Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Income Generation Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed2001

Cost-effectiveness analysis in the courts: recent trends and future prospects.

This article provides an initial look at how managed care organizations (MCOs) might incorporate cost-effectiveness analysis (CEA) into their decision-making process and how the courts might respond. Because so few medical liability cases directly involve CEA, we must look at other areas of the law to assess potential MCO liability for applying CEA. In general negligence cases, courts rely on a risk-benefit test to determine customary practice. Likewise, in product liability cases, courts use a risk-utility calculus to determine liability for product design defects. And in challenges to government regulation, courts examine how agencies use CEA to set regulatory policy. The results have been mixed. In product liability cases, CEA has led to some punitive damage awards against automobile manufacturers. But courts have integrated it in negligence cases without generating juror antipathy, and generally defer to agency expertise in how to incorporate CEA. The article discusses the implications of these cases for MCO use of CEA and outlines various options for setting the standard of care in the managed care era.

Consumer Product Safety↗
PubMed1997

Physician profiling and capitated income distribution.

Increasingly, gastroenterologists are addressing the practice issues of physician profiling and capitation. This article describes a method to easily create practice-generated physician profiles that are used in quality of care management and contracting decisions. These profiles are also used as part of a method for capitation revenue distribution that is described and that has been used by the author's practice for over 3 years. This capitation revenue distribution methodology properly rewards the provision of cost-effective care and bonuses desirable to physician-patient relationships, while protecting against under- or over-utilization.

Capitation Fee↗
PubMed1992

A productivity tool to evaluate NP practice: monitoring clinical time spent in reimbursable, patient-related activities.

Productivity measurements for nurse practitioners often record only the number of visits or the income generated by patient care. Such measurements provide useful information but do not always reflect the actual amount of time spent with patients. In addition, these numbers may not separate the travel time, administrative tasks or other duties from the actual delivery of primary care. At Swedish Hospital Medical Center in Seattle, the staff of the Senior Health Services department participated in the development of a computerized productivity monitor, which assigns a weight to each patient visit according to time spent and then compares the total weights with actual clinical or "productive" time spent during a designated work period. The weighted visits give nurse practitioners a more accurate picture of how they spend their time and allow them to trace billing patterns. A simple software program, tied into the billing and statistics recording, provides an easy and meaningful measurement of nurse practitioner productivity, both individually and departmentally.

Efficiency↗
PubMed2002

Dental care considerations for young children.

Although the majority of America's children enjoy remarkably good oral health, a significant subset of low-income, minority, medically and developmentally compromised, and socially vulnerable children continue to suffer significant and consequential dental and oral disease. Most of this inequitably distributed disease burden is preventable through early and individualized preventive care. Yet the primary-care medical and dental workforce is ill-prepared to manage the oral health needs of young children. Demographic trends suggest that the problem of disparities in both oral health status and access to competent dental services will continue to worsen for young children. Impediments to improving the oral health of young children include barriers between medical and dental systems of care, paucity of private and safety-net facilities and providers in many areas where vulnerable children reside, and dysfunctional Medicaid insurance programs. Barriers are generated by parents, providers, payers, and systems of care as well as by the age-appropriate behaviors of young children. Vulnerable families often do not access the case management services and disease control information needed to effectively address their young children's needs. Approaches to improving the oral health of young children therefore include enhancing public education about oral health, the appropriateness of early and periodic dental care, and primary prevention. Improvements in workforce numbers, distribution, diversity, and competency are needed. Attention to delivery systems and public insurance capacities are also necessary to effectuate improvements. HRSA's Title VII and VIII health professions training programs could potentially address may of these barriers and shortcomings. Training enhancements for predoctoral, postdoctoral, and graduate dentists and hygienists as well as for primary-care medical providers hold the key to marked improvements in the oral health of young children. Enhanced training of health care providers is the necessary if not sufficient condition to children whose daily life experiences are compromised by dental and oral diseases that are overwhelmingly preventable.

Child, Preschool↗
PubMed1996

Medical waste in the environment: do anesthesia personnel have a role to play?

