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At least 433 records · Page 24Linked to original sources
PubMed1998

Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives.

OBJECTIVES: The effects of incentive size on physicians' response rates to a mail survey were determined. METHODS: One thousand US primary care physicians were assigned randomly to receive a survey with either a $5 bill or a $2 bill as an incentive. For each of the two incentive groups, the overall response rate for three mailing waves, the total cost, and the total cost per usable response were measured. RESULTS: The response rate among those receiving the $5 bill (61%) was 32% higher than the response rate among those receiving the $2 bill (46%); overall costs were slightly higher in the $5 group, but the cost per response for each group was similar ($15.46 versus $14.93). For the same cost, a higher response rate could have been achieved in the $2 group if costs saved from foregoing the third mailing were instead used to increase the incentive for a portion of the subjects. CONCLUSIONS: A $5 bill incentive yielded a higher response rate among the physicians in this study than did a $2 bill incentive. Moreover, the powerful effect of the incentive size, combined with the consequent decline in the costs of subsequent mailing waves, suggests that resources in a fixed survey budget are allocated more efficiently to increasing the initial incentive rather than to providing a third wave to nonresponders.

Budgets↗
PubMedDate not supplied

Provision of drug information to patients by pharmacists: the impact of the Omnibus Budget Reconciliation Act of 1990 a decade later.

Drug-related illness in the United States factors substantially in health care costs, although often these illnesses and their attendant costs are preventable. One strategy for minimizing adverse drug reactions is to provide drug information to consumers in the form of prescription counseling at pharmacies. The Omnibus Budget Reconciliation Act of 1990 (OBRA 1990) contained provisions for mandating such counseling to Medicaid patients. OBRA 1990 was implemented in 1993, but most states acted quickly to extend counseling services to all patients receiving prescription drugs. We looked at the extent and quality of prescription counseling available in community pharmacies 1 decade after OBRA 1990 was written. We evaluated the counseling services afforded at large chain pharmacies, independent community pharmacies, and on-line pharmacies for a hydrochlorothiazide prescription. We found that most (69%) pharmacies offered to provide prescription counseling service, and that average counseling index scores, a measure of the quality or extent of information provided as determined by a Rasch analysis, were generally satisfactory. Our observations based on a single prescription for hydrochlorothiazide, along with other studies, suggest that there is a positive upward trend in the number of pharmacies providing prescription drug information, and that the extent of information provided suggests that the objectives of OBRA 1990 and related legislation to reduce ADRs are being fundamentally satisfied.

Antihypertensive Agents↗
PubMed2001

The impact of the Balanced Budget Act of 1997 on the physical therapy profession.

The Balanced Budget Act (BBA) of 1997 was one of the most significant acts of legislation ever to affect the physical therapy profession. Three months after the BBA was implemented, a survey of over 600 physical therapists in the state of Florida was conducted. This article examines the immediate impact of the BBA on physical therapists and their ability--or their perception of their ability--to maintain or successfully seek full-time employment in the profession.

Adult↗
PubMed2001

The manager and equipment decisions: is that in the capital budget?

Although any decision to purchase a piece of capital equipment involves a number of the organization's functions, the department manager has some significant responsibilities in the selection and acquisition of capital equipment. Except for unavoidable replacement of essential equipment that fails unexpectedly, capital purchases must ordinarily be planned in advance through the annual budgeting process. The department manager is ordinarily the organization's primary source of information in major capital expenditure projects; therefore, it is essential that the manager follow a logical process for identifying and evaluating alternative equipment choices and perform a consistent economic analysis of the alternatives.

Budgets↗
PubMed1998

Quality of care and patient satisfaction in budget-holding clinics.

A budget-holding program was implemented in nine primary care clinics in the Negev district of Kupat Holim Clinic, Israel's largest sick fund. This study, carried out from 1991 to 1994, evaluates the impact of this program on patient satisfaction and other selected indicators of quality of care, using a controlled case study methodology. Structured questionnaires were used in face-to-face interviews with a representative stratified sample of 523 patients registered in the clinics. Patient reports were used to measure patient satisfaction, accessibility of services, comprehensiveness of care, responsiveness to patients' needs and performance of preventive medicine activities. Other research tools included staff surveys, in-depth interviews and administrative data on transfer among sick funds. The findings counter fears that budgetary control and cost-containment negatively affect quality of care and patient satisfaction. However, the program did not fulfill expectations regarding improvement in clinic services and patient satisfaction.

Budgets↗
PubMed2003

Reforming Medicare payment: early effects of the 1997 Balanced Budget Act on postacute care.

