A Study of the Strategies of Southwest, RyanAir and Air Asia

    OpenAIRE

    Harsh, Saraogi

    2011-01-01

    The last decade has seen a major overhaul in the Airline Industry, with the emergence of a new breed of Airlines, the Low Cost Airlines. The trend that started from the United States, with Southwest being the pioneer, slowly and gradually replicated its way through Europe, Asia and the Rest of the World. Today, more than 1 flight in every five worldwide is now operated by a low cost carrier (LCC). The purpose of this paper is to explore the reasons for the growth of the Low Cost Carrier Mo...

  9. [Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

    Science.gov (United States)

    Bergholz, W

    2008-11-01

    In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

  10. Strategy to Support Improvement of Healthcare Quality.

    Directory of Open Access Journals (Sweden)

    Ing. Andrea Zejdlova

    2013-01-01

    Full Text Available One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States. Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.

  11. Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study.

    Science.gov (United States)

    Chiroli, Silvia; Mattin, Caroline; Belozeroff, Vasily; Perrault, Louise; Mitchell, Dominic; Gioni, Ioanna

    2012-10-29

    Secondary hyperparathyroidism (SHPT) is associated with mortality in patients with chronic kidney disease (CKD), but the economic consequences of SHPT have not been adequately studied in the European population. We assessed the relationship between SHPT parameters (intact parathyroid hormone [iPTH], calcium, and phosphate) and hospitalisations, medication use, and associated costs among CKD patients in Europe. The analysis of this retrospective cohort study used records of randomly selected patients who underwent haemodialysis between January 1, 2005 and December 31, 2006 at participating European Fresenius Medical Care facilities in 10 countries. Patients had ≥ 1 iPTH value recorded, and ≥ 1 month of follow-up after a 3-month baseline period during which SHPT parameters were assessed. Time at risk was post-baseline until death, successful renal transplantation, loss to follow-up, or the end of follow-up. Outcomes included cost per patient-month, rates of hospitalisations (cardiovascular disease [CVD], fractures, and parathyroidectomy [PTX]), and use of SHPT-, diabetes-, and CVD-related medications. National costs were applied to hospitalisations and medication use. Generalised linear models compared costs across strata of iPTH, total calcium, and phosphate, adjusting for baseline covariates. There were 6369 patients included in the analysis. Mean ± SD person-time at risk was 13.1 ± 6.4 months. Patients with iPTH > 600 pg/mL had a higher hospitalisation rate than those with lower iPTH. Hospitalisation rates varied little across calcium and phosphate levels. SHPT-related medication use varied with iPTH, calcium, and phosphate. After adjusting for demographic and clinical variables, patients with baseline iPTH > 600 pg/mL had 41% (95% CI: 25%, 59%) higher monthly total healthcare costs compared with those with iPTH in the K/DOQI target range (150-300 pg/mL). Patients with baseline phosphate and total calcium levels above target ranges (1.13-1.78 mmol/L and 2

  12. Economic viability of Stratified Medicine concepts: An investor perspective on drivers and conditions that favour using Stratified Medicine approaches in a cost-contained healthcare environment.

    Science.gov (United States)

    Fugel, Hans-Joerg; Nuijten, Mark; Postma, Maarten

    2016-12-25

    Stratified Medicine (SM) is becoming a natural result of advances in biomedical science and a promising path for the innovation-based biopharmaceutical industry to create new investment opportunities. While the use of biomarkers to improve R&D efficiency and productivity is very much acknowledged by industry, much work remains to be done to understand the drivers and conditions that favour using a stratified approach to create economically viable products and to justify the investment in SM interventions as a stratification option. In this paper we apply a decision analytical methodology to address the economic attractiveness of different SM development options in a cost-contained healthcare environment. For this purpose, a hypothetical business case in the oncology market has been developed considering four feasible development scenarios. The article outlines the effects of development time and time to peak sales as key economic value drivers influencing profitability of SM interventions under specific conditions. If regulatory and reimbursement challenges can be solved, decreasing development time and enhancing early market penetration would most directly improve the economic attractiveness of SM interventions. Appropriate tailoring of highly differentiated patient subgroups is the prerequisite to leverage potential efficiency gains in the R&D process. Also, offering a better targeted and hence ultimately more cost-effective therapy at reimbursable prices will facilitate time to market access and allow increasing market share gains within the targeted populations. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Healthcare Data Analytics for Parkinson's Disease Patients: A Study of Hospital Cost and Utilization in the United States.

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.

  14. Impact of minimally invasive surgery on healthcare utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH).

    Science.gov (United States)

    Mikami, Dean J; Melvin, W Scott; Murayama, Michael J; Murayama, Kenric M

    2017-11-01

    Incisional hernia repair is one of the most common general surgery operations being performed today. With the advancement of laparoscopy since the 1990s, we have seen vast improvements in faster return to normal activity, shorter hospital stays and less post-operative narcotic use, to name a few. The key aims of this review were to measure the impact of minimally invasive surgery versus open surgery on health care utilization, cost, and work place absenteeism in the patients undergoing inpatient incisional/ventral hernia (IVH) repair. We analyzed data from the Truven Health Analytics MarketScan ® Commercial Claims and Encounters Database. Total of 2557 patients were included in the analysis. Of the patient that underwent IVH surgery, 24.5% (n = 626) were done utilizing minimally invasive surgical (MIS) techniques and 75.5% (n = 1931) were done open. Ninety-day post-surgery outcomes were significantly lower in the MIS group compared to the open group for total payment ($19,288.97 vs. $21,708.12), inpatient length of stay (3.12 vs. 4.24 days), number of outpatient visit (5.48 vs. 7.35), and estimated days off (11.3 vs. 14.64), respectively. At 365 days post-surgery, the total payment ($27,497.96 vs. $30,157.29), inpatient length of stay (3.70 vs. 5.04 days), outpatient visits (19.75 vs. 23.42), and estimated days off (35.71 vs. 41.58) were significantly lower for MIS group versus the open group, respectively. When surgical repair of IVH is performed, there is a clear advantage in the MIS approach versus the open approach in regard to cost, length of stay, number of outpatient visits, and estimated days off.

  15. The effect of quitting smoking on costs and healthcare utilization in patients with chronic obstructive pulmonary disease: a comparison of current smokers versus ex-smokers in routine clinical practice.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Rejas-Gutiérrez, Javier; Navarro-Artieda, Ruth; Ibáñez-Nolla, Jordi

    2014-08-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent condition mainly related to smoking, which is associated with a substantial economic burden. The purpose was to compare healthcare resource utilization and costs according to smoking status in patients with COPD in routine clinical practice. A retrospective cohort nested case-control study was designed. The cohort was composed of male and female COPD outpatients, 40 years or older, covered by the Badalona Serveis Assistencials (a health provider) health plan. Cases were current smokers with COPD and controls (two per case) were former smokers with COPD (at least 12 months without smoking), matched for age, sex, duration of COPD, and burden of comorbidity. The index date was the last visit recorded in the database, and the analysis was performed retrospectively on healthcare resource utilization data for the 12 months before the index date. A total of 930 COPD records were analyzed: 310 current and 620 former smokers [mean age 69.4 years (84.6 % male)]. Cases had more exacerbations, physician visits of any type, and drug therapies related to COPD were more common. As a consequence, current smokers had higher average annual healthcare costs: €3,784 (1,888) versus €2,302 (2,451), p use of healthcare resources, mainly COPD drugs and physician visits, compared with former smokers who had abstained for at least 12 months. As a consequence, current smokers had higher healthcare costs to the National Health System in Spain than ex-smokers.

  16. Pulp and paper markets peaking amid slow economy, rising input costs, and erosion of profits : markets for paper, paperboard and woodpulp, 2007-2008

    Science.gov (United States)

    Peter J. Ince; Eduard L. Akim; Bernard Lombard; Tomas Parik

    2008-01-01

    In mid-2008, pulp and paper prices were at or near historic peak levels, but global demand conditions were weakening. Industry profits were eroded in 2007 and 2008 as sharply higher energy costs led to higher prices for fuel, freight, pulpwood, recovered paper, chemicals, and other inputs. Expanding pulp and paper capacity in China is having a huge impact on paper and...

  17. Lean Six Sigma in Healthcare

    NARCIS (Netherlands)

    de Koning, H.; Verver, J.P.S.; van den Heuvel, J.; Bisgaard, S.; Does, R.J.M.M.

    2006-01-01

    Keywords: Cost reduction; efficiency; innovation; quality improvement; service management. Abstract Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this article, we outline a methodology and present examples

  18. Healthcare costs of ICU survivors are higher before and after ICU admission compared to a population based control group: A descriptive study combining healthcare insurance data and data from a Dutch national quality registry

    NARCIS (Netherlands)

    van Beusekom, Ilse; Bakhshi-Raiez, Ferishta; de Keizer, Nicolette F.; van der Schaaf, Marike; Busschers, Wim B.; Dongelmans, Dave A.

    2017-01-01

    To identify subgroups of ICU patients with high healthcare utilization for healthcare expenditure management purposes such as prevention and targeted care. We conducted a descriptive cohort study, combining a national health insurance claims database and a national quality registry database for

  19. Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

    Science.gov (United States)

    Smith, Monica; Davis, Matthew A.; Stano, Miron; Whedon, James M.

    2013-01-01

    Objectives The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services. Methods Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71 838), we identified 12 104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases. Results Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007. Conclusion The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness and for health workforce planning. PMID:23380209

  20. A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service.

    Science.gov (United States)

    Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia

    2014-05-01

    Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. © 2014 The Authors. Health and Social Care in the Community published by John

  1. Turnover among healthcare professionals.

    Science.gov (United States)

    Wood, Ben D

    2009-01-01

    Turnover among healthcare professionals is a costly consequence. The existing body of knowledge on healthcare professional turnover is correlated with job satisfaction levels. A landmark study differentiated 2 areas of job satisfaction categories: satisfiers and dissatisfiers (intrinsic and extrinsic motivators). The aim of this article is to examine existing research on precursors of turnover, such as burnout behaviors experienced by healthcare professionals, job satisfaction levels, employee organizational commitment, health complications which precede turnover, some current strategies to reduce turnover, and some effects CEO turnover has on employee turnover intentions.

  2. The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy.

    Science.gov (United States)

    Brixner, D; Biltaji, E; Bress, A; Unni, S; Ye, X; Mamiya, T; Ashcraft, K; Biskupiak, J

    2016-01-01

    To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients. An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources. There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs. 16.1% in the untested group (RR = 0.61, 95% CI = 0.39-0.95, p = 0.027), ED visit rate was 4.4% in the tested group vs. 15.4% in the untested group (RR = 0.29, 95% CI = 0.15-0.55, p = 0.0002) and outpatient visit rate was 71.7% in the tested group vs. 36.5% in the untested group (RR = 1.97, 95% CI = 1.74-2.23, p provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations. Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.