STUDY OBJECTIVE: To conduct a feasibility study of the mechanics of recycling single-use anesthesia breathing systems and practices of anesthesiologists and nurse-anesthetists in a tri-state region. STUDY DESIGN: Two-part, open, prospective analysis using pre-printed questionnaire and cost/time analysis of labor and materials. SETTING: Questionnaire sent to 413 anesthesiology departments in Pennsylvania, New Jersey, and Delaware, and hospital/recycling facility for evaluation of time and cost. MEASUREMENTS AND MAIN RESULTS: Time to disassemble and sort the breathing circuits, analysis of costs and obtainable income from byproducts of recycling, and standard survey questionnaire concerning demographic characteristics of respondents and individual department/hospital practitioners. Data analysis included analysis of variance and Kruskal-Wallis tests. Pilot analysis: Sorting of circuits to economic component required ten minutes at an average cost of $1.60 Value of scraps obtainable was $3.44, leaving a gross margin of $1.84 for a box of 18 circuits. Benefit analysis: Extended reduction in the regulated medical waste in our operating room of 16,875 lb, saving $4,387.50 per year. With generation of revenue from scrap, the net gain is $5,994.64 per yr. Questionnaire: Majority (83%) of departments polled would participate in recycling implemented by suppliers. Most respondents would not consider (58%) recycling unless mandated by law. CONCLUSION: The program described is cost-effective and environmentally beneficial.

Anesthesiology↗
PubMed2006

Building capacity for tobacco control research and policy.

The Fogarty International Center (FIC) initiative, "International Tobacco and Health Research Capacity Building Program" represents an important step in US government funding for global tobacco control. Low- and middle-income countries of the world face a rising threat to public health from the rapidly escalating epidemic of tobacco use. Many are now parties to the Framework Convention on Tobacco Control (FCTC) and capacity development to meet FCTC provisions. One initial grant provided through the FIC was to the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to support capacity building and research programmes in China, Brazil, and Mexico. The initiative's capacity building effort focused on: (1) building the evidence base for tobacco control, (2) expanding the infrastructure of each country to deliver tobacco control, and (3) developing the next generation of leaders as well as encouraging networking throughout the country and with neighbouring countries. This paper describes the approach taken and the research foci, as well some of the main outcomes and some identified challenges posed by the effort. Individual research papers are in progress to provide more in-depth reporting of study results.

Brazil↗
PubMed2002

2001-2002 SAEM emergency medicine faculty salary and benefits survey.

OBJECTIVE: The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 2001 residency review committee (RRC)-EM-accredited programs using the SAEM fifth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Data represent compensation paid for the 2001-02 academic year. Seventy-six of 124 (61%) accredited programs responded, yielding usable data on 1,355 full-time faculty representing all four Association of American Medical Colleges (AAMC) regions. METHODS: Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the AAMC. Demographic data were analyzed with regard to numerous criteria, including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. RESULTS: Mean salaries were reported as follows: all faculty, $180,913; first-year faculty, $147,746; programs reporting data to the AAMC, $174,354; programs not reporting data to the AAMC, $191,397. Mean salaries as reported by AAMC region: northeast, $178,593; south, $176,314; midwest, $200,095; west, $166,779. Full-time emergency medicine residency program faculty work an average of 1,129 clinical hours per year. CONCLUSIONS: Reported salaries for full-time EM residency faculty have risen approximately 8.7% since the last survey. Up to approximately 1,200 clinical hours worked per year, salary varies inversely with clinical hours worked. Total per-faculty patient contact time (overall workload) has grown approximately 13% since the last survey. Patient wait times have increased approximately 27% since the last survey. Significant regional differences in salaries have been present in all five SAEM surveys. Emergency medicine residency faculty continue to work at the upper extremes of patient encounters per physician, patient acuity levels, and department lengths of stay.

Adult↗
PubMed2006

Preparation and response in case of natural disasters: Cuban programs and experience.

Inadequate preparation for national disasters is frequently particularly devastating in lower income countries. The Cuba's location has a diversity of potential natural disasters, including hurricanes, non-tropical depressions, tropical storms, tropical cyclones, and severe local storms, all with intense rains and winds, earthquakes and droughts. Cuban preparation, at all levels, is geared to these predominant threats. Planning for natural disasters is integral to the political and economic life of Cuba, nationally and locally. On several occasions, United Nations (UN) officials have pointed to Cuba as a model for developing countries preparing for hurricanes and other natural disasters. A global policy for managing the risks of natural disasters could improve continuity of assistance for development and reduce the necessity of humanitarian aid. Planning in advance of disasters is a feasible way of helping people, by reducing expenses of emergencies, recuperation, and reconstruction. As climate changes accelerate, many researchers fear a period of irreversible and uncontrollable change. While the atmosphere continues to warm, it generates more intense rains, more frequent heat waves, and more ferocious storms. Thus, achieving better protection of developing countries from an increasing onslaught of natural disasters will only grow in importance. Even though Cuba's contribution to know-how has been recognized by United Nations' officials, progress toward more adequate preparation worldwide has been slow. To support other countries beyond conveying the lessons, Cuba now offers specially trained personnel to cooperate immediately with any country suffering a natural disaster.