The 1997 Balanced Budget Act (BBA) reformed payment for Medicare postacute services. This article examines postacute care use just before and immediately after implementation of the BBA for hospital discharges for five diagnosis-related groups that commonly use postacute care. Changes in treatment patterns were more beneficiaries receiving no postacute care, much less use of home health services both initially and after initial institutional postacute care, and slightly more use of rehabilitation and long-term care hospitals. But no consistent increases in adverse outcomes were observed using logistic regression models. These results demonstrate that financing changes can affect use patterns, that less use does not automatically imply poorer quality, and that the interrelationship of services should be considered when designing reimbursement methodologies.

Budgets↗
PubMed2003

Utilization of home health services before and after the Balanced Budget Act of 1997: what were the initial effects?

OBJECTIVE: To estimate the impact of the Balanced Budget Act of 1997 (BBA), which changed the way Medicare reimbursed for home health services, on a range of home health utilization measures, and to examine whether particular subgroups of beneficiaries were differentially impacted in the post-BBA period. DATA SOURCES: Secondary data from the Centers for Medicare and Medicaid Services (CMS) Standard Analytic Files for the 1 percent sample of Medicare beneficiaries for fiscal years 1997 and 1999, linked with information from CMS eligibility, provider, and cost report files as well as the Area Resources File. STUDY DESIGN: Logistic regression was used to estimate the effects of being in the post-BBA period on the incidence of home health service use and ordinary least squares (OLS) regression was used to estimate the effects of being in the post-BBA period on the amount and type of use by home health service users. Interaction terms we reincluded for all the independent variables to assess whether the effect was disproportionate among particular beneficiary subgroups. PRINCIPAL FINDINGS: Results show a 22 percent decrease in the percentage using home health services post-BBA and a 39 percent decrease in the number of visits per user. Stronger reductions, though not very large, were found in the incidence of use for beneficiaries aged 85 and older, those in states with high historical Medicare home health use, and those with Medicaid buy-in. More intensive reductions in the number of services were found for those aged 85 and older, in high historical Medicare use states, nonwhites, females, those using for-profit agencies, and those treated for certain diagnoses. Less intensive reductions were associated with hospital-based agencies. CONCLUSIONS: This research demonstrates that public program expenditures can be sharply curtailed with financial incentives. As reimbursement shifts to a prospective payment system legislated by the BBA, utilization should be closely monitored, especially for vulnerable subgroups.

Aged↗
PubMedDate not supplied

Proposal of Polish guidelines for conducting financial analysis and their comparison to existing guidance on budget impact in other countries.

BACKGROUND: Financial analysis (budget impact analysis, BIA) is increasingly required by decision-makers to ascertain the macroeconomic consequences of new product reimbursement in addition to proof of cost-effectiveness. Poland is in the process of drafting country-specific guidelines for BIA, positioned as complementary to economic evaluation in decision-making OBJECTIVES: The aim of this article is to present the Polish project and compare it with currently available guidance. METHODS: A checklist was developed that focuses on issues that are unique to BIA. An analysis of the differences between different national guidelines and their Polish counterparts was subsequently undertaken. RESULTS: The Polish project of BIA guidelines is composed of two sections. The first section presents the objective, the use of BIA, the responsibility for the preparation, and the target audience. The second section presents important methodological aspects that researchers should keep in mind when carrying out BIA. In comparison to existing guidance the Polish project appears to be more detailed. It includes more precise recommendations on perspective, time horizon, and reliability of data sources; reporting of results; rates of adoption of new therapies; and the probability of redeploying resources. CONCLUSIONS: Although there is an increased demand for BIA, there is only limited guidance on how such studies should be undertaken. It is hoped that the Polish guidelines can contribute to the development of such analyses and deliver benefit for Polish health-care decision-makers and beyond.

Budgets↗
PubMed2004

Effects of the balanced budget act on Medicare home health utilization.

This article examines the effects of the Balanced Budget Act of 1997 on Medicare home healthcare utilization by older adults in different income groups. Data are drawn from a sample of functionally limited Medicare-eligible elderly respondents (N=2,749) from the Medical Expenditures Panel Survey. Results from multivariate analyses revealed that, although policies succeeded in curbing home health expenditures for all income groups, the reduction was heavily concentrated among the poorest respondents. Between 1997 and 1998, Medicare home health expenditures decreased by 1,404 dollars in lower income respondents, four times as much as the reduction in expenditures in middle-income respondents (352 dollars) and more than twice the reduction in high-income respondents (567 dollars). These findings raise important questions about whether the decrease in expenditures will result in increased incidence of adverse effects or less satisfaction with care of vulnerable individuals.