  3. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    Science.gov (United States)

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  4. Treatment simplification in HIV-infected adults as a strategy to prevent toxicity, improve adherence, quality of life and decrease healthcare costs

    Directory of Open Access Journals (Sweden)

    Vitória M

    2011-07-01

    study not only implications for individual tolerability, toxicity, adherence, persistence and virologic efficacy, but also cost, scalability, and potential for dissemination and implementation, such that limited human and financial resources are optimally allocated for maximal efficiency, coverage and sustainability of global HIV/AIDS treatment.Keywords: ART, simplification, adherence, persistence, once-daily, coformulations, healthcare cost, quality of lifeVideo Abstract: http://dvpr.es/nachega

  5. A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety.

    NARCIS (Netherlands)

    Mens, K.; Lokkerbol, J.; Janssen, R.T.J.M.; van Orden, M.; Kloos, M.; Tiemens, B.

    2018-01-01

    Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental

  6. Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

    Science.gov (United States)

    Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

    2015-07-14

    Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

  7. Healthcare Robotics

    OpenAIRE

    Riek, Laurel D.

    2017-01-01

    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

  8. Some perspectives on affordable healthcare systems in China.

    Science.gov (United States)

    Zhang, Y T; Yan, Y S; Poon, C C Y

    2007-01-01

    Consistent with the global population trend, China is becoming an aging society. Over one-fifth of the world's elderly population (aged 65 and over) lives in China. Statistics show that the elderly populace in China constitutes 8% of the total population in 2006 and the percentage will be tripled to become 24% in 2050. As a result, there is inevitably an increase in the prevalence of chronic disease that accounted for almost 80% of all deaths in China in 2005. On the other hand, from 1978 to 2003, the total expenditure on healthcare in China increased from 11.02 billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare investment is therefore even higher than the annual rate of GDP increase (9.38%) during the last two decades. Meeting the long-term healthcare needs of this growing elderly population and escalating healthcare expenditure pose a grim challenge to the current Chinese healthcare system and the solvency of state budgets. In fact, the healthcare services in China have become less accessible since the early 1980s when its costs soared up. The rising costs have prevented many Chinese people from seeking early medical care. The phenomenon has created a wide disparity in seeking healthcare between urban and rural areas. These trends are of particular concern to the elderly, who have higher healthcare needs yet lesser means to afford the services. Furthermore, according to the 3rd National Health Service Survey, 79.1% of rural residents and 44.8% of urban citizens did not have any form of medical insurance. Such a low percentage of coverage of medical insurance indicates that many people may not be able to afford medical services when they suffer from severe diseases. Therefore, there is a great need of a more effective and low-cost healthcare system. A new system that can allow multi-level, multi-dimensional and standardized healthcare services for urban and rural

  9. Organizational excellence in healthcare

    NARCIS (Netherlands)

    Does, R.J.M.M.; van den Heuvel, J.; Foley, K.J.; Hermel, P.

    2008-01-01

    Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this paper, we outline a methodology and present how principles of two improvement programs, i.e., Lean Thinking and Six Sigma, can be combined to provide an

  10. A Provably Secure Aggregate Signature Scheme for Healthcare Wireless Sensor Networks.

    Science.gov (United States)

    Shen, Limin; Ma, Jianfeng; Liu, Ximeng; Miao, Meixia

    2016-11-01

    Wireless sensor networks (WSNs) are being used in a wide range of applications for healthcare monitoring, like heart rate monitors and blood pressure monitors, which can minimize the need for healthcare professionals. In medical system, sensors on or in patients produce medical data which can be easily compromised by a vast of attacks. Although signature schemes can protect data authenticity and data integrity, when the number of users involved in the medical system becomes huge, the bandwidth and storage cost will rise sharply so that existing signature schemes are inapplicability for WSNs. In this paper, we propose an efficient aggregate signature scheme for healthcare WSNs according to an improved security model, which can combine multiple signatures into a single aggregate signature. The length of such an aggregate signature may be as long as that of an individual one, which can greatly decrease the bandwidth and storage cost for networks.

  11. Agency for Healthcare Research and Quality

    Science.gov (United States)

    ... Clinicians & Providers Data & Measures Education & Training Health Information Technology ... Sources Available from AHRQ Healthcare Cost and Utilization Project (HCUP) Medical Expenditure Panel ...

  12. Ethical issues in healthcare financing.

    Science.gov (United States)

    Maharaj, S R; Paul, T J

    2011-07-01

    The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

  13. Complexity leadership: a healthcare imperative.

    Science.gov (United States)

    Weberg, Dan

    2012-01-01

    The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Complexity leadership theory provides a new framework with which healthcare leaders may practice leadership. Complexity leadership theory conceptualizes leadership as a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. Compared to transactional and transformational leadership concepts, complexity leadership practices hold promise to improve cost and quality in health care. © 2012 Wiley Periodicals, Inc.

  14. Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).

    Science.gov (United States)

    Zulman, Donna M; Ezeji-Okoye, Stephen C; Shaw, Jonathan G; Hummel, Debra L; Holloway, Katie S; Smither, Sasha F; Breland, Jessica Y; Chardos, John F; Kirsh, Susan; Kahn, James S; Asch, Steven M

    2014-12-01

    We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. Employing partnered research to redesign care for high-need, high-cost

  15. Healthcare resource utilization, costs of care, and treatment of mycosis fungoides cutaneous T-cell lymphoma patterns in a large managed care population: a retrospective US claims-based analysis.

    Science.gov (United States)

    Tsang, Yuen; Gu, Tao; Sharma, Gaurav; Raspa, Susan; Drake, Bill; Tan, Hiangkiat

    2018-05-07

    To evaluate health care utilization, treatment patterns and costs among patients with mycosis fungoides-cutaneous T-cell lymphoma (MF-CTCL). This retrospective cohort study queried the HealthCore Integrated Research Database to identify patients ≥18 years with ≥2 diagnoses of MF-CTCL (ICD-9-CM code 202.1x, 202.2x) between 07 January 2006 and 07 January 2013. Index date was defined as first MF-CTCL diagnosis. Patients were continuously enrolled ≥6 months before and ≥12 months after index date. Severe MF-CTCL was identified via systemic therapy use postindex. Generalized linear model (GLM) was used to estimate the relationship between MF-CTCL severity and healthcare costs controlling for selected factors. A total of 1981 MF-CTCL patients were evaluated: 493 (24.9%) severe and 1488 (75.1%) with mild to moderate disease. GLM analysis indicated severe MF-CTCL patients incurred higher all-cause healthcare total costs compared to patients with mild-to-moderate MF-CTCL (coefficient estimate: 4.19, p < .0001). About 51% of patients did not receive any MF-CTCL-specific treatment within 60 days after MF-CTCL diagnosis. MF-CTCL severity was associated with greater healthcare resource utilization and costs. These findings suggest that about half of MF-CTCL patients do not receive MF-CTCL-specific treatment within 60 days following initial diagnosis. Future studies are needed to understand reasons for delayed treatment initiation.

  16. Smart Homes for Elderly Healthcare-Recent Advances and Research Challenges.

    Science.gov (United States)

    Majumder, Sumit; Aghayi, Emad; Noferesti, Moein; Memarzadeh-Tehran, Hamidreza; Mondal, Tapas; Pang, Zhibo; Deen, M Jamal

    2017-10-31

    Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies.

  17. The utilization of activity-based cost accounting in hospitals.

    Science.gov (United States)

    Emmett, Dennis; Forget, Robert

    2005-01-01

    Healthcare costs are being examined on all fronts. Healthcare accounts for 11% of the gross national product and will continue to rise as the "babyboomers" reach retirement age. While ascertaining costs is important, most research shows that costing methods have not been implemented in hospitals. This study is concerned with the use of costing methods; particularly activity-based cost accounting. A mail survey of CFOs was undertaken to determine the type of cost accounting method they use. In addition, they were asked whether they were aware of activity-based cost accounting and whether they had implemented it or were planning to implement it. Only 71.8% were aware of it and only 4.7% had implemented it. In addition, only 52% of all hospitals report using any cost accounting systems. Education needs to ensure that all healthcare executives are cognizant of activity-based accounting and its importance in determining costs. Only by determining costs can hospitals strive to contain them.

  18. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System.

    Science.gov (United States)

    Bertapelle, Maria Paola; Vottero, Mario; Popolo, Giulio Del; Mencarini, Marco; Ostardo, Edoardo; Spinelli, Michele; Giannantoni, Antonella; D'Ausilio, Anna

    2015-08-01

    To assess the relative cost-effectiveness of two therapeutic strategies: one starting with sacral neuromodulation (SNM) versus one starting with Botulinum toxin A (BTX-A) for the management of refractory incontinent idiopathic overactive bladder (OAB) patients, from the perspective of the Italian National Health Service (INHS). Direct medical costs (2011) and benefits (quality-adjusted life years-QALYs) were assessed over a ten-year time frame adapting to the Italian practice a published Markov model. Clinical inputs were based on the published literature and on the expert opinion. Resource consumption rates were provided by clinical experts; unit costs were collected from a single hospital accounting and from standard tariff lists and public prices. Interventional procedures and management of adverse events were costed through a micro-costing approach. The primary outcome was incremental costs per QALYs gained (i.e. differential costs divided by differential benefits). Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were conducted to assess the robustness of the model. Starting with SNM appears to be cost effective (i.e. under 40.000/QALY) from year three (21,259/QALY) onwards and becomes dominant (i.e. more effective and less costly) at year ten: cumulative costs were 32,975 for early SNM and 33,309 for early BTX-A, while cumulative QALYs were 7.52 and 6.93, respectively. At year ten, DSA suggests the results robustness and 99.8 % of the PSA iterations fell within the cost-effectiveness threshold. A therapeutic strategy starting with SNM may be considered cost effective in the midterm and cost saving in the long-term treatment of idiopathic OAB from the INHS perspective.

  19. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  20. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  1. Oncology pharma costs to exceed $150 billion by 2020.

    Science.gov (United States)

    2016-10-01

    Worldwide costs of oncology drugs will rise above $150 billion by 2020, according to a report by the IMS Institute for Healthcare Informatics. Many factors are in play, according to IMS, including the new wave of expensive immunotherapies. Pembrolizumab (Keytruda), priced at $150,000 per year per patient, and nivolumab (Opdivo), priced at $165,000, may be harbingers of the market for cancer immunotherapies.

  2. Leveraging Digital Innovation in Healthcare

    DEFF Research Database (Denmark)

    Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

    2014-01-01

    Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

  3. A retrospective review comparing two-year patient-reported outcomes, costs, and healthcare resource utilization for TLIF vs. PLF for single-level degenerative spondylolisthesis.

