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PubMed2003

Behavioral health issue brief: state budget actions that affect public mental health services and systems: year end report-2003.

With ongoing declines in the economy, states have readjusted their FY 2003 budgets throughout the fiscal year, while at the same time negotiating their upcoming FY 2004 and FY 2005 budgets. Because of the current fluidity of state budgets, this issue brief contains snapshots of actions taken at various times throughout FY 2003. It is intended to provide the reader with a general overview of the effects on public mental health systems, of the decline in state economies. The Health Policy Tracking Service (HPTS) will continue to track this issue, and will update this brief at quarterly intervals.

Budgets↗
PubMed2004

Budget and profitability.

To fully understand profit and how it can be maximized in a dental practice, a proper budget must be developed. A budget helps the dentist understand how every component of practice performance is affecting profitability. When a budget is completed, goals must be set, and the systems needed to reach those goals must be implemented continuously. By carefully analyzing ways to make your practice more profitable, you will see short-term production benefits and long-term profitability benefits that will allow you to achieve financial independence more quickly.

Budgets↗
PubMed2005

A budget model to determine the financial health of nursing education programs in academic institutions.

In the allocation of resources in academic settings, hierarchies of tradition and status often supersede documented need. Nursing programs sometimes have difficulty in getting what they need to maintain quality programs and to grow. The budget is the crucial tool in documenting nursing program needs and its contributions to the entire academic enterprise. Most nursing programs administrators see only an operating expense budget that may grow or shrink by a rubric that may not fit the reality of the situation. A budget is a quantitative expression of how well a unit is managed. Educational administrators should be paying as much attention to analyzing financial outcomes as they do curricular outcomes. This article describes the development of a model for tracking revenue and expense and a simple rubric for analyzing the relationship between the two. It also discusses how to use financial data to improve the fiscal performance of nursing units and to leverage support during times of growth.

Budgets↗
PubMed2005

Budgeting: an analysis of the basic key concepts.

The process of budgeting can be the most important tool available to an EMS department management team. The person(s) responsible for the oversight of the department should have a working knowledge of both the budget numbers themselves and, more important, the process of working through a budgetary cycle. This should include members of the management team who do not have direct responsibility for preparation and presentation of the budget, as they will often be the persons who assist the preparer in budgetary maintenance over its life cycle. A working knowledge of basic financial concepts by all members of the management team is paramount to the continued viability and success of any proactive EMS department.

Budgets↗
PubMed2006

The effect of recombinant activated factor VII in the treatment of intracerebral hemorrhage on health plan budgets.

Treating patients with intracerebral hemorrhage (ICH) using recombinant activated factor VII (rFVIla) has been found to improve survival and functional outcome. To examine how the introduction of rFVIla 80 microg/kg as a treatment for ICH affects the budget of a health plan, a decision-analysis model was developed which considered both short-term hospitalization costs and long-term management of disability. Assuming a health plan enrollment of 1 million members and initial rFVIla uptake of 50% in appropriate patients, the annual health plan cost may be expected to increase by dollar 64,781 (dollar 0.005 per-member per-month). With a 5% increase in uptake each year, the annual health plan's cost may decrease compared with the current budget within three years. The implications for this sample health plan's budget are modest in the first year, and a reduction in costs is expected within three years owing to improved functional outcomes of patients.

Budgets↗
PubMed1991

Small business, cash budgets and general practice.

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

Budgets↗
PubMed1978

The Carter administration's health budget: charting new priorities with limited dollars.

Although the budget is described by the Administration as a "full statement of its priorities," policy and spending are bound by past decisions. New program initiatives are limited to a few discretionary programs under the Public Health Service, but the massive budget does reveal personal preferences of the President and the Secretary. Some of these choices may not find congressional favor; yet the entire budget process shows the Democrats again endorsing the categorical approach reminiscent of the New Deal and the Great Society.

Budgets↗
PubMed1988

Budgets: an underused resource.

Though budgeting is an activity that management readily participates in, the budget often ends up being underused. The author discusses how budgeting activities can be used in revenue allocation, program implementation, planning, coordination, profitability, designation of responsibility, and measurement reviews.

Budgets↗
PubMed1986

Consolidated Omnibus Budget Reconciliation Act of 1985.

This article briefly describes the legislative history of the old-age, survivors, and disability insurance (OASDI) and supplemental security income (SSI) provisions, as well as related Medicare and Medicaid provisions, of the Consolidated Omnibus Budget Reconciliation Act of 1985 (Public Law 99-272). It includes a chronology outlining the interaction of the budget reconciliation process with the development of the OASDI minor and technical changes bill (H.R. 2005) and the development of other social security related legislation resulting in proposals that ultimately combined in the overall Consolidated Omnibus Budget Reconciliation Act of 1985. The article also provides a detailed summary of the provisions of the legislation.

