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Sensing an invasion of their territory, MCOs are jumping into a market forged by a group of upstarts. The development renews a fundamental debate about the juxtaposition of consumer involvement, cost containment, cost shifting, and quality of care.
Class substitution (with cost reduction as the purpose) is only possible if there are equivalent drugs in terms of the pharmacological mode of action and safety both at the individual and population level, as well as per indication. Whether two drugs are found to be equivalent, is in part the consequence of the chosen clinically relevant margin in which equivalency can reasonably be assumed and the accuracy with which the outcome measure could be measured. Good data for carrying out class substitution will in many cases be lacking. It is for the health professional to decide which preparation is indicated for a certain patient whereby the pharmacist provides pharmacotherapeutic information and checks the prescribed treatment. The provision of education in medical and pharmaceutical curricula is the most effective manner for limiting drug costs.
Class substitution is the substitution of a drug by another cheaper drug from the same pharmacological drug class to save costs. This principle is applied in drug formularies and reference-based drug-pricing systems. Class substitution should not only consider similarities in pharmacological mechanisms of action but should also assess whether the different drugs within the class are equivalent at a population level with respect to efficacy, effectiveness, applicability, and safety. The implementation of class substitution requires protocols as well as a monitoring system to evaluate compliance with the protocols and their effects on drug costs. In addition, specific studies are needed to establish whether undesirable effects occur at the patient level.
Rising costs of the International Space Station prompted NASA to convene a panel of experts to assess the quality of ISS cost estimates and review program assumptions and requirements. The panel concluded that NASA was unable to accurately predict ISS costs or to support requests for increased funding for the ISS through 2006 and should maintain a U.S. core complete program with three-person crews with 6-month stays on the ISS. International response to the panel report was negative with space agencies from Japan, Russia, Canada, and Europe taking issue with the expected impact on ISS construction and use.
Tuberculosis (TB) has recently re-emerged as a major public health problem in Thailand. As a consequence of the HIV epidemic in the country, the TB burden has been rising in terms of both morbidity, and mortality which have tremendous socioeconomic impact. However, a study of the cost of various anti-TB drugs in Thailand has never been conducted. A specific aim of this study was to compare the total provider costs of delivering services to different types of TB patient in four zonal TB centers located in the east, northeast, north, and south of Thailand. This aim was accomplished by calculating the unit costs of TB treatment services at these TB centers during the year 1996-1997. All units of the zonal TB centers were classified into 5 cost-center categories: treatment units, laboratory units, radiology units, pharmaceutical units, and administrative/supportive units. The results showed that the average total provider cost of multidrug resistant TB (MDR TB) patients was 89,735.49 baht which was the highest of any type of patient and was 17 times higher than the cost of smear-negative TB cases; this finding was attributed to the high cost of anti-TB drugs for MDR TB cases (65,870 baht), some 95 times higher than the cost for smear-negative cases. Total provider costs were highest in the northeastern region TB centers and lowest in the southern centers for every type of TB patient: smear-negative TB cases (7.727 baht vs 3.916 baht). newly smear positive TB cases (12,539 baht vs 7.020 baht), TB with AIDS cases (15,108 baht vs 8,369 baht). re-treatment TB cases (16,679 baht vs 9,696 baht), and MDR TB cases (102.330 baht vs 82,933 baht). The information from this study may be useful when reviewing the role, function, and cost structure of each TB center in Thailand in order to establish a strategic plan for effective TB control.
The purpose of this paper is to provide hospital managers with important knowledge and skills in developing efficiency measures that hospital can use as guidelines in monitoring and controlling operational costs. Efficiency measures are judgmental and comparative. Cost and quantity are the variables in the computation of efficiency measures but it is very important to integrate these variables with quality. A hospital is efficient if it can render quality service at the most cost effective manner.
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Healthcare organizations can achieve revenue-cycle improvement while maintaining optimum staffing levels by taking a three-step approach-developing a plan, measuring costs, and using benchmarks to measure performance. Planned cost reductions can be achieved without a negative impact on the organization. Cost-reduction strategies should look at purchased services, staffing, and the cost-to-collect ratio. Healthcare organizations should reach target performance levels before implementing a cost-reduction strategy.
Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process.
To address the demand managed care has created and bring the health care economy closer to market equilibrium, we must find a way to balance value and cost, by both using new tools and looking at critical issues in a different way. Although the concepts of consumer-driven health care described in this article are not the only health care cost-management solution, they are surely a next logical step.
The purpose of this article is to identify financial strategies that are truly effective. The principal research questions include whether specific dialysis cost reductions can be implemented without adversely affecting other operating costs or clinical outcomes. The regression analysis involves 120 months of data, 1990 to 1999, from each of six dialysis centers. Financial data include both operating and capital costs. Severity-adjusted hospitalizations are used as the measure of clinical outcomes. The results indicate that three financial strategies are effective in reducing long-term sustainable costs while preserving patient care quality. First, some adjustments in cost mix can achieve sustainable savings over time. However, the relative lack of substitutability among resources and their cost stickiness limit this strategy. Second, institutional experience results in operating efficiencies and cost reductions. In a stable and mature environment, however, managers may not be able to preserve these savings through improved operational efficiencies. Third, clinic managers can reduce their costs when they avoid episodic clinical complications. This strategy may not be sustainable, of course, as hospitals find their revenues constrained when providing acute care services. Contrary to our expectations, we did not find that reducing labor costs was an effective financial strategy. Moreover, we did not find that reducing indirect costs was an effective financial strategy, although the specific 10-year period of this study could be unique in producing this result, and additional research could produce evidence that a strategy of reducing occupancy or other indirect costs is one with significant potential.
The estimates of potential savings as a result of reductions in administrative costs have generated considerable controversy. In response to this debate, the Robert Wood Johnson Foundation sponsored an invitational workshop for policymakers, health services researchers, and key stakeholders in the health care system. The workshop, conducted by the Alpha Center in February this year, provided a framework for identifying, measuring, and weighing the value of administrative costs and served as a vehicle for discussion of these issues. This article summarizes the presentations, the issues raised, and questions for further research. Overall, the papers and presentations emphasized that while the focus of attention has been on the controversy over whether particular aggregate estimates of administrative costs and potential savings are correct, the fundamental underlying issue is how the health care system might best be managed.
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Dual enrollees in Medicare and Medicaid are among the poorest, sickest and highest users of health-care services in the United States. Yet they face numerous difficulties in coordinating benefits between these programs. In this brief we look at who the dual enrollees are and offer tips as to how you can help your clients maximize their benefits.
The evolution of health care created a climate in which cost was subordinate to medical treatment. Current reimbursement constraints have increased the need for providers to be cost conscious, but they have discovered that current accounting practices do not provide the appropriate information to determine the cost of service or make decisions. This article argues that activity-based costing (ABC) can bridge the gap between the medical and financial communities and provide a foundation for performance improvement.
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As a healthcare CFO, you know that effective financial control has enormous impact on a hospital's bottom line. But how do you maintain that financial control? Well, a few simple improvements in cost management techniques-assigning accountability, adopting useful monitoring and reporting methods, and reducing resource consumption, among others--can reap significant benefits.