Activities of Daily Living↗
PubMed2002

Mission-based budgeting hours model: an accurate way to understand physician costs.

Financial resources to manage academic emergency departments are becoming more scarce. The Association of American Medical Colleges (AAMC) has embraced mission-based management (MBM) as one viable option to allocate financial and personnel resources based on medical school goals. The key features of this style are integrating financial statements, measuring faculty activity, holding service line leaders accountable, and building a trust through information sharing. The authors describe how they integrated their service line cost through an hours model. From this they describe a formula for calculating the cost of protected time. The authors use mission-based budgeting to more accurately understand their physician costs and use the formula to effectively negotiate internal and external contracts.

Academic Medical Centers↗
PubMed2000

Mars exploration. Plan for two rovers squeezes NASA budget.

NASA's decision last week to send two rovers to Mars in 2003 is being hailed by researchers as affirming the agency's commitment to exploring the Red Planet. But once the applause dies down, cash-strapped space science managers will be forced to make tough decisions about how to shoulder the added $200 million cost of a second mission, starting with $96 million that must come out of NASA's 2001 budget.

Budgets↗
PubMed1990

Shortfall of equipment for neonatal intensive care and the introduction of budget holding contracts.

As adequate allowance must be made for the costs of purchasing, maintaining, and updating equipment during the development of contracts the current standing of neonatal units with regard to available equipment was assessed. Data were collected as part of a one year prospective survey of the 17 perinatal units in the Trent region. Adequacy of provision of equipment for recognised intensive care cost was assessed using the recommendations of the British Paediatric Association and British Association of Perinatal Paediatrics. It was assumed that units without recognised intensive care cost had to be able to equip one cot to a standard of intensive care level 1 in the short term. Equipment more than 5 years old was considered likely to warrant replacement or major maintenance within the next two years. With these guidelines over 600,000 pounds would be required to provide sufficient equipment for all recognised level 1 intensive care cost and to allow units without funded cost to provide this level of care in the short term and to replace existing equipment more than 5 years old for these cost alone. This amount could be reduced by 25% by subdividing intensive care cost into levels 1 and 2, thereby reducing equipment requirements, but this would impair the units' ability to perform level 1 care at funded provision, which has already been shown to need expansion. Neither figure takes account of equipment requirements for infants requiring special care. In addition, no allowance has been made for purchase or update of ultrasound scanners or blood gas analysers. If the government's proposed reforms are to be implemented clinicians need to revise guidelines regarding essential equipment, and plans must be made to correct any existing shortfalls so that they do not become inherited financial liabilities for future budget holders.

Budgets↗
PubMed2000

Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis.

OBJECTIVE: To develop a weighted capitation formula for setting target allocations for prescribing expenditures for health authorities and primary care groups in England. DESIGN: Regression analysis relating prescribing costs to the demographic, morbidity, and mortality composition of practice lists. SETTING: 8500 general practices in England. SUBJECTS: Data from the 1991 census were attributed to practice lists on the basis of the place of residence of the practice population. MAIN OUTCOME MEASURES: Variation in age, sex, and temporary resident originated prescribing units (ASTRO(97)-PUs) adjusted net ingredient cost of general practices in England for 1997-8 modelled for the impact of health and social needs after controlling for differences in supply. RESULTS: A needs gradient based on the four variables: permanent sickness, percentage of dependants in no carer households, percentage of students, and percentage of births on practice lists. These, together with supply characteristics, explained 41% of variation in prescribing costs per ASTRO(97)-PU adjusted capita across practices. The latter alone explained about 35% of variation in total costs per head across practices. CONCLUSIONS: The model has good statistical specification and contains intuitively plausible needs drivers of prescribing expenditure. Together with adjustments made for differences in ASTRO(97)-PUs the model is capable of explaining 62% (35%+0.65% (41%)) of variation in prescribing expenditure at practice level. The results of the study have formed the basis for setting target budgets for 1999-2000 allocations for prescribing expenditure for health authorities and primary care groups.

Budgets↗
PubMed1997

Budget management.

Budgetary responsibility gives you more control. Take time to master the fine detail, ask questions of your management and finance colleagues about anything you do not understand (you will not lose face), and develop the skills of lateral thinking and creative accountancy. Even if your budget is repeatedly overspent do not take it personally, ensure that management are aware of it and have a good night's sleep. Do not worry about it.

Accounting↗