    Science.gov (United States)

    Kim, Elliott; Chotai, Silky; Stonko, David; Wick, Joseph; Sielatycki, Alex; Devin, Clinton J

    2018-03-01

    The purpose of this study was to compare patient-reported outcomes (PROs), morbidity, and costs of TLIF vs PLF to determine whether one treatment was superior in the setting of single-level degenerative spondylolisthesis. Patients undergoing TLIF or PLF for single-level spondylolisthesis were included for retrospective analysis. EQ-5D, ODI, SF-12 MCS/PCS, NRS-BP/LP scores were collected at baseline and 24 months after surgery. 90-day post-operative complications, revision surgery rates, and satisfaction scores were also collected. Two-year resource use was multiplied by unit costs based on Medicare payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost was used to assess mean total 2-year cost per QALYs gained after surgery. 62 and 37 patients underwent TLIF and PLF, respectively. Patients in the PLF group were older (p differences were seen in baseline or 24-month PROs between the two groups. There was a significant improvement in all PROs from baseline to 24 months after surgery (p difference in 24-month direct, indirect, and total cost. Overall costs and health care utilization were similar in both the groups. Both TLIF and PLF for single-level degenerative spondylolisthesis provide improvement in disability, pain, quality of life, and general health.

  4. An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014.

    Science.gov (United States)

    Sari, Nazmi; Rotter, Thomas; Goodridge, Donna; Harrison, Liz; Kinsman, Leigh

    2017-08-03

    The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. The total cost for implementation of Lean over two years (2012-2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.

  5. Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study

    NARCIS (Netherlands)

    Martin, Richard J.; Price, David; Roche, Nicolas; Israel, Elliot; van Aalderen, Willem M. C.; Grigg, Jonathan; Postma, Dirkje S.; Guilbert, Theresa W.; Hillyer, Elizabeth V.; Burden, Anne; von Ziegenweidt, Julie; Colice, Gene

    2014-01-01

    Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice. To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US). These retrospective

  6. Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems : a retrospective matched cohort study

    NARCIS (Netherlands)

    Martin, Richard J.; Price, David; Roche, Nicolas; Israel, Elliot; van Aalderen, Willem M. C.; Grigg, Jonathan; Postma, Dirkje S.; Guilbert, Theresa W.; Hillyer, Elizabeth V.; Burden, Anne; von Ziegenweidt, Julie; Colice, Gene

    2014-01-01

    BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice. AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US). METHODS:

  7. Estimating the Cost of Preeclampsia in the Healthcare System: Cross-Sectional Study Using Data From SCOPE Study (Screening for Pregnancy End Points).

    Science.gov (United States)

    Fox, Aimée; McHugh, Sheena; Browne, John; Kenny, Louise C; Fitzgerald, Anthony; Khashan, Ali S; Dempsey, Eugene; Fahy, Ciara; O'Neill, Ciaran; Kearney, Patricia M

    2017-12-01

    To estimate the cost of preeclampsia from the national health payer's perspective using secondary data from the SCOPE study (Screening for Pregnancy End Points). SCOPE is an international observational prospective study of healthy nulliparous women with singleton pregnancies. Using data from the Irish cohort recruited between November 2008 and February 2011, all women with preeclampsia and a 10% random sample of women without preeclampsia were selected. Additional health service use data were extracted from the consenting participants' medical records for maternity services which were not included in SCOPE. Unit costs were based on estimates from 3 existing Irish studies. Costs were extrapolated to a national level using a prevalence rate of 5% to 7% among nulliparous pregnancies. Within the cohort of 1774 women, 68 developed preeclampsia (3.8%) and 171 women were randomly selected as controls. Women with preeclampsia used higher levels of maternity services. The average cost of a pregnancy complicated by preeclampsia was €5243 per case compared with €2452 per case for an uncomplicated pregnancy. The national cost of preeclampsia is between €6.5 and €9.1 million per annum based on the 5% to 7% prevalence rate. Postpartum care was the largest contributor to these costs (€4.9-€6.9 million), followed by antepartum care (€0.9-€1.3 million) and peripartum care (€0.6-€0.7 million). Women with preeclampsia generate significantly higher maternity costs than women without preeclampsia. These cost estimates will allow policy-makers to efficiently allocate resources for this pregnancy-specific condition. Moreover, these estimates are useful for future research assessing the cost-effectiveness of preeclampsia screening and treatment. © 2017 American Heart Association, Inc.

  8. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  9. Removal of waterborne pathogens from liver transplant unit water taps in prevention of healthcare-associated infections: a proposal for a cost-effective, proactive infection control strategy.

    Science.gov (United States)

    Zhou, Z Y; Hu, B J; Qin, L; Lin, Y E; Watanabe, H; Zhou, Q; Gao, X D

    2014-04-01

    Hospital water supplies often contain waterborne pathogens, which can become a reservoir for healthcare-associated infections (HAIs). We surveyed the extent of waterborne pathogen contamination in the water supply of a Liver Transplant Unit. The efficacy of point-of-use (POU) water filters was evaluated by comparative analysis in routine clinical use. Our baseline environmental surveillance showed that Legionella spp. (28%, 38/136), Pseudomonas aeruginosa (8%, 11/136), Mycobacterium spp. (87%, 118/136) and filamentous fungi (50%, 68/136) were isolated from the tap water of the Liver Transplant Unit. 28.9% of Legionella spp.-positive water samples (n = 38) showed high-level Legionella contamination (≥10(3) CFU/L). After installation of the POU water filter, none of these pathogens were found in the POU filtered water samples. Furthermore, colonizations/infections with Gram-negative bacteria determined from patient specimens were reduced by 47% during this period, even if only 27% (3/11) of the distal sites were installed with POU water filters. In conclusion, the presence of waterborne pathogens was common in the water supply of our Liver Transplant Unit. POU water filters effectively eradicated these pathogens from the water supply. Concomitantly, healthcare-associated colonization/infections declined after the POU filters were installed, indicating their potential benefit in reducing waterborne HAIs. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  10. Reducing patient drug acquisition costs can lower diabetes health claims.

    Science.gov (United States)

    Mahoney, John J

    2005-08-01

    Concerned about rising prevalence and costs of diabetes among its employees, Pitney Bowes Inc recently revamped its drug benefit design to synergize with ongoing efforts in its disease management and patient education programs. Specifically, based on a predictive model showing that low medication adherence was linked to subsequent increases in healthcare costs in patients with diabetes, the company shifted all diabetes drugs and devices from tier 2 or 3 formulary status to tier 1. The rationale was that reducing patient out-of-pocket costs would eliminate financial barriers to preventive care, and thereby increase adherence, reduce costly complications, and slow the overall rate of rising healthcare costs. This single change in pharmaceutical benefit design immediately made critical brand-name drugs available to most Pitney Bowes employees and their covered dependents for 10% coinsurance, the same coinsurance level as for generic drugs, versus the previous cost share of 25% to 50%. After 2 to 3 years, preliminary results in plan participants with diabetes indicate that medication possession rates have increased significantly, use of fixed-combination drugs has increased (possibly related to easier adherence), average total pharmacy costs have decreased by 7%, and emergency department visits have decreased by 26%. Hospital admission rates, although increasing slightly, remain below the demographically adjusted Medstat benchmark. Overall direct healthcare costs per plan participant with diabetes decreased by 6%. In addition, the rate of increase in overall per-plan-participant health costs at Pitney Bowes has slowed markedly, with net per-plan-participant costs in 2003 at about 4000 dollars per year versus 6500 dollars for the industry benchmark. This recent moderation in overall corporate health costs may be related to these strategic changes in drug benefit design for diabetes, asthma, and hypertension and also to ongoing enhancements in the company's disease

  11. Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

    Science.gov (United States)

    Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

    2009-01-01

    More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.

  12. Cost considerations

    NARCIS (Netherlands)

    Michiel Ras; Debbie Verbeek-Oudijk; Evelien Eggink

    2013-01-01

    Original title: Lasten onder de loep The Dutch government spends almost 7 billion euros  each year on care for people with intellectual disabilities, and these costs are rising steadily. This report analyses what underlies the increase in costs that occurred between 2007 and 2011. Was

  13. The making of a European healthcare union

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Martinsen, Dorte Sindbjerg

    2016-01-01

    that federalism offers the most fruitful way to do so because of its sensitivity to the EU’s institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However......, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps, and fiscal stress of member states. The emerging European healthcare union is a system of cooperative federalism without much cost-sharing...

  14. The Rise of Iran

    DEFF Research Database (Denmark)

    Rahigh-Aghsan, Ali

    Iran is viewed as a rising power that poses an increasing threat to regional and even global security. This view is wrong for three reasons. Iran's hard and soft power is exaggerated by most accounts; it is too limited to allow the Iranians to dominate the Persian Gulf let alone the Middle East...

  15. The Rise of Iran

    DEFF Research Database (Denmark)

    Rahigh-Aghsan, Ali; Jakobsen, Peter Viggo

    2010-01-01

    Iran is viewed as a rising power that poses an increasing threat to regional and even global security. This view is wrong for three reasons. Iran's hard and soft power is exaggerated by most accounts; it is too limited to allow the Iranians to dominate the Persian Gulf let alone the Middle East...

  16. Customers' Precedence for Service Quality Dimensions in Indian Private Healthcare Setting: A Ridit Approach.

    Science.gov (United States)

    Panda, Rajeev Kumar; Kondasani, Rama Koteswara Rao

    2017-01-01

    Changes in demographic and sociocultural environment, improved health awareness, and information technology have considerably changed the outlook of healthcare sector in India. While both the public and the private healthcare sectors have priority of increasing access while minimizing costs, they try hard to achieve goals without letting the quality suffer. Customers with rising disposable income no longer have faith in the public healthcare system and are willing to migrate to the private healthcare sector, which is more professional, technology savvy, and trustworthy. However, there are enough loopholes in the private healthcare sector that are yet to be plugged. The purpose of this research study was to identify and assess the relative importance of the diverse service quality dimensions and prioritize them to draw meaningful conclusions. Survey responses from 370 customers were analyzed using factor analysis to find underlying relationships between the survey items. This allowed the individual items to be placed into related groups. Independently, a ridit analysis was conducted to determine the relative importance of each item to the survey respondents. Based on the ridit analysis a priority ranking was assigned to each item. An analysis was then undertaken of the degree to which the items grouped into each particular factor tended to have high or low priority rankings. The results of the study may be helpful to the managers of the private healthcare sector to focus their strategies and plan their efforts in line with the findings to gain superior customer satisfaction and retention.