Aged↗
PubMed1995

The nominal and real effects of hospital global budgets in France.

If global budgets consistently reduce health care expenditures by cutting inefficiency and economic rents (i.e., by lowering the relative price of services), their appeal as a public policy tool is clear. This paper shows the French inpatient global budget policy, implemented in 1984, was successful in slowing expenditure growth. It did so, however, by reducing the volume of services; the relative price of these services remained constant. Compared with previous research, these findings suggest the effect of global budgets depends on the method of implementing the policy and the health care infrastructure on which the expenditure policy is imposed.

Budgets↗
PubMed1994

Strategies for implementing global budgets.

Implementing global budgets requires setting a desired level of spending as well as establishing a set of policies to assure the budget will be met. Four alternative approaches are analyzed: one relies on all-payer rate setting coupled with volume controls; the second is a system of premium regulation that controls both the levels and rates of insurance premium increase; in another system, price competition among insuring organizations limits growth in spending while incorporating a global budget that limits the aggregate costs of all premiums; finally, either managed competition or premium regulation is combined with all-payer rate setting. The fourth model is singled out for its ability to control costs. An independent policy toward capital expenditures could increase the likelihood of success under any of the strategies.

Budgets↗
PubMed2004

Seasonal variations in the activity budget of Japanese macaques in the coniferous forest of Yakushima: effects of food and temperature.

Seasonal variations in the activity budget of Japanese macaques in the coniferous forest of Yakushima were studied over the course of 1 year. On an annual basis, they spent 38% of the daytime feeding, 16% traveling, 14% in social interactions, and 32% engaged in resting. The effects of temperature and food-related factors (i.e., food distribution, feeding speed, and food abundance) on the seasonal variations of activity budget were examined by stepwise multiple regression analysis. When the temperature was low, the macaques decreased traveling and feeding time, in accordance with the prediction that endothermal animals save energy under severe thermoregulatory cost. When the feeding speed of available foods was slow, they spent more time feeding. When high-quality foods were abundant, they decreased feeding time. These macaques did not respond to fluctuations in food distribution. The present results indicate the importance of temperature, in addition to food-related factors, as a determinant of activity budgets.

Animals↗
PubMed2005

Analysis of a pharmaceutical risk sharing agreement based on the purchaser's total budget.

Many public and private healthcare payers use formularies as a tool for controlling drug costs and quality. Although the price per dose is often negotiated as part of the formulary listing, payers may still face unlimited financial risk if demand is much greater than expected at the time of listing. The requirement for drug manufacturers to submit a budget impact analysis as part of the drug approval process suggests that payers are concerned not only with the cost effectiveness of a proposed drug but also with the potential increase in total expenditures that may result from new formulary listings. In this paper we define and analyze a model for financial risk sharing based on the total budget. Our analysis focuses on optimal decision making by manufacturers in the presence of a specific risk sharing agreement. We derive a manufacturer's optimal statement of budget impact and discuss several properties of the optimal solution.

Cost-Benefit Analysis↗
PubMed2002

Variability in abciximab (ReoPro) prescribing: evidence based or budget driven?

PURPOSE: Abciximab improves outcomes in patients undergoing percutaneous transluminal coronary intervention (PTCA). Clinicians, however, have expressed concerns that they do not have enough budget to administer abciximab to all eligible patients. We studied the patterns of prescribing of abciximab and identified factors that correlate with the level of usage. METHODS: In each of all 13 Dutch PTCA centres one opinion-leading cardiologist was approached to provide data on the abciximab prescribing in their centre and to co-operate in an interview on this topic. We performed linear regression analysis in which the level of abciximab prescribing was the dependent variable. Potential determinants investigated were the number of PTCAs performed, the criteria for abciximab prescribing, funding and possible financial restrictions, participation in clinical trials in the past, percentage stenting, and desired level of abciximab prescribing. RESULTS: All 13 PTCA centres in the Netherlands participated in our study. The level of abciximab prescribing varied from 2 to 36% of all PTCAs. The criteria for patient selection significantly differed between centres. Together budget, investigatorship, size, and type of the institution were highly predictive for the level of abciximab prescribing (R2 = 0.93, p < 0.001). The more patients doctors had included in clinical trials in the past, the higher was the likelihood that they had prescribed abciximab. CONCLUSIONS: Shortly after its introduction, patterns of abciximab prescribing varied widely between PTCA centres. There was no agreement on which patients to select for this preventive treatment. Budget and involvement in clinical trials in the past were important predictors of the level of prescribing in each centre.

Abciximab↗
PubMed1998

Behavioural time-energy budgets of cooperatively breeding Neolamprologus pulcher (Pisces: Cichlidae).

