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PubMed1999

[Rapid development of a uniform computerized health information system in the Zenica-Doboj Canton].

It is very expensive and long-termed process to establish a complex information system, and it requires to include large number of people and processing of large number of information. As I believe that health economics and management are the key factors for maintaining health system, I think that it is now essential to create information system which will, above all, ensure accurate and prompt information to the health managers. Therefore, I suggest building of a cheaper variant of the information system which could be upgrated, and which will involve, on this stage, small number of health workers. Computerized part of this information system would be built in several levels. At each of these levels data for the needs of health statistics, economic-financial activities, and management would be processed. Communication within information system, on this stage, would be enabled through telephone lines and modems. The system would work "off line". The change of data would be carried out periodically.

Bosnia and Herzegovina↗
PubMed2000

Cost analysis: a tool for measuring the value of nurse practitioner practice.

The survival of nurse-managed centers and their ability to provide practice opportunities for advanced practice nurses depends on combining sound business practices and active financial management with clinical excellence. Using cost analysis methodologies, this study examined the operational costs of 2 academic-based nursing centers and analyzed the practices that resulted in profitability for 1 and questionable survival for the other.

Costs and Cost Analysis↗
PubMed2001

[The psyche of the aging man].

The process of ageing is a very complex phenomenon which takes place on an individual basis. Therefore factors such as gender, personality, private and professional circumstances, state of health, level of activity, financial means, attitude towards and plans for the future play an important role. These factors determine--even to a larger extent than the biological process--whether ageing turns out to be a successful experience which enhances the feeling of being satisfied with one's life. All those, who professionally deal with men's health and the male process of ageing, should bear in mind that psychosocial aspects have to be an undisputable part of every conception of illness and therefore also of any treatment offered. Thus our medical attention is not only centred an adequate somatic therapy but leads to a global understanding of the concept of health for an advanced age.

Adaptation, Psychological↗
PubMed2005

Spending on medicines in Israel in an international context.

BACKGROUND: Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. OBJECTIVES: To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. METHODS: Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. RESULTS: Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. CONCLUSIONS: Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.

Developed Countries↗
PubMed2006

Quality of life among unemployed and employed people in northern Sweden. Are there any differences?

This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (Hörnquist's QLcs) covering the life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", in 487 unemployed subjects and 2917 employed subjects aged 25-64, in a population-based cross-sectional study in northern Sweden. In line with previous findings, results showed that unemployed people exhibited poorer QoL. Unemployed women scored higher in existential life domains than unemployed men did. Unemployed men were worst off in terms of general life situation. Employed respondents benefited in QoL by a university/college education, while unemployed respondents with a university/college education did not. Close social relations and money reserve were associated with higher QoL generally. It was concluded that further research is needed to differentiate various aspects of QoL and unemployment, and to compare with other samples.

Adult↗
PubMed1991

Medicare reimbursement deficits: are nursing costs to blame?

Nursing costs were found to be only 11% of the total operating costs. This finding dispels the myth that nursing service is an expensive expenditure for hospitals. The range of facility cost compared with DRG reimbursement was wide, which points to the need to scrutinize costs other than nursing as the sources of hospital deficits. Nursing costs were found to be lower than facility or OR costs. Nurse managers need to emphasize this cost effectiveness to decrease the chance of staffing cuts and requests for concessions in wages or benefits for nurses. Nurse managers need to plan their financial activities to ensure their hospital cost is less than, or at most equal to, the DRG payment.

Costs and Cost Analysis↗
PubMed1982

Role of the director of pharmacy: the first four months.

Specific goals and tasks that should be addressed during a pharmacy director's first four months of employment are reviewed. Individuals must prepare themselves for the director's role, find the right job, and negotiate an acceptable benefits package. During the first two months as director of pharmacy, an individual should primarily work on gathering facts and assessing the department's operations without making many changes. Interrelationships within the hospital should be studied, and many pharmacy and hospital documents should be reviewed so that the director has an understanding of past history. The director should interview all employees of the department and work as a staff pharmacist for one to two days in each area. During the third and fourth months, the new director will need to determine the extent of authority, develop working relationships with key individuals, assess the pharmacy-management team, develop a data-collection system, learn the processes for making changes, and consolidate authority. A major document, containing a departmental-operations analysis, statement of philosophy, goals, and approach to goal completion, should be the culmination of the four months. The director of pharmacy must meld professional, administrative, and financial activities; the final determinant of success will be the director's ability to implement and follow through with proposed changes.

