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A prototype software application developed for the Vanderbilt University School of Medicine answered our need for an enterprise budgeting tool--one that has application across the entire organization. This application, built on Microsoft Access, provides a flexible user interface without requiring sophisticated technical support.
HIV/AIDS advocates have expressed dismay, if not surprise, over the proposed funding for domestic HIV programs outlined in the budget submitted in the spring by President George W. Bush. Despite the reality of rising drug costs and increasing numbers of newly infected Americans, the Ryan White CARE Program was flat-funded in the proposal. Other programs fared no better, except for research and international HIV funding.
To cope with current budget restraints and cutbacks, hospital security departments are increasingly integrating their manpower with technology in the form of access control, CCTV cameras, and alarm systems to supplement their services as well as becoming more dependent on computerized information technology systems and IT departments to track hospital activities and incidents. Security directors contacted for this report also emphasize that they are doing more with less by providing value-added services both to expand activities and to demonstrate the importance of their departments to top management.
Increasing drug costs are a concern in Sweden. The costs for statin treatment are considerable, and among those increasing most rapidly (by 30-35% per year). Our survey of eligibility for statin treatment in Stockholm according to current Swedish recommendations (i.e. patients < 75 years with elevated cholesterol and manifest atherosclerotic disease, hereditary dyslipidemia, and diabetes) indicates marked undertreatment. The cost for statins in Stockholm 2000 was SEK 175 M (144 M for patients < 75 years). The projected cost, if current recommendations were to be fully implemented, is SEK 450 M for the target group and > 100 M extra for patients > 75 years and/or high cardiovascular risk. We propose that individual risk assessments should replace crude patient group recommendations to obtain reasonable "numbers needed to treat", i.e. to optimize the expenditure on statins and cost-effectiveness of the therapy. Prioritization of drug expenditures (within and between patient categories) must be debated, and medical needs must be made clear to those who determine the medical budget.
In his State of the Union address last week, President Bush barely mentioned healthcare. But he tried to make up for it when he released his healthcare budget for 2003, which calls for $190 billion over 10 years to reform Medicare. The plan got a lukewarm reception from those in the industry, along with most Democrats and even some Republicans, who were hoping for a stronger stand.
OBJECTIVE: To assess the medical care costs of hypertension and their impact on the health care expenditures and on Mexico's Gross National Product (GNP). MATERIAL AND METHODS: An ecological study was conducted from June to November 1999, at Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Monterrey, Nuevo Leon, Mexico. A random sample of medical charts of patients with hypertension was selected, to extract data on utilization of health services and unitary costs per care episode. The cost per care episode and per hypertensive patient was calculated by adjusting the unitary cost as a function of standard and extreme utilization of IMSS health services. The resulting figure was then projected to the total population of hypertensive patients and compared to the annual health care expenditures of Mexico. RESULTS: The annual cost per patient with hypertension was $1,067 in the standard scenario and $3,913 in the extreme scenario. The annual expenditures from hypertension corresponded to 13.95% of the budget allocated to health care and to 0.71%, of Mexico's GNP. These figures changed to 51.17% and 2.61% in the extreme scenario, respectively. CONCLUSIONS: The costs of hypertension medical care account for a good portion of healthcare resources. This problem should be analyzed by multidisciplinary health teams in search of more efficient medical care alternatives.
OBJECTIVE: The DAta Food NEtworking (DAFNE) initiative was conceived in the 1980s and aims at using data already collected in the context of household budget surveys (HBSs) for the assessment of dietary patterns across Europe. DESIGN: HBSs are country-representative surveys conducted, with similar methodology, at regular time intervals by the National Statistical Offices of almost all European countries. DAFNE focuses at the designation of comparable, between European countries, categories of food and socio-demographic data, and the estimation of daily per capita food availability. With food and socio-demographic data classified into common categories, comparisons of food habits between European countries become possible. SETTING: Fifteen European countries with one or more HBS all undertaken during the period 1981-1999. SUBJECTS: Representative population samples in 15 European countries. RESULTS: DAFNE HBS data are comparable and allow a wide range of dietary analyses. Preliminary data document differences in food habits among European countries and provide insights into the socio-demographic determinants of food preferences. CONCLUSION: The DAFNE databank, if properly expanded and exploited, could become a valuable tool for national food and nutrition policy planning across Europe and for the identification of groups at higher risk for developing nutrition-related conditions.
OBJECTIVE: To derive estimates of age-gender specific food availability, based on data collected at household level. DESIGN: Two alternative modelling approaches are described leading to linear and non-linear optimisation, respectively. The idea of penalised least squares is used for estimation of model parameters. The effect of household characteristics can be incorporated into both modelling approaches. SETTING: Household budget survey data from four European countries (Belgium, Greece, Norway and the United Kingdom), circa 1990.
OBJECTIVE: To describe the methodology applied in order to render comparable, at the level of the dietary information collected, the household budget survey (HBS) and individual nutrition survey (INS) data from four European countries (Belgium, Greece, Norway and the United Kingdom). SETTING: In Belgium, data from the HBS of 1987-88 were compared with data from the Belgian Interuniversity Research on Nutrition and Health collected from 1980 to 1985. In Greece, data from the HBS undertaken in 1993-94 in the greater Athens area were compared with data collected around 1994 in the same region, in the context of the Greek segment of the European Prospective Investigation on Cancer and Nutrition study. In Norway, data from the HBS carried out in 1992, 1993 and 1994 were compared with the NORKOST study conducted in 1993-94. In the United Kingdom, data from four HBSs carried out in 1985, 1986, 1987 and 1988 were compared with the National Dietary and Nutritional Survey of British adults conducted in 1987-88. DESIGN: INS-generated data were converted into 'HBS-like' estimates with the application of yield factors for weight changes during cooking, recipe-based calculations and edible proportion coefficients taking into account weight changes during the food preparation. The 'HBS-like' estimates thus obtained were compared with the original HBS values, after applying an adjustment factor for food spoiled or given to pets. CONCLUSION: The methodological considerations overviewed in the present paper indicate that a number of issues need to be taken into account before a proper comparison of the dietary data collected through surveys implemented with varied methodologies is carried out.
