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PubMedDate not supplied

Health plan budget impact analysis for pimecrolimus.

OBJECTIVE: Budget impact models are useful tools for managed care organizations to make drug formulary decisions. The objective of this study was to estimate the incremental budgetary change in per-member-per-month (PMPM) medical and pharmacy costs for atopic dermatitis (AD) or eczema after the introduction of pimecrolimus cream 1%, a topical calcineurin inhibitor. METHODS: Estimates of the percentage of patients seeking care, treatment patterns, and quantities of medications dispensed for AD were measured using 2001 and 2002 medical and pharmacy records in a proprietary database for health plans distributed throughout the United States. Approximately 2.5 million health plan members had continuous health insurance coverage during the study period. Costs for medications were assigned using the 2003 wholesale acquisition cost, and costs for physician visits were based on average 2003 Medicare reimbursement rates. Efficacy data from clinical trials were used to model the impact of pimecrolimus on subsequent physician visits. Sensitivity analyses were performed to evaluate the impact of varying the percentage of patients seeking care, practice patterns, medication quantities, percentage of pimecrolimus users, and levels of patient cost sharing. RESULTS: The estimated percentage of health plan members seeking care for AD in 2001 was 3.2%. The estimated total cost PMPM for AD treatment prior to introduction of pimecrolimus was 0.362 dollars for all covered lives, assuming no patient cost sharing. In the year after its introduction, 5.2% of the AD population filled a prescription for pimecrolimus. The incremental increase in pharmacy benefit cost was 0.008 dollars PMPM in 2003 dollars, but the total incremental medical and pharmacy cost was 0.002 dollars PMPM after accounting for the projected reduction in physician visit costs, representing a 0.7% increase in all AD-related costs. Based on sensitivity analyses, the incremental total cost PMPM after the introduction of pimecrolimus ranged from -0.004 dollars to 0.026 dollars. CONCLUSION: Using claims data for the medical treatment of AD in 2001-2002 and the utilization of pimecrolimus, the addition of pimecrolimus as a treatment option for AD had a minimal impact on PMPM costs for AD-related care in 2003 dollars. As with all pharmacoeconomic models, health plans should perform their own budget forecasting using assumptions derived from their own pharmacy and medical claims data.

Budgets↗
PubMed1996

Consequences of implementing a drug budget for office-based physicians in Germany.

For many years, drug prices in Germany were the highest in Europe and the level of regulation of the pharmaceutical industry was lower than in other states. This situation has, however, changed radically in recent years. Pharmaceutical prices have been regulated, without the introduction of direct price controls, through a combination of pressures exerted by the authorities and the German sickness funds, which are responsible for reimbursement. The process of price restriction began in 1984 with the imposition of a negative pharmaceuticals list, which was further extended in 1989. A reference pricing system was also introduced in 1989, and a drug budget for office-based physicians in 1993. An overview of these measures is provided in the first section of this article. This is followed by a report of a study of the impact of Germany's global pharmaceutical budgets for office-based general practitioners and internists.

Budgets↗
PubMed2002

Pathbreaking Congressional Budget Office study shows dramatic increases in income disparities in the 1980s and 1990s: an analysis of the CBO data.

Researchers at the Center on Budget and Policy Priorities analyze the data presented in a Congressional Budget Office study that includes the best data any agency or institution has compiled on income and tax trends in recent decades. The CBO report shows that the average after-tax income of the richest 1 percent of Americans grew by $414,000 between 1979 and 1997 (after adjusting for inflation) while average after-tax income fell $100 for the poorest 20 percent of Americans and grew a modest $3,400 for those in the middle of the income spectrum. In percentage terms, after-tax income grew an average of 157 percent over this period for the top 1 percent, rose a modest 10 percent for the middle 20 percent, and was effectively unchanged for those in the bottom fifth. Income gaps between rich and poor and between the rich and the middle class widened in the 1980s and 1990s and reached their widest point on record in 1997. Even before enactment of the 2001 federal tax cuts, the percentage of income Americans pay in federal taxes has declined since 1979 for every income group. By one key measure, the percentage of income paid in federal taxes fell the most for those with the highest incomes.

Budgets↗
PubMed1990

Developing a variable budget for occupational therapy contract work.

Contract occupational therapists need to develop a financial plan for improved control of their business. The variable budget allows financial planning according to actual performance volume. This paper describes a step-by-step method for the development of a variable budget through the illustration of a case example.

Budgets↗
PubMed1992

Transitional funding: changing Ontario's global budgeting system.

In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.

Budgets↗
PubMed1992

The continuing impact of home oxygen therapy for respiratory patients on a hospital budget.

Home oxygen therapy for chronic lung disease is a prominent example of an increasing tendency for the provision of adaptive medical technologies by tertiary-level hospital outreach. Flinders Medical Centre has carefully monitored its home oxygen service using cost-centre management. Despite strict prescription criteria and cost-saving technological advance, this budget remains under continued pressure. Demand from eligible patients is increasing, and their enhanced survival means that numbers accumulate over the years. Unfortunately, long-term community support does not fit easily into conventional hospital budgetting. Hospitals at present do not explicitly record the benefits nor bring to account the cost savings from maintaining patients in the community. Several intermediate improvements are suggested.