Administrative Personnel↗
PubMed1980

Chronic gastric ulcer and life events.

The purpose of this study was to define the frequency of stress preceding or during the course of chronic gastric ulcer (CGU). Stress was measured by the occurrence of 62 selected life events over 2 yr in two groups of CGU patients. One group (A) was studied for events during the 2 yr before their diagnosis (147 patients) and the second group (B) was studied for events occurring after diagnosis (73 patients). The ulcer groups were compared with community controls matched for age, sex, and social grade. Groups A and B did not differ in any significant way in their reported life events, indicating no temporal relationship between stressful life events and CGU. The combined ulcer groups, when compared with controls showed no differences in the number of events experienced or the associated scores for change and distress caused by the events. There was no difference in the order of the three most frequent events. Only the event "minor illness" was more frequent in controls on matched pairs analysis (P less than 0.05). The other 61 events showed no differences. When events were grouped into areas of activity, financial and legal events were reported by 38 patients and 23 controls (P less than 0.05). Significantly, few of these 38 patients were in the 60+ age range (P less than 0.02). Twenty-four patients reported no events, compared to 12 controls (P less than 0.05). Although there is no difference in the life events experienced by CGU patients and their controls, this assessment of stress has not taken account of the significance of the event as perceived by a particular individual, the ulcer patient perhaps reacting differently to stress and the ulcer being one result of this abnormal reaction. Consequently, the role of emotional stress remains open.

Adult↗
PubMed1982

Nondiscrimination on the basis of age in programs or activities receiving federal financial assistance from HHS. Final rules.

These final regulations implement provisions of the Age Discrimination Act of 1975, and the general, governmentwide regulation published in the Federal Register on June 12, 1979, codified at 45 CFR Part 90. The Age Discrimination Act of 1975 prohibits discrimination on the basis of age in programs or activities receiving federal financial assistance. The Act also contains certain exceptions that permit, under limited circumstances, use of age distinctions or factors other than age that may have a disproportionate effect on the basis of age. The Act applies to persons of all ages. These final regulations are designed to guide the actions of recipients of financial assistance from HHS. The regulations incorporate the basic standards for determining what is age discrimination that were set forth in the general regulations. They discuss the responsibilities of HHS recipients and the investigations, conciliation and enforcement procedures HHS will use to ensure compliance with the Act.

Age Factors↗
PubMed1995

The carrot, the stick and the general practitioner: how have changes in financial incentives affected health promotion activity in general practice?

BACKGROUND: Financial incentives for increasing health promotion activity in primary care, introduced with the 1990 contract for general practitioners, were amended in 1993 and are now focused on cardiovascular disease. Payments for health promotion clinics were abolished and target payments were introduced. AIM: The study aimed to evaluate the effect of the change, in June 1993, in financial incentives for health promotion activity in primary care on the distribution of health promotion payments in two family health services authorities. METHOD: A retrospective study was undertaken in which data from two family health services authorities were used to determine the annual level of health promotion payments per 1000 practice population before and after the contractual amendment. Health promotion clinic payment data were analysed for 78 practices in Bedfordshire Family Health Services Authority and 85 practices in Kensington, Chelsea and Westminster Family Health Services Authority. Changes in health promotion payments were calculated and related to two measures of relative need: all cause standardized mortality ratios, for patients aged 74 years or less, of the electoral ward in which the practice is located; and the Jarman underprivileged area score. High relative need was defined as a standardized mortality ratio of over 100 or more than 25% of the practice population living in electoral wards with a Jarman score of over 30. RESULTS: Health promotion payments were more evenly distributed after the change in June 1993 than before between the two family health services authorities and between general practices. Single-handed practices were carrying out more clinics in 1992 than multi-partner practices and consequently were one of the greatest financial losers as a result of the change. In addition, practices located in electoral wards with high relative needs lost proportionally more than those in electoral wards with lower needs. CONCLUSION: Changes in the general practitioner health promotion contract have created new financial winners and losers. It now appears that health promotion payments are more evenly distributed but that the distribution is unrelated to need or treatment given. More evidence on the effectiveness of health promotion interventions is required before policies aimed at promoting better health through primary care can be fully evaluated.