  17. New working conditions and consequences on activity of home healthcare workers.

    Science.gov (United States)

    Van De Weerdt, Corinne; Baratta, René

    2012-01-01

    Home healthcare is steadily growing in Europe. There are a number of reasons for this development: aging population, rising hospital costs, preference to stay in one's own home. Nevertheless, it has been known that home healthcare workers are frequently exposed to a variety of potentially serious occupational hazards. Furthermore, emotional labor is frequently high in this profession. This paper describes an ergonomic study conducted at a home healthcare service. The research focuses on analyzing working conditions of home healthcare aides and nurses, as well as the impacts of their work in terms of job satisfaction, well-being, emotions at work, relationships with the others and occupational stress. The study show that employee strategies are specifically centered around preserving the relationship between patients and workers and coping with the job demands. This paper also shows that home healthcare workers express emotions and conceal them from others. Finally, recommendations discussed with the manager and workers to improve working conditions in this sector led to practical proposals: for example, implementing certain equipment items better suited to difficult care, encouraging assistance between healthcare workers when operations require this through adequate organizational measures, extending work emotion-focused discussion groups with management involvement.

  18. Big Data, Big Problems: A Healthcare Perspective.

    Science.gov (United States)

    Househ, Mowafa S; Aldosari, Bakheet; Alanazi, Abdullah; Kushniruk, Andre W; Borycki, Elizabeth M

    2017-01-01

    Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."

  19. The management of small area burns and unexpected illness after burn in children under five years of age - A costing study in the English healthcare setting.

    Science.gov (United States)

    Kandiyali, R; Sarginson, J H; Hollén, L I; Spickett-Jones, F; Young, A E R

    2018-02-01

    The objective of this economic study was to evaluate the resource use and cost associated with the management of small area burns, including the additional costs associated with unexpected illness after burn in children of less than five years of age. This study was conducted as a secondary analysis of a multi-centre prospective observational cohort study investigating the physiological response to burns in children. 452 children were included in the economic analysis (median age=1.60years, 61.3% boys, median total burn surface area [TBSA]=1.00%) with a mean length of stay of 0.69 days. Of these children, 21.5% re-presented to medical care with an unexpected illness within fourteen days of injury. The cost of managing a burn of less than 10% TBSA in a child less than five years of age was £785. The additional cost associated with the management of illness after burn was £1381. A generalised linear regression model was used to determine the association between an unexpected illness after burn, presenting child characteristics and NHS cost. Our findings may be of value to those planning economic evaluations of novel technologies in burn care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  20. Innovation Concepts in Healthcare

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the He...

  1. A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

    Directory of Open Access Journals (Sweden)

    Zindel Sonja

    2012-07-01

    Full Text Available Abstract Background Patients undergoing major orthopaedic surgery (MOS, such as total hip (THR or total knee replacement (TKR, are at high risk of developing venous thromboembolism (VTE. For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI and the German hospital perspective. Objectives To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI perspective and to analyse financial incentives from the German hospital perspective. Methods Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR and two perspectives (SHI and hospital per setting. Results Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (€27.3 saving per patient treated. However, the cost-effectiveness after THR (€17.8 cost per person remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by €20.6 (TKR and €31.8 (THR per case respectively. Conclusions Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.

  2. Integrated decision making in healthcare: an operations research and management science perspective

    NARCIS (Netherlands)

    Hulshof, P.J.H.

    2013-01-01

    The pressure on healthcare systems rises as both demand for healthcare and expenditures are increasing steadily. As a result, healthcare professionals face the challenging task to design and organize the healthcare delivery process more effectively and efficiently. Designing and organizing processes

  3. Public healthcare interests require strict competition enforcement.

    Science.gov (United States)

    Loozen, Edith M H

    2015-07-01

    Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Teaching medical students about fair distribution of healthcare resources.

    NARCIS (Netherlands)

    Leget, C.J.W.; Hoedemaekers, R.H.M.V.

    2007-01-01

    Healthcare package decisions are complex. Different judgements about effectiveness, cost-effectiveness and disease burden influence the decision-making process. Moreover, different concepts of justice generate different ideas about fair distribution of healthcare resources. This paper presents a

  5. The Rise of Iran

    DEFF Research Database (Denmark)

    Jakobsen, Peter Viggo; Rahigh-Aghsan, Ali

    2010-01-01

    Iran is viewed by many as a rising power that poses an increasing threat to regional and even global security. This view is wrong for three reasons. Iran's hard and soft power is exaggerated by most accounts; it is too limited to allow the Iranians to dominate the Persian Gulf let alone the Middle...... East, and its brand of Shi‘ism has very limited appeal outside of Iran. Second, growing internal political and economic instability will seriously limit Iran's bid for regional dominance. Third, the failure to stop the Iranian nuclear program has led analysts to underestimate the ability of the other...... regional powers and the West to balance Iran and contain its influence, even if it acquires nuclear weapons. If these limitations on Iranian power are taken into account the rise seems destined to be a short one....

  6. Regional Healthcare Effectiveness

    Directory of Open Access Journals (Sweden)

    Olga Vladimirovna Kudelina

    2016-03-01

    Full Text Available An evaluation of healthcare systems effectiveness of the regions of the Russian Federation (federal districts was conducted using the Minmax method based on the data available at the United Interdepartmental Statistical Information System. Four groups of components (i.e. availability of resources; use of resources; access to resources and medical effectiveness decomposed into 17 items were analyzed. The resource availability was measured by four indicators, including the provision of doctors, nurses, hospital beds; agencies providing health care to the population. Use of resources was measured by seven indicators: the average hospital stay, days; the average bed occupancy, days; the number of operations per 1 physician surgical; the cost per unit volume of medical care: in outpatient clinics, day hospitals, inpatient and emergency care. Access to the resources was measured by three indicators: the satisfaction of the population by medical care; the capacity of outpatient clinics; the average number of visits to health facility. The medical effectiveness was also measured by three indicators: incidence with the "first-ever diagnosis of malignancy"; life expectancy at birth, years; the number of days of temporary disability. The study of the dynamics of the components and indexes for 2008–2012 allows to indicate a multidirectional influence on the regional healthcare system. In some federal districts (e.g. North Caucasian, the effectiveness decreases due to resource availability, in others (South, North Caucasian — due to the use of resources, in others (Far Eastern, Ural — due to access to resources. It is found that the effectiveness of the healthcare systems of the federal districts differs significantly. In addition, the built matrix proves the variability the of effectiveness (comparison of expenditures and results of healthcare systems of the federal districts of the Russian Federation: the high results can be obtained at high costs

  7. Contemporary sea level rise.

    Science.gov (United States)

    Cazenave, Anny; Llovel, William

    2010-01-01

    Measuring sea level change and understanding its causes has considerably improved in the recent years, essentially because new in situ and remote sensing observations have become available. Here we report on most recent results on contemporary sea level rise. We first present sea level observations from tide gauges over the twentieth century and from satellite altimetry since the early 1990s. We next discuss the most recent progress made in quantifying the processes causing sea level change on timescales ranging from years to decades, i.e., thermal expansion of the oceans, land ice mass loss, and land water-storage change. We show that for the 1993-2007 time span, the sum of climate-related contributions (2.85 +/- 0.35 mm year(-1)) is only slightly less than altimetry-based sea level rise (3.3 +/- 0.4 mm year(-1)): approximately 30% of the observed rate of rise is due to ocean thermal expansion and approximately 55% results from land ice melt. Recent acceleration in glacier melting and ice mass loss from the ice sheets increases the latter contribution up to 80% for the past five years. We also review the main causes of regional variability in sea level trends: The dominant contribution results from nonuniform changes in ocean thermal expansion.

  8. MARKETING PLANNING IN HEALTHCARE INDUSTRY

    Directory of Open Access Journals (Sweden)

    Bobeica Ana Amaria

    2013-04-01

    Full Text Available The purpose of this paper is to develop a perspective on what is important or critical to the discipline of healthcare marketing by analyzing the marketing plan from the institutional (or organizational perspective. This “salience issue” is complicated by the structural problems in healthcare such as new advertising programs, advances in medical technology, and the escalating costs of care in the recent economic situation of world economic crisis. Reviewing a case study, the paper examines how marketing managers face increasingly difficult management and it emphasizes one more time the importance of marketing in the internal organizational structure. Also it shows the direct connection between the marketing strategy, the Quality of Healthcare and marketing planning in the internal organization of Private Healthcare Practice in Romania. Also it concludes that marketing planning in healthcare has to be very precised in order to achieve some major objectives: customer care, financial stability, equilibrium between stakeholders and shareholders and future improvement in communication to customers. The marketing strategies and programs discussed in this paper follow the analysis of the 4Ps of Healthcare Marketing Services and propose call to action plans and possibilities that might result in a more particular case study analysis of the Romanian Healthcare Market.

  9. Robot-assisted surgery in a broader healthcare perspective: a difference-in-difference-based cost analysis of a national prostatectomy cohort.

    Science.gov (United States)

    Hyldgård, Vibe Bolvig; Laursen, Karin Rosenkilde; Poulsen, Johan; Søgaard, Rikke

    2017-07-21

    To estimate costs attributable to robot-assisted laparoscopic prostatectomy (RALP) as compared with open prostatectomy (OP) and laparoscopic prostatectomies (LP) in a National Health Service perspective. Register-based cohort study of 4309 consecutive patients who underwent prostatectomy from 2006 to 2013 (2241 RALP, 1818 OP and 250 LP). Patients were followed from 12 months before to 12 months after prostatectomy with respect to service use in primary care (general practitioners, therapists, specialists etc) and hospitals (inpatient and outpatient activity related to prostatectomy and comorbidity). Tariffs of the activity-based remuneration system for primary care and the Diagnosis-Related Grouping case-mix system for hospital-based care were used to value service use. Costs attributable to RALP were estimated using a difference-in-difference analytical approach and adjusted for patient-level and hospital-level risk selection using multilevel regression. No significant effect of RALP on resource-use was observed except for a marginally lower use of primary care and fewer bed days as compared with OP (not LP). The overall cost consequence of RALP was estimated at an additional €2459 (95% CI 1377 to 3540, p=0.003) as compared with OP and an additional €3860 (95% CI 559 to 7160, p=0.031) as compared with LP, mainly due to higher cost intensity during the index admissions. In this study from the Danish context, the use of RALP generates a factor 1.3 additional cost when compared with OP and a factor 1.6 additional cost when compared with LP, on average, based on 12 months follow-up. The policy interpretation is that the use of robots for prostatectomy should be driven by clinical superiority and that formal effectiveness analysis is required to determine whether the current and eventual new purchasing of robot capacity is best used for prostatectomy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  10. Healthcare resource use and costs of managing children and adults with lysosomal acid lipase deficiency at a tertiary referral centre in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Julian F Guest

    Full Text Available To estimate clinical progression and resource utilisation together with the associated costs of managing children and adults with LAL Deficiency, at a tertiary referral centre in the UK.A retrospective chart review was undertaken of patients in the UK with a confirmed diagnosis of LAL Deficiency who were managed at a LAL Deficiency tertiary referral treatment centre. Patients' pathways, treatment patterns, health outcomes and resource use were quantified over differing lengths of time for each patient enabling the NHS cost of patient management in tertiary care to be estimated.The study population comprised 19 patients of whom 58% were male. Mean age at the time of initial presentation was 15.5 years and the mean age at diagnosis was 18.0 years. 63%, 53% and 42% of patients had hepatomegaly, abnormal lipid storage and splenomegaly at a mean age of presentation of 17.8, 17.1 and 20.9 years, respectively. Over a period of 50 years there were a mean of 48.5 clinician visits and 3.4 hospital admissions per patient. The mean NHS cost of patient management at a LAL Deficiency tertiary referral treatment centre, spanning a period of over 50 years was £61,454 per patient.This study provides important insights into a number of aspects of the disease that are difficult to ascertain from published case reports. Additionally, it provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to managing this ultra-orphan disease.