Cuba↗
PubMed2004

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use.

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was dollar 241 (95% CI dollar 191 to dollar 291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87 per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.

Age Distribution↗
PubMed2002

The economic payoffs of integrated malaria control in the Zambian copperbelt between 1930 and 1950.

It has long been suggested that malaria is delaying the economic development of countries that are most severely affected by the disease. Several studies have documented the economic consequences of malaria at the household level, primarily in communities engaged in subsistence farming. A missing element is the appraisal of the economic impact of malaria on the industrial and service sectors that will probably become the backbone of many developing economies. We estimate the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia). Integrated malaria control was characterized by strong emphasis on environmental management, while part of the mining communities also benefited from rapid diagnosis and treatment and the use of bednets. The programmes were highly successful as an estimated 14,122 deaths, 517,284 malaria attacks and 942,347 work shift losses were averted. Overall, 127,226 disability adjusted life years (DALYs) were averted per 3-year incremental period. The cumulative costs of malaria control interventions were 11,169,472 US dollars (in 1995 US dollars). Because the control programmes were so effective, the mining companies attracted a large reservoir of migrant labourers and sustained healthy work forces. The programmes averted an estimated 796,622 US dollars in direct treatment costs and 5,678,745 US dollars in indirect costs as a result of reduced work absenteeism. Within a few years of programme initiation, Northern Rhodesia became the leading copper producer in Africa, and mining generated the dominant share of national income. Copper production and revenues, which increased dramatically during malaria control interventions, amounted to the equivalent of 7.1 billion US dollars (in 1995 US dollars). Integrated malaria control in copper mining communities was a sound investment. It had payoff for public and occupational health, generally, and without it copper extraction and social and economic development would have been impossible.

Absenteeism↗
PubMedDate not supplied

Factors affecting the uptake of community recreation as health promotion for women on low incomes.

BACKGROUND: There have been repeated calls for research on the factors that promote the spread of successful local health promotion initiatives from one community to another. We examined the factors that affected the uptake of an initiative designed in one community to improve the health of women living below the poverty line through increased access to community recreation. METHODS: Workshops were held in three other communities and uptake efforts were tracked for one year through follow-up site visits and telephone interviews with workshop participants. RESULTS: Making the issue a priority, actively involving the women in planning, pooling resources, sharing responsibility through partnerships, and addressing the structural dimensions of poverty were factors that enabled uptake. Factors that inhibited uptake included an emphasis on revenue generation, professionally led planning, inadequate attention to structural barriers, the undervaluing of certain resources, and an over-reliance on one idea champion. CONCLUSION: A shift in how municipal recreation departments view their role as partners in community health promotion is required if programs are to promote health and be accessible to under-served populations.

Community Health Services↗
PubMed1989

Maximizing profitability in a hospital outpatient pharmacy.

This paper describes the strategies employed to increase the profitability of an existing ambulatory pharmacy operated by the hospital. Methods to generate new revenue including implementation of a home parenteral therapy program, a home enteral therapy program, a durable medical equipment service, and home care disposable sales are described. Programs to maximize existing revenue sources such as increasing the capture rate on discharge prescriptions, increasing "walk-in" prescription traffic and increasing HMO prescription volumes are discussed. A method utilized to reduce drug expenditures is also presented. By minimizing expenses and increasing the revenues for the ambulatory pharmacy operation, net profit increased from +26,000 to over +140,000 in one year.

Ambulatory Care↗
PubMed1998

Review of US medical school finances, 1996-1997.

Based on data from the Annual Medical School Questionnaire of the Liaison Committee on Medical Education, to which 100% of schools responded, the revenues that supported the programs and activities of the 125 accredited medical schools in the United States totaled $34897 million in 1996-1997. A large proportion (78.9%) of these revenues was derived from 3 sources: practice plans, grants and contracts, and hospital support. Both public and private medical schools, in aggregate, have continued to experience growth throughout the last decade but at a progressively slower rate, primarily because of a slowing in the growth of practice plan revenues. Federal revenues supporting research in public and private medical schools since 1992-1993 have grown at annualized, constant-dollar rates of 5.6% and 4%, respectively. Growth in state and local appropriations to public medical schools has tended to lag behind inflation. Growth in reported revenues from endowments that are used to support programs at private medical schools is on the rise. The aggregate numbers mask considerable variation among schools with regard to changes in financing. A small, but appreciable, number of schools have witnessed a constant-dollar decline in their total practice plan revenues since 1992-1993. The financial data reviewed in this report demonstrate the continued dependence of medical schools on faculty-generated sources of revenue and confirm the perception that medical schools, as a group, are experiencing constraints on the growth of their enterprises.