England↗
PubMed2001

Six-year trends in productivity and utilization of 73 clinical laboratories: a College of American Pathologists Laboratory Management Index Program study.

OBJECTIVES: To describe longitudinal trends in the efficiency, labor productivity, and utilization of clinical laboratories in the United States. METHODS: Financial and activity data were prospectively collected from 73 clinical laboratories continuously enrolled in the College of American Pathologists Laboratory Management Index Program from 1994 through 1999. Each laboratory reported quarterly on its costs, labor inputs, and test activity using uniform data definitions. RESULTS: During the 6-year study period, there was a significant increase in laboratory labor productivity (2.1% more tests/full-time equivalent/y; P <.001). Productivity increases were offset by increasing labor expense (1.5%/full-time equivalent/y; P <.001), consumable expense (1.7%/on-site test/y; P =.005), and blood expense, which comprised more than 10% of laboratory expenses by 1999 (4.4% increase/y; P <.001). As a result, overall expense per test showed no significant change in non-inflation-adjusted dollars. Reference laboratory expense per test did not change significantly during the study period; the proportion of tests sent to reference laboratories grew slightly (0.06% increase/y; P <.001). Test volume of the median laboratory grew by 5442 tests per year (2.3% annual increase; P <.001), while the proportion of testing from inpatients declined by 1.7% per year (P <.001). Inpatient test utilization declined on a discharge basis (annual decline of 1.2 tests/inpatient discharge; P <.001) and on a per diem basis (annual decline of 0.08 tests/inpatient day; P =.002). Inpatient laboratory expense declined on a discharge basis (annual decline of $2.40 or 1.3% per discharge; P <.001), but did not change significantly per inpatient day. Most of the reduction in the expense per discharge occurred during 1994-1996. CONCLUSIONS: Between 1994 and 1999, clinical laboratories in the United States experienced significant changes in the cost of operations, utilization, and labor productivity. Laboratory administrators who compare local institutional performance with that of peers are advised to use current or forward-trended peer data. Quarter-to-quarter improvement in many measures of laboratory financial activity may not signal a superior operation, as performance of the whole industry appears to be improving.

Blood↗
PubMed2003

Context-dependent cortical activation in response to financial reward and penalty: an event-related fMRI study.

An event-related fMRI technique was used to assess neural responses to financial reward and penalty during a simple gambling task. We attempted to determine whether brain activities are dependent on the unique context of an event sequence. Thirty-six healthy volunteers participated in the study. The task was to guess the color of the suit of a card on each trial and to respond by pressing a button. Every correct response ("win") and incorrect response ("loss") was associated with financial reward and penalty, respectively. The magnitude of reward or penalty in each trial did not change; however, the subjects' self-reported emotional arousal was significantly higher for the events of "the fourth win of four wins in a row" and "the fourth loss of four losses in a row." We also found that the bilateral anterior cingulate and medial prefrontal cortices were specifically activated when the subjects experienced "the fourth win of four wins in a row" and "the fourth loss of four losses in a row." When the subjects experienced "a win following four losses in a row" or "a loss following four wins in a row," the right dorsolateral prefrontal cortex was specifically activated. Our data indicate that there exist brain activities associated with the event-sequence context in which abstract reward or penalty is received. These context-dependent activities appear to be crucial for adapting oneself to new circumstances and may account for clinical symptoms of various mental illnesses in which dysfunction of these regions has been reported.

Adolescent↗