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PubMed1999

The impact of accounting and actuarial practice differences on medical loss ratios: an exploratory study of five HMOs.

This paper explores the quantitative implications of accounting differences by examining detailed cost information on five health maintenance organizations (HMOs). Standardized cost allocations and actual medical expenses were compared to those publicly reported by HMOs in medical loss ratios (MLRs) and administrative expense ratios (AERs). Differences in accounting and actuarial practices were found to have a small percentage impact on the MLR and the AER, but they accounted for a large percentage of observed differences in reported MLRs and AERs. Policies that regulate MLR floors or AER ceilings encourage HMOs to adopt accounting practices producing the most favorable ratios for regulatory purposes.

Accounting↗
PubMed1999

The effect of a copay increase on pharmaceutical utilization, expenditures, and treatment continuation.

OBJECTIVE: No research has evaluated the impact of an increase to a copay that is reflective of today's healthcare market. This study examined the effect of an increase from a $10 to $15 copay for brand drugs on key pharmaceutical utilization measures, including participation rates, treatment continuation, and expenditures, in an adult population. STUDY DESIGN: A quasi-experimental, pre-post design with control group was used. PATIENTS AND METHODS: Two different employer plans implemented an increase from $10 to $15 for brand copays in January of 1997. The utilization and expenditures of these plans were compared with those of a control group with a constant brand copay of $10 for 6 months preceding and 6 months following the copay increase. RESULTS: When other predictor variables were controlled for, the copay increase was not associated with a statistically significant difference in overall utilization compared with the control group, although brand utilization was significantly lower in the copay group. Savings to the payer were substantial, and resulted primarily from cost-shifting, reduction in brand utilization, and an increase in the generic fill rate. The rates of continuation with chronic medications in the 6 months following the copay increase were not reduced in the copay group compared with the control group. CONCLUSION: A copay increase can provide substantial savings to a payer without being a major deterrent to overall utilization or resulting in discontinuation of chronic medications.

Adult↗
PubMed1999

Using activity-based costing to track resource use in group practices.

Research shows that understanding how resources are consumed can help group practices control costs. An American Academy of Orthopaedic Surgeons study used an activity-based costing (ABC) system to measure how resources are consumed in providing medical services. Teams of accounting professors observed 18 diverse orthopedic surgery practices. The researchers identified 17 resource-consuming business processes performed by nonphysician office staff. They measured resource consumption by assigning costs to each process according to how much time is spent on related work activities. When group practices understand how their resources are being consumed, they can reduce costs and optimize revenues by making adjustments in how administrative and clinical staff work.

Accounting↗
PubMed2000

Inadequate health insurance: costs and consequences.

CONTEXT: Changes in the healthcare marketplace have begun to test the nature and adequacy of health insurance. The complex nature of insurance is driving us away from the notion that there are 2 distinct groups - the insured and the uninsured - toward an idea that insurance is best represented along a continuum, from the very well insured to the chronically uninsured, with a wide range of quality of coverage in between. OBJECTIVE: The objective of this study was to examine the experiences of insured adults as they try to get needed healthcare and balance the payment for these services against other basic needs. DESIGN: Using data from the Commonwealth Fund 1999 Survey of Workers' Health Insurance, the study analyzes the cost and access problems of insured adults by a number of different variables including income, plan satisfaction, health status, and insurance stability. RESULTS: Bivariate results indicate that insured adults with low incomes and those reporting fair or poor health are more likely to experience problems getting and paying for healthcare. These groups are also more likely to have problems paying for basic living expenses. CONCLUSIONS: The most essential notion of insurance is that it will provide protection against financial risk and assurance that we can get healthcare services when we are sick. Yet, we find substantial proportions of low- and modest-income, insured adults who struggle to afford insurance premiums; we also find that their insurance plans do not provide them with either access to care when needed or financial protection from the cost of that care.

Adult↗
PubMed2000

Economic considerations in overactive bladder.

Many costs are associated with overactive bladder (OAB). They include direct costs, such as those associated with treatment, diagnosis, routine care, and the consequences of the disease; indirect costs of lost wages and productivity; and intangible costs associated with pain, suffering, and decreased quality of life. Quantification of all these costs is essential for establishing the total economic burden of a disease on society. Currently, the total economic burden of OAB is unknown. However, various studies have determined that the economic burden of urinary incontinence, one of the symptoms of OAB, is substantial. It is also important to establish the economic impact of various interventions for OAB. Cost-minimization, cost-outcome, cost-utility, and cost-benefit models can be used for these analyses. The most difficult aspect of evaluating the economic impact of a treatment is estimating the intangible costs.

Cost Allocation↗
PubMed2001

Realizing positive returns from your e-health investments.

Although the healthcare industry still is in the beginning stages of e-health adoption and has yet to achieve a significant return on e-health investments, healthcare organizations can anticipate increasingly positive results over time. To capitalize on the potential of e-health, financial managers need to adopt a clear, concise approach to valuing e-health investment options, making investment decisions, and managing an organization's return on invested capital. Key actions to take are developing a strategy, looking beyond cost reduction to other advantages of e-health strategies, understanding the needs of the stakeholders, becoming comfortable with experimentation, having realistic expectations, and instituting a process for valuing e-health investments that does not duplicate valuation processes for traditional information technology projects.