  11. Healthcare resource use and costs of managing children and adults with lysosomal acid lipase deficiency at a tertiary referral centre in the United Kingdom.

    Science.gov (United States)

    Guest, Julian F; Ingram, Andy; Ayoub, Nadia; Hendriksz, Christian J; Murphy, Elaine; Rahman, Yusof; McKiernan, Patrick; Mundy, Helen; Deegan, Patrick

    2018-01-01

    To estimate clinical progression and resource utilisation together with the associated costs of managing children and adults with LAL Deficiency, at a tertiary referral centre in the UK. A retrospective chart review was undertaken of patients in the UK with a confirmed diagnosis of LAL Deficiency who were managed at a LAL Deficiency tertiary referral treatment centre. Patients' pathways, treatment patterns, health outcomes and resource use were quantified over differing lengths of time for each patient enabling the NHS cost of patient management in tertiary care to be estimated. The study population comprised 19 patients of whom 58% were male. Mean age at the time of initial presentation was 15.5 years and the mean age at diagnosis was 18.0 years. 63%, 53% and 42% of patients had hepatomegaly, abnormal lipid storage and splenomegaly at a mean age of presentation of 17.8, 17.1 and 20.9 years, respectively. Over a period of 50 years there were a mean of 48.5 clinician visits and 3.4 hospital admissions per patient. The mean NHS cost of patient management at a LAL Deficiency tertiary referral treatment centre, spanning a period of over 50 years was £61,454 per patient. This study provides important insights into a number of aspects of the disease that are difficult to ascertain from published case reports. Additionally, it provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to managing this ultra-orphan disease.

  12. Healthcare mergers and acquisitions: strategies for consolidation.

    Science.gov (United States)

    Zuckerman, Alan M

    2011-01-01

    The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.

  13. Effect of an evidence-based website on healthcare usage: an interrupted time-series study

    Science.gov (United States)

    Spoelman, Wouter A; Bonten, Tobias N; de Waal, Margot W M; Drenthen, Ton; Smeele, Ivo J M; Nielen, Markus M J; Chavannes, Niels H

    2016-01-01

    Objectives Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage. Design Interrupted time series analysis of observational primary care data of healthcare use in the Netherlands from 2009 to 2014. Setting General community primary care. Population 912 000 patients who visited their general practitioners 18.1 million times during the study period. Intervention In March 2012, an evidence-based health information website was launched by the Dutch College of General Practitioners. It was easily accessible and understandable using plain language. At the end of the study period, the website had 2.9 million unique page views per month. Main outcomes measures Primary outcome was the change in consultation rate (consultations/1000 patients/month) before and after the release of the website. Additionally, a reference group was created by including consultations about topics not being viewed at the website. Subgroup analyses were performed for type of consultations, sex, age and socioeconomic status. Results After launch of the website, the trend in consultation rate decreased with 1.620 consultations/1000 patients/month (p<0.001). This corresponds to a 12% decline in consultations 2 years after launch of the website. The trend in consultation rate of the reference group showed no change. The subgroup analyses showed a specific decline for consultations by phone and were significant for all other subgroups, except for the youngest age group. Conclusions Healthcare usage decreased by 12% after providing high-quality evidence-based online health information. These findings show that e-Health can be effective to improve self-management and reduce healthcare usage in times of increasing healthcare costs. PMID:28186945

  14. Effect of an evidence-based website on healthcare usage: an interrupted time-series study.

    Science.gov (United States)

    Spoelman, Wouter A; Bonten, Tobias N; de Waal, Margot W M; Drenthen, Ton; Smeele, Ivo J M; Nielen, Markus M J; Chavannes, Niels H

    2016-11-09

    Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage. Interrupted time series analysis of observational primary care data of healthcare use in the Netherlands from 2009 to 2014. General community primary care. 912 000 patients who visited their general practitioners 18.1 million times during the study period. In March 2012, an evidence-based health information website was launched by the Dutch College of General Practitioners. It was easily accessible and understandable using plain language. At the end of the study period, the website had 2.9 million unique page views per month. Primary outcome was the change in consultation rate (consultations/1000 patients/month) before and after the release of the website. Additionally, a reference group was created by including consultations about topics not being viewed at the website. Subgroup analyses were performed for type of consultations, sex, age and socioeconomic status. After launch of the website, the trend in consultation rate decreased with 1.620 consultations/1000 patients/month (pHealthcare usage decreased by 12% after providing high-quality evidence-based online health information. These findings show that e-Health can be effective to improve self-management and reduce healthcare usage in times of increasing healthcare 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/.

  15. Is Canadian Healthcare Affordable? A Comparative Analysis of the Canadian Healthcare System from 2004 to 2014.

    Science.gov (United States)

    Soril, Lesley J J; Adams, Ted; Phipps-Taylor, Madeleine; Winblad, Ulrika; Clement, Fiona

    2017-08-01

    To compare cost-related non-adherence (CRNA), serious problems paying medical bills and average annual out-of-pocket cost over time in five countries. Repeated cross-sectional analysis of the Commonwealth Fund International Health Policy survey from 2004 to 2014. Responses were compared between Canada, the UK, Australia, New Zealand and the US. Compared to the UK, respondents in Canada, Australia and New Zealand were two to three times and respondents in the US were eight times more likely to experience CRNA; these odds remained stable over time. From 2004 to 2014, Canadian respondents paid US $852-1,767 out-of-pocket for care. The US reported the largest risks of serious problems paying for care (13-18.5%), highest out-of-pocket costs (US $2,060-3,319) and greatest rise in expenditures. Over the 10-year period, financial barriers to care were identified in Canada and internationally. Such persistent challenges are of great concern to countries striving for equitable access to healthcare. Copyright © 2017 Longwoods Publishing.

  16. Business intelligence in healthcare organizations

    NARCIS (Netherlands)

    Spil, Antonius A.M.; Stegwee, R.A.; Teitink, Christian J.A.

    2002-01-01

    The management of healthcare organizations is starting to recognize the relevance of the definition of care products in relation to management information. In the turmoil between costs, care results and patient satisfaction, the right balance is needed, and it can be found in upcoming information

  17. mHealth transforming healthcare

    CERN Document Server

    Malvey, Donna

    2014-01-01

    Examines regulatory trends and their impact on mHealth innovations and applications Offers solutions for those in the health care industry that are attempting to engage consumers in reducing healthcare costs and in improving their health care encounters and personal health Explains what is necessary for long-term viability of mHealth as a health care delivery medium.

  18. Healthcare 2025 : buildings for the future

    NARCIS (Netherlands)

    2008-01-01

    Healthcare in Europe is changing. Many countries are introducing reforms, and creating more competition and an open healthcare market. Product pricing is becoming normal; in some cases, such as the Netherlands, capital costs are becoming a component of charges. Experiments with public/private

  19. An interoperable security framework for connected healthcare

    NARCIS (Netherlands)

    Asim, M.; Petkovic, M.; Qu, M.; Wang, Changjie

    2011-01-01

    Connected and interoperable healthcare system promises to reduce the cost of healthcare delivery, increase its efficiency and enable consumers to better engage with clinicians and manage their care. However at the same time it introduces new risks towards security and privacy of personal health

  20. A Case for Telestroke in Military Medicine: A Retrospective Analysis of Stroke Cost and Outcomes in U.S. Military Health-Care System.

    Science.gov (United States)

    Dave, Ajal; Cagniart, Kendra; Holtkamp, Matthew D

    2018-06-07

    The development of primary stroke centers has improved outcomes for stroke patients. Telestroke networks have expanded the reach of stroke experts to underserved, geographically remote areas. This study illustrates the outcome and cost differences between neurology and primary care ischemic stroke admissions to demonstrate a need for telestroke networks within the Military Health System (MHS). All adult admissions with a primary diagnosis of ischemic stroke in the MHS Military Mart database from calendar years 2010 to 2015 were reviewed. Neurology, primary care, and intensive care unit (ICU) admissions were compared across primary outcomes of (1) disposition status and (2) intravenous tissue plasminogen activator administration and for secondary outcomes of (1) total cost of hospitalization and (2) length of stay (LOS). A total of 3623 admissions met the study's parameters. The composition was neurology 462 (12.8%), primary care 2324 (64.1%), ICU 677 (18.7%), and other/unknown 160 (4.4%). Almost all neurology admissions (97%) were at the 3 neurology training programs, whereas a strong majority of primary care admissions (80%) were at hospitals without a neurology admitting service. Hospitals without a neurology admitting service had more discharges to rehabilitation facilities and higher rates of in-hospital mortality. LOS was also longer in primary care admissions. Ischemic stroke admissions to neurology had better outcomes and decreased LOS when compared to primary care within the MHS. This demonstrates a possible gap in care. Implementation of a hub and spoke telestroke model is a potential solution. Published by Elsevier Inc.

  1. Medico-economic evaluation of healthcare products. Methodology for defining a significant impact on French health insurance costs and selection of benchmarks for interpreting results.

    Science.gov (United States)

    Dervaux, Benoît; Baseilhac, Eric; Fagon, Jean-Yves; Biot, Claire; Blachier, Corinne; Braun, Eric; Debroucker, Frédérique; Detournay, Bruno; Ferretti, Carine; Granger, Muriel; Jouan-Flahault, Chrystel; Lussier, Marie-Dominique; Meyer, Arlette; Muller, Sophie; Pigeon, Martine; De Sahb, Rima; Sannié, Thomas; Sapède, Claudine; Vray, Muriel

    2014-01-01

    Decree No. 2012-1116 of 2 October 2012 on medico-economic assignments of the French National Authority for Health (Haute autorité de santé, HAS) significantly alters the conditions for accessing the health products market in France. This paper presents a theoretical framework for interpreting the results of the economic evaluation of health technologies and summarises the facts available in France for developing benchmarks that will be used to interpret incremental cost-effectiveness ratios. This literature review shows that it is difficult to determine a threshold value but it is also difficult to interpret then incremental cost effectiveness ratio (ICER) results without a threshold value. In this context, round table participants favour a pragmatic approach based on "benchmarks" as opposed to a threshold value, based on an interpretative and normative perspective, i.e. benchmarks that can change over time based on feedback. © 2014 Société Française de Pharmacologie et de Thérapeutique.