Despite the need to meet growing threats within a facility, cutbacks in hospital income and the resultant budget restraints continue to challenge hospital security departments to do more with less. This article reports on a number of approaches being employed to successfully meet the challenges.
AIDS Drug Assistance Programs in several states already have to put HIV-infected people on waiting lists to receive life-saving antiretroviral drugs because of budget shortfalls, and AIDS advocates say this problem will continue through 2002 and 2003 unless Congress provides a financial boost to HIV programs. Activists also say the United States will never achieve its goal of reducing new HIV infection rates by 50% within the next few years unless prevention spending is increased.
BACKGROUND AND OBJECTIVES: This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States. METHODS: We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis. RESULTS: A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988-1997 to 4.8 per year in the 4 years following passage of the BBA. CONCLUSIONS: The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.
Like many specialized branches of medicine, the future of nephrology will be entrusted to organizational models that are able to withstand the impact of both the new and increasing demand for assistance and the rationalization of resources. Therefore, it is necessary to clearly understand that the model must integrate and unify many aspects that regulate the activities in the health care service. Budget means "who does what and with material and what human resources" with respect to the constraints imposed by the decisions of the controlling entities, and it is mainly a system of planning and control. Management control utilizes a combined and coordinated synthesis of various company techniques including an auditing system, analytical accounting (or per cents of cost), a reporting system able to change the data gathered into measures of syntheses that can be used to carry out sound evaluations. The health system needs a type of organization--typical of professional organizations--that is an absolute prerogative of the technical/professional component which is the only one able to discern, understand and propose new diagnostic and therapeutic trends and approaches. At the end an evaluation of quality system is depicted. ISO 9004 norms, for example, provide principles on which an organization must be based, in order to reach high levels of quality and that must be used by the top management to lead the organization towards improved performance.
Most hospitals increased their capital equipment budgets this year, finds a new survey sponsored by Hospitals and the Linc Group Inc. Rather than adding new services, hospitals are replacing equipment. But they remain cautious about adding new services, experts note.
The total number of vacant budgeted positions (296) fell by eleven positions between 2002-03 and 2003-04. However, the reported number of lost positions increased from thirty-nine to 147. The average number of vacancies per school was 5.3. The average number of vacancies reported to be usual and normal at any one time was 3.6 per school, the same as last year. Forty-three percent of the vacancies had been vacant less than seven months, a decline from 55 percent in 2002-03, indicating an increase in the number of positions vacant longer than six months. Meeting position requirements was the most frequently reported factor cited as influencing the ability to fill a position. This is a change from recent previous years when the most influencing factors were salary/budget limitations and lack of response to position announcements. While there was no indication expressed in the survey that vacancies were adversely affecting the quality of dental education, almost 50 percent of the deans reported faculty recruitment and retention was a problem at their school, and over 55 percent indicated that they anticipated it would become more difficult over the next five years to fill vacated positions. Faculty recruitment, development, and retention remain priority issues in meeting the teaching, research, patient care, and administrative needs of the dental education community.
The worldwide drive for budget cutting and privatization, led by the WorldBank and the International Monetary Fund, has led to serious deterioration of health services as well as education, housing, nutrition and other social services in many countries. The model for this policy is the United States, which represents the pinnacle of private enterprise in the health field. The U.S. experience with this model--its effects on preventive and treatment services and health status--is reviewed. The example of the current drive toward privatization in Spain is discussed, and alternative recommendations are made to protect and improve the health of the Spanish public.
Trade-off management is a management system that leverages new technology to enable hospitals to reduce costs while simultaneously delivering exceptional service and quality care. It provides the means to more effectively engage managers in establishing targets that balance what hospitals seek to achieve with what they can afford to spend, while also addressing clinical and operational constraints. It is not a replacement for budgeting, balanced scorecard, or activity-based costing, but rather an approach for integrating them with clinical and operational systems into a more effective management system.
The number of vacant budgeted faculty positions in dental schools has continued to decline, dropping from 296 in 2003-04 to 275 in 2004-05. The number of lost positions declined to twenty-five, from 147 lost positions reported in 2003-04. While the average number of vacancies per dental school was just under five, three-quarters of these vacancies were considered usual and normal to the operation of the dental school. Based on ADEA's annual survey of dental educators, there was approximately a 9 percent faculty turnover between 2003-04 and 2004-05, and according to the 2003-04 and 2004-05 surveys of vacant faculty positions, it is taking longer to fill vacant positions. The greatest challenges influencing the ability of a school to fill a vacancy were salary/budget limitations and lack of response to a position announcement. Still, between 2003-04 and 2004-05, the number of dental school faculty increased from 11,348 to 11,715, including 4,736 full-time, 5,097 part-time, and 1,791 volunteer faculty members. Employment status was not reported for ninety-one individuals. Private practice remains the primary reason for faculty separations and the source of new faculty. In addition, nearly one in four new faculty members entered dental education directly following graduation from a dental or postdoctoral education program. While it may take longer to fill positions and it has become more difficult to fill some vacancies, overall, dental school deans indicated that the number of vacancies was not affecting the quality of dental education. However, between anticipated faculty retirements and current levels of faculty turnover, continued support for and development of faculty recruitment and retention programs remains essential to maintaining a quality dental education workforce.