Bed Occupancy↗
PubMed1993

Medicare program; data, standards and methodology used to establish fiscal year 1992 budgets for fiscal intermediaries and carriers--HCFA. Final notice.

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final without revision proposed data, standards, and methodology used to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1992, beginning October 1, 1991. It also contains our response to public comments on the proposal.

Budgets↗
PubMed1994

Medicare program: data, standards and methodology used to establish fiscal year 1993 budgets for fiscal intermediaries and carriers--HCFA. Final notice.

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which requires us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final, and responds to comments about, the data, standards, and methodology we proposed to use to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1993, beginning October 1, 1992.

Budgets↗
PubMed1994

Medicare program: data, standards, and methodology used to establish fiscal year 1994 budgets for fiscal intermediaries and carriers--HCFA. Final notice.

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards, and methodology used to establish budgets for Medicare intermediaries and carriers. In this notice, we respond to the comments received in response to our notice of October 5, 1993 and we announce the adoption of the proposed data, standards, and methodology that we used to establish the Medicare fiscal intermediary and carrier budgets for fiscal year (FY) 1994, beginning October 1, 1993, as final and without revision.

Budgets↗
PubMedDate not supplied

Is small really beautiful? Some thoughts on the 1995 federal budget.

The 1995 federal budget meets the financial markets' expectations by proposing deep funding cuts and defining a smaller federal presence in several sectors of Canadian society. The most significant aspect of the budget for health care is the creation of the Canada Health and Social Transfer, which merges federal funding for health, post-secondary education and social assistance into one block grant. Provinces will be free to shift funds among these programs.

Budgets↗
PubMedDate not supplied

Budgeting for a more likely future.

"The future isn't what it used to be!" Medical group managers must take this humorous truth as gospel. Managed care and capitation are rapidly changing everything about medical group planning and budgeting. Profit centers will cease to exist and instead, all departments will become cost centers. Specialists and primary care physicians will find themselves in very different--and much less comfortable--roles. Administrators must strive to keep the whole team working together even in the face of unprecedented stress. Incentives may change, but quality of care and patient satisfaction will need to stay high and even improve to ensure survival. The budgeting process can be an important tool for helping to prepare for the evolution of medical groups, but first the implications of medical marketplace reform must be understood and accepted. This task will be emotionally and intellectually challenging. Accepting the shape of our future is painful but necessary. The choice is clear: rapidly evolve or disappear.

Budgets↗
PubMed1991

The impact of family and budget structure on health treatment in Nigeria.

Health-treatment decisions, in much of the world, are affected by the family's ability to meet the cost. In West Africa the situation is more complex because husbands and wives typically have separate budgets. This article reports an exploration of the impact on treatment of divided family budgets in Nigeria where health services now charge for prescribed drugs. It was found that most child treatment is paid for by one person only, usually a parent, and that the treatment chosen is decided by the person meeting the cost. Mothers are most likely to pay for minor illnesses but the father's role becomes more important as the cost rises. Because the type, and even fact, of treatment depends on the ability to pay, and because the family is not a unity in these decisions, the health system may have to devise charging procedures that make both parents responsible, possibly with community involvement in securing payment.

Adolescent↗
PubMed1995

Hospital staffing adjustments under global budgeting.

The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems.

Budgets↗
PubMed1992

Use of demand surveys to support budget requests.

Like pharmacy staff members at many hospitals, pharmacy personnel at Deborah Heart and Lung Center have been affected by new programs or increased activities undertaken by their organization and/or other departments requiring pharmacy support. At Deborah, these programs and activities were initiated after department budgets for the year were already approved. For the past 2 years the pharmacy department has employed a method of planning that effectively eliminated this problem as well as supported budget requests for increased services.

Budgets↗
PubMedDate not supplied

Developing a budget for the laboratory.

Cost accounting is the basic "tool" for identifying the expenses associated with laboratory operations. A budget is a planning tool that allows the director and manager to visualize the evolution of expenses, assets, liabilities, and revenues over a period of time. It is a quantitative annual plan of activities and programs that helps an organization measure the progress toward its financial goals on a periodic basis. A knowledge of how to develop and understand a budget is essential for every director and manager.

Accounting↗
PubMedDate not supplied

Laboratory administration--capital budgeting.

The process of capital budgeting varies among different health-care institutions. Understanding the concept of present value of money, incremental cash flow statements, and the basic budgeting techniques will enable the laboratory manager to make the rational and logical decisions that are needed in today's competitive health-care environment.

Budgets↗
PubMed1979

The capital budget: a case study in physician involvement.

The Capital Budget Committee of a community general hospital in New Jersey includes three physician members (along with six trustees and an administrative staff member) and is headed by a physician chairman. How this successful multidisciplinary approach to capital budgeting works is summarized in practical detail.

Budgets↗
PubMed1982

Involving the medical staff in budgeting.

Involvement of the medical staff in the capital budgeting process at one facility resulted in greater commitment by the staff to the organization and the incorporation of 60 percent of the programs and equipment requested in the final budget. This article discusses the process used to secure that involvement.

Budgets↗