  2. The 1988 coal outlook: steadily rising consumption

    Energy Technology Data Exchange (ETDEWEB)

    Soras, C.G.; Stodden, J.R.

    1987-12-01

    Total coal use - domestic and foreign - will reach 910 million tons in 1988, an expansion of 1.3% from an estimated 898 million tons in 1987. The overall rise in consumption will add to inventory needs. Moreover, lower interest rates cut effective carrying costs and further encourage the holding of coal stocks by users. The results will be a gain in inventories of 3.5 tons by the end of 1988. As a result of all these factors, coal production is anticipated to rise by 11.6 million tons, or 1.2%, which projects firm markets in a time of relatively soft economic conditions in the USA. 2 tabs.

  3. Coal prices rise

    International Nuclear Information System (INIS)

    McLean, A.

    2001-01-01

    Coking and semi hard coking coal price agreements had been reached, but, strangely enough, the reaching of common ground on semi soft coking coal, ultra low volatile coal and thermal coal seemed some way off. More of this phenomenon later, but suffice to say that, traditionally, the semi soft and thermal coal prices have fallen into place as soon as the hard, or prime, coking coal prices have been determined. The rise and rise of the popularity of the ultra low volatile coals has seen demand for this type of coal grow almost exponentially. Perhaps one of the most interesting facets of the coking coal settlements announced to date is that the deals appear almost to have been preordained. The extraordinary thing is that the preordination has been at the prescience of the sellers. Traditionally, coking coal price fixing has been the prerogative of the Japanese Steel Mills (JSM) cartel (Nippon, NKK, Kawasaki, Kobe and Sumitomo) who presented a united front to a somewhat disorganised force of predominantly Australian and Canadian sellers. However, by the time JFY 2001 had come round, the rules of the game had changed

  4. The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

    Science.gov (United States)

    Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

    2016-03-11

    This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

  5. Patients, the public and priorities in healthcare

    National Research Council Canada - National Science Library

    Littlejohns, Peter; Rawlins, Michael

    2009-01-01

    "Sharing the costs of ill health is the mark of a civilised society. However, every society has limited healthcare resources, and must therefore make finely balanced decisions on how best to allocate...

  6. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Lewin, Simon; Lavis, John N; Oxman, Andrew D; Bastías, Gabriel; Chopra, Mickey; Ciapponi, Agustín; Flottorp, Signe; Martí, Sebastian García; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S; Haines, Andy

    2008-09-13

    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

  7. Construction waste rises up the agenda.

    Science.gov (United States)

    Moon, David

    2010-10-01

    Building maintenance and the construction of new healthcare facilities are central to maintaining the NHS's infrastructure, but such work is costly, and subject to intense financial scrutiny. Dr David Moon, programme manager, Clients and Policy, at Government-backed WRAP (the Waste & Resources Action Programme), which works in England, Scotland, Wales, and Northern Ireland, to help businesses and individuals reduce waste, develop sustainable products, and use resources efficiently, outlines the crucial role that NHS Trusts play in securing cost savings through minimising construction waste, as set out in a new WRAP guide.

  8. Minimizing deviant behavior in healthcare organizations: the effects of supportive leadership and job design.

    Science.gov (United States)

    Chullen, C Logan; Dunford, Benjamin B; Angermeier, Ingo; Boss, R Wayne; Boss, Alan D

    2010-01-01

    In an era when healthcare organizations are beset by intense competition, lawsuits, and increased administrative costs, it is essential that employees perform their jobs efficiently and without distraction. Deviant workplace behavior among healthcare employees is especially threatening to organizational effectiveness, and healthcare managers must understand the antecedents of such behavior to minimize its prevalence. Deviant employee behavior has been categorized into two major types, individual and organizational, according to the intended target of the behavior. Behavior directed at the individual includes such acts as harassment and aggression, whereas behavior directed at the organization includes such acts as theft, sabotage, and voluntary absenteeism, to name a few (Robinson and Bennett 1995). Drawing on theory from organizational behavior, we examined two important features of supportive leadership, leader-member exchange (LMX) and perceived organizational support (POS), and two important features of job design, intrinsic motivation and depersonalization, as predictors of subsequent deviant behavior in a sample of over 1,900 employees within a large US healthcare organization. Employees who reported weaker perceptions of LMX and greater perceptions of depersonalization were more likely to engage in deviant behavior directed at the individual, whereas employees who reported weaker perceptions of POS and intrinsic motivation were more likely to engage in deviant behavior directed at the organization. These findings give rise to specific prescriptions for healthcare managers to prevent or minimize the frequency of deviant behavior in the workplace.

  9. 1995 Emerging Leaders in Healthcare. The new leaders: Gita Budd, Colene Daniel, Elizabeth Gallup, Scott Wordelman.

    Science.gov (United States)

    Southwick, K

    1995-01-01

    Fierce pressures for cost containment. Demands for quality improvements. The drive toward patient-centered care. The push for community involvement. Insistent voices of payers, patients, consumers, physicians. Accumulated tensions amid the chaos of change. Balancing all of these demands while inspiring and encouraging the professionals and other workers within the healthcare organization requires a high level of leadership ability. One that insists on the best from everyone involved in a healthcare system--from physicians to staff, nurses to social workers. And then strives for more. The four young executives who are this year's Emerging Leaders in Healthcare have all pushed their systems beyond traditional boundaries into new territory, helping their patients, their employees, their physicians, and their communities rise to new levels of achievement. At the same time, these leaders emphasize teamwork and consensus-style management, so that their co-workers feel like they're participating in the changes, not being victimized by them. Gita Budd, Colene Daniel, Elizabeth Gallup, and Scott Wordelman are winners of the 1995 award from The Healthcare Forum and Korn/Ferry International that honors ¿dynamic, decisive young leaders (under 40) with the proven ability to nurture the growth of the industry.¿ Korn/Ferry International and The Healthcare Forum are proud to present 1995's Emerging Leaders.

  10. Rising energy prices and the economics of water in agriculture

    NARCIS (Netherlands)

    Zilberman, D.; Sproul, T.; Rajagopal, D.; Sexton, S.; Hellegers, P.J.G.J.

    2008-01-01

    Rising energy prices will alter water allocation and distribution. Water extraction and conveyance will become more costly and demand for hydroelectric power will grow. The higher cost of energy will substantially increase the cost of groundwater, whereas increasing demand for hydroelectric power

  11. Designing the future of healthcare.

    Science.gov (United States)

    Fidsa, Gianfranco Zaccai

    2009-01-01

    This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

  12. The rise of Chrome

    Directory of Open Access Journals (Sweden)

    Jonathan Tamary

    2015-10-01

    Full Text Available Since Chrome’s initial release in 2008 it has grown in market share, and now controls roughly half of the desktop browsers market. In contrast with Internet Explorer, the previous dominant browser, this was not achieved by marketing practices such as bundling the browser with a pre-loaded operating system. This raises the question of how Chrome achieved this remarkable feat, while other browsers such as Firefox and Opera were left behind. We show that both the performance of Chrome and its conformance with relevant standards are typically better than those of the two main contending browsers, Internet Explorer and Firefox. In addition, based on a survey of the importance of 25 major features, Chrome product managers seem to have made somewhat better decisions in selecting where to put effort. Thus the rise of Chrome is consistent with technical superiority over the competition.

  13. Plume rise predictions

    International Nuclear Information System (INIS)

    Briggs, G.A.

    1976-01-01

    Anyone involved with diffusion calculations becomes well aware of the strong dependence of maximum ground concentrations on the effective stack height, h/sub e/. For most conditions chi/sub max/ is approximately proportional to h/sub e/ -2 , as has been recognized at least since 1936 (Bosanquet and Pearson). Making allowance for the gradual decrease in the ratio of vertical to lateral diffusion at increasing heights, the exponent is slightly larger, say chi/sub max/ approximately h/sub e/ - 2 . 3 . In inversion breakup fumigation, the exponent is somewhat smaller; very crudely, chi/sub max/ approximately h/sub e/ -1 . 5 . In any case, for an elevated emission the dependence of chi/sub max/ on h/sub e/ is substantial. It is postulated that a really clever ignorant theoretician can disguise his ignorance with dimensionless constants. For most sources the effective stack height is considerably larger than the actual source height, h/sub s/. For instance, for power plants with no downwash problems, h/sub e/ is more than twice h/sub s/ whenever the wind is less than 10 m/sec, which is most of the time. This is unfortunate for anyone who has to predict ground concentrations, for he is likely to have to calculate the plume rise, Δh. Especially when using h/sub e/ = h/sub s/ + Δh instead of h/sub s/ may reduce chi/sub max/ by a factor of anywhere from 4 to infinity. Factors to be considered in making plume rise predictions are discussed

  14. Superphenix set to rise again

    International Nuclear Information System (INIS)

    Dorozynski, A.

    1993-01-01

    Superphenix, France's seemingly jinxed fast breeder reactor, which has not produced a single kilowatt of energy in more than 3 years, looks set to rise up next year like the mythical bird it is named after. The $5 billion reactor, the largest fast breeder in the world, has just been given the seal of approval by a public commission ordered by the government to look at the pros and cons of restarting. It still has hoops to jump through: a safety check and approval from the ministries of industries and environment. But the consortium of French, Italian, and German power utilities that run the plant are confident they can get it running by next summer. The Superphenix that rises out of the ashes will, however, be a different species of bird from the one planned 20 years ago. The consortium plans to turn the reactor into a debreeder, one that will incinerate more plutonium than it produces and so eat into Europe's plutonium stockpile. Calculations by Superphenix staff and the Atomic Energy Commission indicate that a plutonivorous fast breeder could incinerate 15 to 25 kilograms of plutonium while producing 1 billion kilowatt-hours of electricity-scarcely enough to make a dent in the tonnes of plutonium produced by Electricite de France's reactors each year. The Superphenix consortium is anxious to get the reactor back on line. The annual cost of upkeep and repair of the idle plant and salaries for its 700 staff may reach $140 million this year, 20% more than if the plant was running normally. If restarted, the existing core and a second one ready on the shelf will generate electricity worth $1.3 billion

  15. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  16. Rising Long-term Interest Rates

    DEFF Research Database (Denmark)

    Hallett, Andrew Hughes

    Rather than chronicle recent developments in European long-term interest rates as such, this paper assesses the impact of increases in those interest rates on economic performance and inflation. That puts us in a position to evaluate the economic pressures for further rises in those rates......, the first question posed in this assignment, and the scope for overshooting (the second question), and then make some illustrative predictions of future interest rates in the euro area. We find a wide range of effects from rising interest rates, mostly small and mostly negative, focused on investment...... till the emerging European recovery is on a firmer basis and capable of overcoming increases in the cost of borrowing and shrinking fiscal space. There is also an implication that worries about rising/overshooting interest rates often reflect the fact that inflation risks are unequally distributed...