Data Collection↗
PubMed2006

U.S. State-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

Capital Financing↗
PubMed2006

Competition and quality as dynamic processes in the Balkans of American health care.

The American health care system embodies a complex amalgamation of fractured and conflicting parts. As such, any call to enhance quality or competition necessarily presupposes some ability to introduce greater harmony and coordination. But how does one make a complicated system work well? Dynamic theories of economics stress the significance of section mechanisms, learning, and adaptive modes of behavior in directing markets toward more efficient outcomes under conditions of uncertainty. Unfortunately, the American health care sector suffers from intense factional divisions. Policy makers need a more self-conscious understanding of the interactive and often conflicting effects of regulation if the health care system is to be reshaped in a manner that will generate more desired social outcomes. Evolutionary theories of economics can provide the conceptual framework in which such a restructuring could take place. This article examines how health care quality and competition can be improved through a better understanding of dynamic economic processes and evaluates the Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition in light of these perspectives.

Economic Competition↗
PubMed1997

Economics of gastrointestinal parasitism of cattle.

Understandably, cattle are raised for profit, as beef and/or dairy. Anything that negates that equation results in a loss to the producer and to the livestock economy. Thus, parasites negatively affect the economy of the industry. Worldwide, gastrointestinal nematode parasites, especially Ostertagia ostertagi, and those of the respiratory tract (Dictyocaulus viviparus) have a potentially major impact on herd health. In the past 10-15 years, anthelmintic (AH) drug development and the strategic use of AH have positively balanced the economic equation, so that overall, parasitism in cattle is often observed or determined to be subclinical or economical. Other control measures, such as better pasture management, are also being developed to enhance herd health and the cattle economy. The determination of the economic impact of parasitism has thus become less apparent, to the extent that measures, such as performance parameters, must be used to measure differences between treated and untreated animals or herds. These include weight gain, reproduction, lactation and forage use. To determine the effectiveness of control measures, field trials are designed to measure these parameters by the demonstration of improved performance. Because these trials are conducted in a competitive mode, results are often debated by competitors and by the scientific community because of study design. Variables must then be taken into consideration in the interpretation of results. It is now well known that, with the generation of new AH and appropriately-timed administration, parasitism of well-managed herds has been reduced to subclinical levels. Thus, we are now in the process of fine-tuning the positive effect of these control measures for enhanced production. Understandably, beef and dairy producers have 'production of high quality commodities' at a cost-effective level as a common goal. Successful cattlemen calculate expenditures and income by line item including veterinary expenses and cost and labor in administration of AH. Return is based on performance. Again, nematode parasites can disturb the equation enough to make production less profitable or even unprofitable. Most USA beef cattle producers believe that worm parasites do have an effect on cattle health and production so that 77% use AH and the market impact is that AH have become integrated into cattle herd health programs. However, to be most cost-effective, programs must be strategic but flexible with scheduling tailored for the region and the cattle operation. Other technologies should eventually provide rapid identification of worm populations by species and numbers and recognition of individual animal response to parasites and inheritance of that trait by their progeny. Computerized programs for analysis of seasonality of the epidemiology of gastrointestinal parasites and of herd performance could predict appropriate timing and cost benefit for control measures. Modes of AH administration are being developed which are more reliable and convenient in terms of delivery and labor. Control measures must also include better pasture management with less impact on the environment and to justify investment in land. In addition, successful producers are better educated, more cost-conscious, consumer-oriented, sensitive to the environment and attuned to the economics of parasitism.

Animals↗
PubMed1991

Effectively marketing prepaid medical care with decision support systems.

The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.

Accounting↗
PubMed2005

Making a home in the community for the academic medical center.

Academic medical centers (AMCs) have traditionally provided primary care for low-income and other underserved populations. However, they have had difficulty developing lasting partnerships with other organizations serving the same populations. This article describes an exception to the rule, in which an academic division was created at Duke University Medical Center to develop effective collaborations with health care and social service providers in Durham, North Carolina, including both public agencies and private organizations. Together, the division and its partners have created and operate programs that improve health outcomes and access to care for those at risk. These programs share a number of characteristics: they are designed to meet the needs of the patient, not the provider; they are based in the community, not in the AMC; they bring services to people's homes, schools, and neighborhoods; they are multidisciplinary, combining health, social, and even mental health services; and, once established, they are revenue-generating and can be made self-supporting when grant funding ends. These programs are also innovative. They are designed to model and test new ways of organizing and delivering care. Preliminary indications suggest that they also strengthen the AMC's relationships with the surrounding community.

Academic Medical Centers↗