We estimated the energy expenditures resulting from helping behaviour in the cooperatively breeding cichlid N. pulcher by measuring the metabolic rates directly associated with specific social and territory maintenance behaviours of individual pair males and females, and their helpers, in a respirometer. In pair males, pair females and helpers, routine metabolism was raised on average 4.4, 3.8 and 3.6 times, respectively, during agonistic behaviour. Helpers spent 3.3 and 6.1 times routine metabolism, respectively, on submissive behaviour (tail quivering) and digging. These estimates of energy expenditure were combined with laboratory time budgets, obtained previously, to calculate behavioural time-energy budgets for pair members and helpers. Both groups spent on average 98.5% of total metabolism on routine and standard metabolism. With regard to the energy expended on specific behaviours, pair males invested almost exclusively in intrafamily agonistic behaviour, while pair females and helpers shared the investment in territory maintenance and direct brood care. The behavioural energy budget of helpers was strongly determined by their submissive behaviour. This serves to maintain the social status of the helpers within the family hierarchy and may therefore be regarded as 'paying for staying', which may also be true for direct brood care and other helper duties. We conclude that the substantial energy expenditures associated with helping behaviours are probably partly responsible for the reduced growth rates of helpers. This is the first study in which energy expenditures associated with specific helping behaviours have been measured in brood care helpers, and it provides the first estimate of total behavioural energy expenditure in a cooperatively breeding fish. (c) 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1990

Prophylactic antibiotics and the hospital budget: controversy for patients and hospital financial strategies?

Although total drug costs account for only 2 to 3% of the total hospital budget, the management of these costs is of much interest. Total costs can be subdivided into numerous items; each can be influenced to some extent. Such costs are analysed in this article. The Dutch system of hospital budgeting is also described. The way in which (prophylactic) antibiotics can influence budget parameters is described and quantified by an example in gynaecological surgery. It is concluded that the profits of modern pharmacotherapy in the hospitals are earned outside the hospital. Society should realize that these profits must be re-invested to assure a healthy health-care system in the near future.

Anti-Bacterial Agents↗
PubMed2004

Using sediment budgets to investigate the pathogen flux through catchments.

We demonstrate a materials budget approach to identify the main source areas and fluxes of pathogens through a landscape by using the flux of fine sediments as a proxyfor pathogens. Sediment budgets were created for three subcatchment tributaries of the Googong Reservoir in south-eastern New South Wales, Australia. Major inputs, sources, stores, and transport zones were estimated using sediment sampling, dam trap efficiency measures, and radionuclide tracing. Particle size analyses were used to quantify the fine-sediment component of the total sediment flux, from which the pathogen flux was inferred by considering the differences between the mobility and transportation of fine sediments and pathogens. Gullies were identified as important sources of fine sediment, and therefore of pathogens, with the pathogen risk compounded when cattle shelter in them during wet periods. The results also indicate that the degree of landscape modification influences both sediment and pathogen mobilization. Farm dams, swampy meadows and glades along drainage paths lower the flux of fine sediment, and therefore pathogens, in this landscape during low-flow periods. However, high-rainfall and high-flow events are likely to transport most of the fine sediment, and therefore pathogen, flux from the Googong landscape to the reservoir. Materials budgets are a repeatable and comparatively low-cost method for investigating the pathogen flux through a landscape.

Animals↗
PubMed2002

Budget impact model for determining the costs of introducing inhaled salmeterol/fluticasone propionate combination for the management of persistent asthma in France.

A budget impact model was used to estimate the effect of introducing inhaled salmeterol/fluticasone propionate combination on asthma drug-related costs in France. The model is based on disease prevalence, drug use, drug acquisition cost and sales forecasting data specific to France. It takes the perspective of social security and has a time horizon of 1 year. All drug acquisition costs are adjusted for the average rate of reimbursement of asthma medications in France (77.3%). All costs are expressed in euros. The model shows that if patients receiving concurrent salmeterol plus fluticasone propionate (or budesonide plus formoterol switch to combined salmeterol/fluticasone propionate, the anticipated annual savings would be 2,691,580 and 1,916,966 euros, respectively. On a fixed budget 4067 additional patients could be treated if salmeterol/fluticasone propionate is substituted for concurrent salmeterol plus fluticasone propionate and an additional 2939 patients if the combination is used to replace concurrent budesonide plus formoterol. Overall, using sales forecasting data to estimate how many patients will switch to the new combination from their current therapy, it is estimated that the introduction of salmeterol/fluticasone propionate will increase the national expenditure in France on asthma medications by a maximum of 3%. This budget impact model shows that the introduction of inhaled salmeterol/fluticasone propionate combination is likely to have minimal impact on asthma-related medication costs in France. Moreover, the available data on the salmeterol/fluticasone propionate combination suggest that it is clinically effective, cost-effective and affordable to the French healthcare system.

Journal Article↗