  17. Comparison of medical costs and healthcare resource utilization of post-menopausal women with HR+/HER2- metastatic breast cancer receiving everolimus-based therapy or chemotherapy: a retrospective claims database analysis.

    Science.gov (United States)

    Li, Nanxin; Hao, Yanni; Koo, Valerie; Fang, Anna; Peeples, Miranda; Kageleiry, Andrew; Wu, Eric Q; Guérin, Annie

    2016-01-01

    To analyze medical costs and healthcare resource utilization (HRU) associated with everolimus-based therapy or chemotherapy among post-menopausal women with hormone-receptor-positive, human-epidermal-growth-factor-receptor-2-negative (HR+/HER2-) metastatic breast cancer (mBC). Patients with HR+/HER2- mBC who discontinued a non-steroidal aromatase inhibitor and began a new line of treatment with everolimus-based therapy or chemotherapy (index therapy/index date) between July 20, 2012 and April 30, 2014 were identified from two large claims databases. All-cause, BC-related, and adverse event (AE)-related medical costs (in 2014 USD) and all-cause HRU per patient per month (PPPM) were analyzed for both treatment groups across patients' first four lines of therapies for mBC. Adjusted differences in costs and HRU between the everolimus and chemotherapy treatment group were estimated pooling all lines and using multivariable generalized linear models, accounting for difference in patient characteristics. A total of 3298 patients were included: 902 everolimus-treated patients and 2636 chemotherapy-treated patients. Compared to chemotherapy, everolimus was associated with significantly lower all-cause (adjusted mean difference = $3455, p well as significantly lower HRU (emergency room incidence rate ratio [IRR] = 0.83; inpatient IRR = 0.74; inpatient days IRR = 0.65; outpatient IRR = 0.71; BC-related outpatient IRR = 0.57; all p chemotherapy.

  18. Licensed Healthcare Facilities

    Data.gov (United States)

    California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  19. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study.

    Science.gov (United States)

    Walker, Jochen; Mertens, Ulf Kai; Schmidt, Carsten Oliver; Chenot, Jean-François

    2017-01-01

    Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18%) received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]). SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.

  20. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study.

    Directory of Open Access Journals (Sweden)

    Jochen Walker

    Full Text Available Spinal manual therapy (SMT is a popular treatment option for low back pain (LBP. The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18% received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]. SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.

  1. Healthcare economics for the emergency physician.

    Science.gov (United States)

    Propp, Douglas A; Krubert, Christopher; Sasson, Andres

    2003-01-01

    Although the principles of healthcare economics are not usually part of the fundamental education of emergency physicians, an understanding of these elements will enhance our ability to contribute to improved health-care value. This article introduces the practical aspects of microeconomics, insurance, the supply-and-demand relationship, competition, and costs as they affect the practice of medicine on a daily basis. Being cognizant of how these elements create a dynamic interplay in the health-care industry will allow physicians to better understand the expanded role they need to assume in the ongoing cost and quality debate. Copyright 2003, Elsevier Science (USA). All rights reserved.)

  2. Challenges and Opportunities in Scaling-Up Nutrition in Healthcare

    OpenAIRE

    Darnton-Hill, Ian; Samman, Samir

    2015-01-01

    Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity,...

  3. Big Data and Analytics in Healthcare.

    Science.gov (United States)

    Tan, S S-L; Gao, G; Koch, S

    2015-01-01

    This editorial is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". The amount of data being generated in the healthcare industry is growing at a rapid rate. This has generated immense interest in leveraging the availability of healthcare data (and "big data") to improve health outcomes and reduce costs. However, the nature of healthcare data, and especially big data, presents unique challenges in processing and analyzing big data in healthcare. This Focus Theme aims to disseminate some novel approaches to address these challenges. More specifically, approaches ranging from efficient methods of processing large clinical data to predictive models that could generate better predictions from healthcare data are presented.

  4. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Lue-Ping Zhao

    Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

  5. Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries.

    Science.gov (United States)

    Heijink, Richard; Koolman, Xander; Westert, Gert P

    2013-06-01

    Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production functions using avoidable mortality as outcome measure. Avoidable mortality comprises deaths from certain conditions "that should not occur in the presence of timely and effective healthcare". We investigated the relationship between total avoidable mortality and healthcare spending using descriptive analyses and multiple regression models, focussing on within-country variation and growth rates. We aimed to take into account the role of potential confounders and dynamic effects such as time lags. Additionally, we explored a method to estimate macro-level cost-effectiveness. We found an average yearly avoidable mortality decline of 2.6-5.3% across countries. Simultaneously, healthcare spending rose between 1.9 and 5.9% per year. Most countries with above-average spending growth demonstrated above-average reductions in avoidable mortality. The regression models showed a significant association between contemporaneous and lagged healthcare spending and avoidable mortality. The time-trend, representing an exogenous shift of the health production function, reduced the impact of healthcare spending. After controlling for this time-trend and other confounders, i.e. demographic and socioeconomic variables, a statistically significant relationship between healthcare spending and avoidable mortality remained. We tentatively conclude that macro-level healthcare spending increases provided value for money, at least for the disease groups, countries and years included in this study.

  6. Employer Health Benefit Costs and Demand for Part-Time Labor

    OpenAIRE

    Jennifer Feenstra Schultz; David Doorn

    2009-01-01

    The link between rising employer costs for health insurance benefits and demand for part-time workers is investigated using non-public data from the Medical Expenditure Panel Survey- Insurance Component (MEPS-IC). The MEPS-IC is a nationally representative, annual establishment survey from the Agency for Healthcare Research and Quality (AHRQ). Pooling the establishment level data from the MEPS-IC from 1996-2004 and matching with the Longitudinal Business Database and supplemental economic dat...

  7. Schooling, Child Labor, and the Returns to Healthcare in Tanzania

    Science.gov (United States)

    Adhvaryu, Achyuta R.; Nyshadham, Anant

    2012-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…

  8. Health technology assessment and its role in the future development of the Indian healthcare sector.

    Science.gov (United States)

    Hass, Bastian; Pooley, Jayne; Feuring, Martin; Suvarna, Viraj; Harrington, Adrian E

    2012-04-01

    Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada) that demonstrates how a new treatment for patients with atrial fibrillation - although more expensive than the current standard of care - improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

  9. Health technology assessment and its role in the future development of the Indian healthcare sector

    Directory of Open Access Journals (Sweden)

    Bastian Hass

    2012-01-01

    Full Text Available Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada that demonstrates how a new treatment for patients with atrial fibrillation - although more expensive than the current standard of care - improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

  10. Re-architecting oral healthcare for the 21st century.

    Science.gov (United States)

    Shetty, Vivek; Yamamoto, John; Yale, Kenneth

    2018-07-01

    The convergent forces of rising costs, growing consumerism, expensive new treatments, sociodemographic shifts and increasing health disparities are exerting intense and unsustainable pressures on healthcare systems. As with the other health domains, these disruptive forces demand new approaches and delivery models for oral healthcare. Technological innovations and practices borrowed from the e-commerce and tech sectors could facilitate the move to a sustainable 21st century oral healthcare system, one that delivers high-quality, value-based care to wider groups of patients. The broad reach of mobile technologies and changing digital lifestyles provide unique opportunities for using remote monitoring and self-care tools to reinforce preventive oral hygiene behaviours. By leveraging big data analytics and insights gleaned from the use of sensor-enabled oral care devices, providers will be able to engage patients more effectively and deliver timely, personalized behavioural nudges to support optimal oral health. Dental insurers and payers will need to reinvent their business models to incentivize dental providers and patients who embrace the digital-dentistry paradigm. This could involve increasing reimbursements for mHealth-delivered preventive dental services and holding individuals accountable for behaviours that put them at higher risk for dental disease. While Dentistry 1.0 was defined largely by the treatment of established dental disease, Dentistry 2.0 portends a new era of patient-centric, technology-enabled, outcomes-driven, and prevention-focused oral healthcare delivery with significant individual, provider and societal benefits. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Architecture and implementation for a system enabling smartphones to access smart card based healthcare records.

    Science.gov (United States)

    Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John

    2013-01-01

    The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.

  12. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  13. Social Medicine: Twitter in Healthcare.

    Science.gov (United States)

    Pershad, Yash; Hangge, Patrick T; Albadawi, Hassan; Oklu, Rahmi

    2018-05-28

    Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care. The sharing of information on Twitter can create a communicative and collaborative atmosphere for patients, physicians, and researchers and even improve quality of care. However, risks involved with using Twitter for healthcare discourse include high rates of misinformation, difficulties in verifying the credibility of sources, overwhelmingly high volumes of information available on Twitter, concerns about professionalism, and the opportunity cost of using physician time. Ultimately, the use of Twitter in healthcare can allow patients, healthcare professionals, and researchers to be more informed, but specific guidelines for appropriate use are necessary.

  14. Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

    Science.gov (United States)

    Cecchini, Michele; Sassi, Franco

    2015-07-01

    With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

  15. Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

  16. On Capillary Rise and Nucleation

    Science.gov (United States)

    Prasad, R.

    2008-01-01

    A comparison of capillary rise and nucleation is presented. It is shown that both phenomena result from a balance between two competing energy factors: a volume energy and a surface energy. Such a comparison may help to introduce nucleation with a topic familiar to the students, capillary rise. (Contains 1 table and 3 figures.)

  17. Plume rise from multiple sources

    International Nuclear Information System (INIS)

    Briggs, G.A.

    1975-01-01

    A simple enhancement factor for plume rise from multiple sources is proposed and tested against plume-rise observations. For bent-over buoyant plumes, this results in the recommendation that multiple-source rise be calculated as [(N + S)/(1 + S)]/sup 1/3/ times the single-source rise, Δh 1 , where N is the number of sources and S = 6 (total width of source configuration/N/sup 1/3/ Δh 1 )/sup 3/2/. For calm conditions a crude but simple method is suggested for predicting the height of plume merger and subsequent behavior which is based on the geometry and velocity variations of a single buoyant plume. Finally, it is suggested that large clusters of buoyant sources might occasionally give rise to concentrated vortices either within the source configuration or just downwind of it

  18. Concepts and trends in healthcare information systems

    CERN Document Server

    Koutsouris, Dionysios-Dimitrios

    2014-01-01

    ​Concepts and Trends in Healthcare Information Systems covers the latest research topics in the field from leading researchers and practitioners. This book offers theory-driven research that explores the role of Information Systems in the delivery of healthcare in its diverse organizational and regulatory settings. In addition to the embedded role of Information Technology (IT) in clinical and diagnostics equipment, Information Systems are uniquely positioned to capture, store, process, and communicate timely information to decision makers for better coordination of healthcare at both the individual and population levels. For example, data mining and decision support capabilities can identify potential adverse events for an individual patient while also contributing to the population's health by providing insights into the causes of disease complications. Information systems have great potential to reduce healthcare costs and improve outcomes. The healthcare delivery systems share similar characteristics w...

