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PubMed2004

Improvement potential in Danish elderly care.

This paper examines Danish elderly care resource utilization among municipalities. The available production data are aggregated, which means that it is virtually impossible to allocate costs to specific services. We show that Multi-directional Efficiency Analysis (MEA) provides a much more subtle performance picture than Data Envelopment Analysis (DEA) because we are able to assess the input specific relative improvement potentials. The empirical results show considerable improvement potential for all inputs. The largest relative potential for improvement is found for administrative staff.

Aged↗
PubMed1999

Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation.

A randomized controlled trial (RCT) comparing primary-care-centred follow-up of breast cancer patients with the current standard practice of specialist-centred follow-up showed no increase in delay in diagnosing recurrence, and no increase in anxiety or deterioration in health-related quality of life. An economic evaluation of the two schemes of follow-up was conducted concurrent with the RCT Because the RCT found no difference in the primary clinical outcomes, a cost minimization analysis was conducted. Process measures of the quality of care such as frequency and length of visits were superior in primary care. Costs to patients and to the health service were lower in primary care. There was no difference in total costs of diagnostic tests, with particular tests being performed more frequently in primary care than in specialist care. Data are provided on the average frequency and length of visits, and frequency of diagnostic testing for breast cancer patients during the follow-up period.

Breast Neoplasms↗
PubMed2001

A critical review of cost reduction in neonatal intensive care. I. The structure of costs.

Neonatal intensive care is expensive. In the current era of intense cost containment in hospital care, neonatologists and hospital administrators are under intense pressure to find strategies for cost reduction for neonatal services. Few neonatal clinicians are trained in economics, management, or accounting, and few hospital administrators are familiar with neonatal intensive care. In this review, we describe the structure and sources of hospital costs and the accounting systems needed to isolate and measure such costs. We discuss where efficiencies might be found and consider specific issues in capitated settings such as health maintenance organizations in the United States, the Canadian health care system and the National Health System in the United Kingdom.

Accounting↗
PubMed2003

[Universal newborn hearing screening in Marien Hospital Hamburg from September 1999 till April 2002].

BACKGROUND: With a prevalence of 5 in 1000 newborns with a hearing disorder, the congenital hearing disorders apparently constitute a serious health problem. The aim of this study was the introduction of a universal newborn hearing screening at our clinic. We also investigated if a universal screening only on parents' demand is possible. METHODS: From September 1999 to April 2002 a total of 3049 newborns, delivered at the Marien Hospital in Hamburg 97 %, were screened with the Echo-Screen TE (Fischer-Zoth). RESULTS: Only 2 of the 3049 screened infants showed signs of severe sensori-neural hearing loss. Both children belonged to high risk groups. During the period of the parental request for an investigation only 10.4 % of the newborn were screened compared to 97 % newborns during the universal newborn hearing screening. CONCLUSION: By measurement of TEOAE alone, we found a significantly lower incidence of hearing disorders than reported in literature; it may therefore not be sufficient for screening. Universal newborn hearing screening only performed on parents' demand seems to be impossible to conduct. Also before establishing a universal newborn hearing screening, cost allocation has to be solved.

Cross-Sectional Studies↗
PubMed1997

To market, to market: corporatisation, privatisation and hospital costs.

The Australian political arena echoes with calls for the privatisation of health care institutions, the contracting-out of health care services and the introduction of various marketing strategies into hospital management. These calls are justified by asserting that the market, rather than the public sector, can provide better services, greater productivity and increased efficiency. The National Health Strategy (1991, p 17) provides a good example. Noting that Australia is copying American investment trends for hospital 'chains' rather than for independent small establishments, the strategy dismisses any concern over changes in ownership, pointing instead to a 'process of rationalisation' that is to be 'welcomed'. Using evidence from the United States, United Kingdom and Australian hospital sectors, this paper examines claims for the greater efficiency of market processes.

Australia↗
PubMed1998

The second national hospital costing study: background, results and implications.