Cost Allocation↗
PubMed2001

Development of a matrix of cost domains in economic evaluation of rheumatoid arthritis.

The aim of our study was to comprehensively review and critically appraise the cost domains used in economic evaluations of the rheumatic diseases and to use this information to propose standardization of cost domains. The literature search identified 210 abstracts, 32 of which included original cost data. The listed cost categories were grouped into 3 major areas: (direct) health care costs, other (direct) disease related costs, and productivity costs (indirect costs). The number of individual cost categories was reduced by considering the following criteria: (1) inclusion of all relevant cost domains; (2) avoidance of double counting; (3) summarizing of related categories under one representative heading; (4) feasibility of level of aggregation. After adjustment for synonymous labeling, 38 cost categories remained. The subsequent development of a classification scheme of cost categories led to a set of 19 separate cost domains including 7 outpatient, 3 inpatient, 6 other disease related, and 3 productivity cost domains. This literature review indicates that cost assessment in economic evaluations in rheumatoid arthritis lacks standardization. A preliminary scheme to categorize cost assessment in rheumatic conditions is presented. The adoption of standards for economic evaluation would greatly facilitate national and international comparisons.

Arthritis, Rheumatoid↗
PubMed2001

Cost assessment instrument in rheumatology: evaluation of applied instrument characteristics.

We compared the major characteristics of internationally applied cost assessment instruments (CAI) in rheumatic conditions. Fifteen utilization questionnaires were identified and assessed using a structured approach. The forms differed considerably with respect to applied characteristics: length (3-113 items), recall period (between 1 week and 1 year), format (2 interview, 13 self-administered), response categories, cost units (physical vs monetary), and cost domains covered. While all included a gross assessment of outpatient and inpatient costs, the level of disaggregation differed. Only a few CAI included an assessment of other direct disease related costs (e.g., home remodeling or home health care services) and out-of-pocket expenditure. Productivity costs were included in all but 2 CAI. Efforts to further standardize the applied CAI should (1) be based on sound psychometric data, (2) define a required core set of cost domains covered, (3) discriminate between generic and relevant disease related cost components, and (4) examine the feasibility of developing international standards for cost data.

Arthritis, Rheumatoid↗
PubMed2001

[Computerized information system support in continuous quality improvement in hospital care].

DRG (Diagnosis Related Groups) classification system requests much of medical and financial data from patients record. We also need comprehensive Clinical Information System with computer database to manage such system. In our research we were using HCFA (Health Care Financing Administration) and AN-DRG (Australian National-DRG) methodology for DRG classification. We also used ICD 10-Revision for diagnosis coding. We have chosen ORL Clinic for DRG classification because of two reasons: 1) They treat two basic types of patients medical and surgical and 2) They had pretty good sorted patients' records. Our base for DRG classification was 1997 year. During our research we found many deficiencies in patient records in both its parts: medical and financial. Since all records were processed and stored manually, financial data didn't exist. So we had to use other ways for direct and indirect costs allocation (for Prospective Payment System purpose). In 1998 we processed 680 patient records (treated in 1997), and made DRG classification putting all 680 patients' records into 183 DRG: 47 medical and 136 surgical. This is so called CASE-MIX of the ORL Clinic for year 1997. DRG classification we made at Tuzla ORL Clinic was identical with HCFA DRG classification system in 92%.

Bosnia and Herzegovina↗
PubMedDate not supplied

Cost comparison of at-home treatment of deep venous thrombosis with low molecular weight heparin to inpatient treatment with unfractionated heparin.

AIMS: Low molecular weight heparins (LMWH) permit safe and effective treatment of uncomplicated deep venous thrombosis (DVT) at home. The aim of this study was to evaluate the cost minimization, cost shifting and patient satisfaction associated with at-home DVT treatment using the LMWH enoxaparin, compared to standard inpatient care in an Australian health-care setting. METHODS: Subjects presenting with a principal diagnosis of uncomplicated DVT to the Emergency Department at The Queen Elizabeth Hospital, Adelaide, were recruited over 1997-1999. Costs to the hospital, to Federal funding (Medicare) and to patients were tracked prospectively, and satisfaction was also measured. Subjects were matched to historical controls (1994-1997) for age, gender and level of comorbidity (same or lower) by two medical officers who were blinded to costs. Control costs were obtained using the clinical costing system Trendstar, and adjusted for consumer price index. RESULTS: Twenty-eight subjects participated in the at-home programme. Of these, 26 were discharged without any inpatient admission (including one who agreed to self-injection) and two were admitted briefly. Audit demonstrated that only 29% of eligible subjects were managed at home. Mean (SEM) total treatment cost was $756 (76) per patient for at-home, and $2,208 (146) for controls. Minimal cost shifts to patients and to Medicare occurred, and satisfaction was high. CONCLUSIONS: At-home treatment of uncomplicated DVT using enoxaparin in an Australian metropolitan setting provides effective cost minimization, with little cost-shifting. Our cost minimisation estimates are conservative as most at-home subjects received enoxaparin twice daily (now used once per day) and controls had at least as high comorbidity. However, uptake of the at-home programme was limited.

Anticoagulants↗