  19. Responsiveness of Lebanon's primary healthcare centers to non-communicable diseases and related healthcare needs.

    Science.gov (United States)

    Yassoub, Rami; Hashimi, Suha; Awada, Siham; El-Jardali, Fadi

    2014-01-01

    Lebanon currently faces a rise in non-communicable diseases (NCD) that is stressing the population's health and financial well-being. Preventive care is recognized as the optimal health equitable, cost-effective solution. The study aims to assess the responsiveness of primary health care centers (PHCs) to NCD, and identify the needed health arrangements and responsibilities of PHCs, the Ministry Of Public Health and other healthcare system entities, for PHCs to purse a more preventive role against NCD. Single and group interviews were conducted via a semi-structured questionnaire with 10 PHCs from Lebanon's primary health care network that have undergone recent pilot accreditation and are recognized for having quality services and facilities. This manifested administrative aspects and NCD-related services of PHCs and generated information regarding the centers' deficiencies, strengths and areas needing improvement for fulfilling a more preventive role. Administrative features of PHCs varied according to number and type of health personnel employed. Variations and deficiencies within and among PHCs were manifested specifically at the level of cardiovascular and respiratory diseases and cancer. PHCs identified the pilot accreditation as beneficial at the administrative and clinical levels; however, various financial and non-financial resources, in addition to establishing a strong referral system with secondary care settings and further arrangements with MOPH, are necessary for PHCs to pursue a stronger preventive role. The generated results denote needed changes within the healthcare system's governance, financing and delivery. They involve empowering PHCs and increasing their breadth of services, allocating a greater portion of national budget to health and preventive care, and equipping PHCs with personnel skilled in conducting community-wide preventive activities. Copyright © 2013 John Wiley & Sons, Ltd.

  20. [Healthcare patient loyalty].

    Science.gov (United States)

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  1. The rise of private health insurande in Denmark

    DEFF Research Database (Denmark)

    Dejgaard, Thomas Engel

    2011-01-01

    The Danish healthcare system has since the early 1970s been tax financed and with free and equal access to health care. It still is, but within the last decade there has been an exponential growth in the number of private health insurances – from less than 50.000 in 2002 to approximately 1.......1 million in 2010. These private health insurances to great extent cover the same kind of treatments that can be obtained through the public tax financed system, but without the waiting lists that has been the an unsolvable problem for the public health care system over the past two decades. The rise...... of private health insurances in Denmark means that alongside the public healthcare institution there has grown a private institutional layer. The existence of this private institutional layer raises questions of what kind of influence the new private institutions can have on the existing public healthcare...

  2. Inequalities versus Utilization: Factors Predicting Access to Healthcare in Ghana

    Directory of Open Access Journals (Sweden)

    Dominic Buer Boyetey

    2016-08-01

    Full Text Available Universal access to health care remains a significant source of inequality especially among vulnerable groups. Challenges such as lack of insurance coverage, absence of certain types of care, as well as high individual financial care cost can be blamed for the growing inequality in the healthcare sector. The concern is worrying especially when people are denied care. It is in this light that the study set to find out what factors are likely to impact the chances of access to health care, so far as the Ghana Demographic and Health Survey Data 2014 data are concerned, particularly to examine the differences in access to healthcare in connection with varying income groups, educational levels and residential locations. The study relied on the logistic regression analysis to establish that people with some level of education have greater chances of accessing health care compared with those without education. Also chances of access to health care in the sample were high for people in the lower quartile and upper quartile of the household wealth index and a local minimum for those in the middle class. It became evident also that increased number of people with NHIS or PHIS or combination of cash with NHIS or PHIS will give rise to a corresponding increment in the probability of gaining access to health care.

  3. Atomic energy in healthcare

    International Nuclear Information System (INIS)

    Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

    2013-01-01

    One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

  4. Communicating with Healthcare Professionals

    Science.gov (United States)

    ... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

  5. Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients.

    Science.gov (United States)

    van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W; Pols, Huibert A P; van der Cammen, Tischa J M

    2008-01-01

    Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. Within a common geriatric outpatient population, patients with a history of falls were assessed for falls risk (n = 139). Fall-risk-increasing drugs were withdrawn when appropriate (n = 75). All participants had a 2-month follow-up for fall incidents. The number of prevented falls was calculated using a loglinear regression model. The savings on health expenditures as a result of prevented injuries (estimated from a literature review) and reduced consumption of pharmaceuticals were compared with the intervention costs. After adjustment for confounders, drug withdrawal resulted in a falls risk reduction of 0.89 (95% CI 0.33, 0.98) per patient compared with the non-withdrawal group. Net cost savings were euro1691 (95% CI 662, 2181) per patient in the cohort. This resulted in a cost saving of euro491 (95% CI 465, 497) per prevented fall. Withdrawal of fall-risk-increasing drugs generates significant cost savings. Extrapolation of these findings to a national scale results in an estimated reduction of euro60 million in healthcare expenditures, that is, 15% of fall-related health costs.

  6. Combating employee theft in the healthcare industry.

    Science.gov (United States)

    Marquet, Christopher T

    2011-01-01

    The healthcare industry is especially susceptible to internal fraud and employee theft, the author's research has found. He presents details of 14 costly healthcare embezzlements that took place in three months and gives insight into schemes employed on the most common types of embezzlement. He also describes proactive steps which can be taken to prevent, detect and respond to this phenomenon as well as providing a primer on conducting an internal theft investigation.

  7. Late-Life Depression in Home Healthcare

    OpenAIRE

    Pickett, Yolonda; Raue, Patrick J.; Bruce, Martha L.

    2012-01-01

    Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to und...

  8. World medical schools: The sum also rises.

    Science.gov (United States)

    Rigby, Perry G; Gururaja, Ramnarayan P

    2017-06-01

    There is a worldwide shortage of doctors, which is true in most countries and on most continents. To enumerate the number of medical schools in the world at two different times, showing the trends and relating this to population is a beginning. The number is actually going up and has done so for some time; this has increased the supply of physicians and broadened healthcare delivery. The number to count for geographic and regional information about the medical schools relates directly to the supply of doctors. Regions were chosen from WHO and Foundation for the Advancement of International Medical Education and Research data to illustrate geographic distributions, physicians per patient and kinetics. The number of medical schools has consistently been rising around the world. However, world order is reverting to disorder, considering wars, disease and beleaguered stand-offs. None. Eight countries contain 40% of medical schools; however, several locations are rising faster than the rest. Some regions are stable, but sub-Saharan Africa, the Caribbean, South Asia and South America have increased the most in percentage recently, but not uniformly. Medical schools are related not only by geography, political boundaries and population but are concentrated in some regions. Graduate Medical Education positions appear to be short on a worldwide basis, as well as in some regions and countries. The number of medical schools is increasing worldwide and the identification of rapidly rising geographic areas is useful in exploring, planning and comparing regions. Controversy continues in a variety of locations, especially concerning Graduate Medical Education. In addition to funding, faculty candidates and accreditation, new schools are confronting a variety of choices in standards and quality, sizing and regional concerns.

  9. Healthcare resources and expenditure in financial crisis: scenarios and managerial strategies.

    Science.gov (United States)

    Nuti, Sabina; Vainieri, Milena; Frey, Marco

    2012-10-01

    What are the implications of financial crisis on healthcare expenditure? This paper explores different approaches applied across European countries focusing on the role that managerial tools may have in coping with this challenge. The paper reports the results of recent studies on responses to financial crisis from European countries and which are the techniques they had applied to reallocate resources. Although resources scarcity, some governments did not reduce the healthcare expenditure because they believe in its focal role on the economic development and on maintaining social cohesion and protection of vulnerable people. Other countries decided a strong reduction of costs which often has affected services delivered. In both cases authors suggest to avoid across-the-board cuts in favor of approach involving priority setting. The public sector has assumed new responsibilities following the global crisis and the rising demand for social services. Some countries shifted the healthcare costs from the public purse to private households undermining the survival of the health system and the universal coverage. A way to avoid this risk is based on the ability to share discussion about where to cut and where to reallocate resources.

  10. Data warehousing as a healthcare business solution.

    Science.gov (United States)

    Scheese, R

    1998-02-01

    Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.

  11. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  12. Rise of a cold plume

    International Nuclear Information System (INIS)

    Kakuta, Michio

    1977-06-01

    The rise of smoke from the stacks of two research reactors in normal operation was measured by photogrametric method. The temperature of effluent gas is less than 20 0 C higher than that of the ambient air (heat emission of the order 10 4 cal s -1 ), and the efflux velocity divided by the wind speed is between 0.5 and 2.8 in all 16 smoke runs. The field data obtained within downwind distance of 150m are compared with those by plume rise formulas presently available. Considering the shape of bending-over plume, the Briggs' formula for 'jet' gives a reasonable explanation of the observed plume rise. (auth.)

  13. Visualizing desirable patient healthcare experiences.

    Science.gov (United States)

    Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

    2010-01-01

    High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider.

  14. Healthcare Firms and the ERP Systems

    Directory of Open Access Journals (Sweden)

    A. Garefalakis

    2016-04-01

    Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

  15. The orthopaedist's role in healthcare system governance.

    Science.gov (United States)

    Probe, Robert A

    2013-06-01

    Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

  16. National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis with Policy Implications

    OpenAIRE

    Harris, Catherine R.; Osterberg, E. Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W.; McAninch, Jack W.; McCulloch, Charles E.; Breyer, Benjamin N.

    2016-01-01

    To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality.We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear ...

  17. Reforming the U.S. Healthcare System

    OpenAIRE

    Bart Gordon

    2009-01-01

    I have heard from countless Tennesseans who have said they simply can't keep up with the rising costs of health insurance. In Tennessee alone, insurance costs have risen 129% for small businesses since 2000, forcing many to cut benefits or stop offering coverage for employees.

  18. E-commerce in healthcare: changing the traditional landscape.

    Science.gov (United States)

    Aggarwal, A K; Travers, S

    2001-01-01

    The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

  19. Safety and Accountability in Healthcare From Past to Present

    International Nuclear Information System (INIS)

    Hendee, William R.

    2008-01-01

    Healthcare is transitioning into a new era-an era of accountability. This era demands heightened awareness of the quality, cost, and safety of healthcare, with value (quality/cost) and safety being the watchwords of accountability. Many factors are driving this transition, and it is affecting all healthcare disciplines, including radiation oncology. The transition is accompanied by the transformation of healthcare from a craft-based culture to an information-age culture in which patient needs and information are given top priority. These changes call for new measures to quantify and document the value and safety of procedures in radiation oncology

  20. Costing bias in economic evaluations.

    Science.gov (United States)

    Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

    2015-01-01

    Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.