The costing of hospital outputs, and especially of acute admitted patients categorised by DRG, has been the focus of considerable attention in the last decade. Many individual hospitals now routinely estimate the costs of their main products, several State and Territory health authorities undertake periodic multi-site studies, and there have been a few one-off national studies. This paper summarises the methods and results of the most recent national study, which measured costs at a sample of public and private hospitals around Australia for the 1996-97 financial year. We briefly describe the main results and note some implications.

Australia↗
PubMed1982

Economics of food irradiation.

This article examines the cost competitiveness of the food irradiation process. An analysis of the principal factors--the product, physical plant, irradiation source, and financing--that impact on cost is made. Equations are developed and used to calculate the size of the source for planned product throughput, efficiency factors, power requirements, and operating costs of sources, radionuclides, and accelerators. Methods of financing and capital investment are discussed. A series of tables show cost breakdowns of sources, buildings, equipment, and essential support facilities for both a cobalt-60 and a 10-MeV electron accelerator facility. Additional tables present irradiation costs as functions of a number of parameters--power input, source size, dose, and hours of annual operation. The use of the numbers in the tables are explained by examples of calculations of the irradiation costs for disinfestation of grains and radicidation of feed.

Cesium↗
PubMed1998

Activity-based cost management. Part II: Applied to a respiratory protection program.

To demonstrate the relevance of activity-based cost management (ABCM) for the occupational and environmental health community, the investigators used data generated by an ABCM model of a respiratory protection program (RPP) to develop options for solving a business problem. The RPP manager in this hypothetical but realistic business scenario is faced with a 25% budget cut and a 10% increase in demand for RPP services. The manager's dilemma is to maintain the integrity of the RPP while absorbing a significant budget cut. Various cost savings options are developed, and the assumptions under which these options operate are presented. It is emphasized that the RPP manager's primary responsibility is to assure worker health and safety by first understanding the technical issues, merits, and implications of any cost-cutting option that may be considered. It is argued that only then should the manager consider the financial merits of the possible solutions to this business problem. In this way worker health and safety, and environmental protection goals, can continue to be achieved in an economic climate of cost cutting and downsizing.

Accounting↗
PubMed1999

The usefulness of pathologists' assistants.

The usefulness of pathologists' assistants (PAs) has not been assessed rigorously. Data from a time-motion self-report log generated by an Allegheny General Hospital (Pittsburgh, PA) PA and from the corresponding surgical specimen logs were reviewed to determine the daily distribution of PA time and multiple parameters of practice for gross examination of specimens. Using these data in specific scenarios, PA and non-PA practices were compared. The majority of the PA's time (56.5%) was spent performing gross examination of surgical biopsy specimens. The average cost of gross examination per specimen for a PA and a pathologist was $4.37 and $15.19, respectively. In this practice setting, $91,970.00 is saved per year by the use of a PA. The use of PAs instead of pathologists results in considerable practice cost savings ($560,000 in a practice of 50,000 specimens) or saves pathologists time to perform other necessary functions. PAs are highly useful in an era of cost containment.

Cost Allocation↗
PubMed2000

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

According to official figures, HIV infection in Zimbabwe stood at 700 000-1 000 000 in 1995, representing 7-10% of the population, with even higher expected numbers in 2000. Such high numbers will have far reaching effects on the economy and the health care sector. Information on costs of treatment and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through an in-patient note review) to identify the direct treatment and diagnostic costs such as medication, laboratory tests and X-rays, and the standard step-down costing methodology to capture all the remaining resources used such as hospital administration, meals, housekeeping, laundry, etc. The findings of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference could be attributed to higher direct costs per in-patient day (medication, laboratory tests and X-rays) as well as longer average lengths of stay in hospital for HIV/AIDS patients compared with non-infected patients. Therefore, the impact on hospital services of increasing number of HIV/AIDS patients will be enormous.

Cost Allocation↗