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Hospital linen managers can reduce costs most effectively by devising and imposing controls on linen operations rather than by merely limiting linen usage. Such controls include use of work load timetables for the laundry department, an itemized charge system for each linen-using department, standards for daily usage, and immediate investigation of deviations from the standards.
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In order to test the hypothesis that medical staff physicians affect hospital behavior, this paper relates cost data for a sample of non-major-teaching, short-term hospitals to information on the characteristics of the medical staff which treats patients in those hospitals. Measured characteristics of the staff include specialty mix of attending physicians, board-certification status, and the concentration of hospital output among attending physicians. Medical staff variables are found to be as important as measured casemix in explaining cost variation across hospitals. The results are shown to have implications for behavioral models of the hospital and for hospital reimbursement policy.
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After nearly 2 years of study, the 1979 Advisory Council on Social Security submitted its findings and recommendations in December. In February the Bulletin published the Executive Summary of the Council's report. Because of the continuing wide public interest in the future of social security financing, the Council's detailed findings and recommendations on that subject are published below. The Council unanimously reports that all current and future beneficiaries can count on receiving the payments to which they are entitled. Among the recommendations it calls for are partial financing with nonpayroll-tax revenues. Suggested changes include hospital insurance (HI) financed through portins of personal and corporate income taxes and a part of the HI insurance payroll tax diverted to cash benefits with the balance of this tax repealed. The Council also recommends that the social security cash benefits program be brought into long-run actuarial balance--with a payroll-tax rate increase in the year 2005. It rejects the idea of a value-added tax as being inflationary. Parenthetical remarks represent additional views of the Council members cited.
Concerned about the high and rising costs of compliance with regulations imposed by all sources, the Hospital Association of New York State (HANYS) undertook a study to determine the precise nature of those costs. The study shows both that the costs are high and that regulatory influence is pervasive. HANYS recommends that all concerned with the regulatory process, regulators and regulated alike, take a new, hard look at regulations.
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Managed care (MC) refers to capitated practice (HMOs), utilization management (UM), and programs of case management for persons with mental illness and problems of substance abuse. These approaches differ substantially, and within each type are variations. Management of mental health and substance abuse services is increasingly prevalent, often sharply reducing costs. Savings result from reducing inpatient hospitalization and, sometimes, by substituting less expensive services for more costly ones. Most studies of managed care, however, measure costs narrowly, neglecting shifts in costs to patients, professionals, families, and the larger community. Strategies typical of HMOs and UM may result in lower-quality care for persons with serious mental illness and problems of substance abuse. Studies on this topic are reviewed, an analytic frame of reference is presented, and research needs are defined.
OBJECTIVE: To establish a system of attributing costs of Health Centres (HC) in the Primary Care network in function of health care activity. DESIGN: Crossover study with a descriptive component. SETTING: Management. Primary Care. PATIENTS OR OTHER PARTICIPANTS: 22 Health Centres open during December 1991 within the Health Area. MEASUREMENTS AND MAIN RESULTS: Two groups for cost attribution per Health Centre were agreed: articles from Chapter II relating to health care activity and Pharmacy spending-->costs relating to activity (CRA); the remaining articles from Chapter II and Chapter I (staff payments)-->costs not relating to activity (CNRA). Costs relating to activity made up 62.51% of the total cost per HC (2.72% articles from Chapter II and 59.79% Pharmacy). The remaining 37.49% corresponded to costs not relating to activity (1.38% to the remaining articles from Chapter II and 36.11% to staff payments). CONCLUSIONS: We consider that the attribution of costs in function of the activity per HC is useful for the planning and management of Area resources and assists the application of efficiency criteria in Health Centres.
Actuarial and economic methods are combined to predict the costs of mental health and substance abuse benefits in insurance. Costs are predicted for two employers under alternative benefit plans that contain some of the features proposed under national health reform. The cost of a given benefit differs greatly across population groups. In order to make accurate cost forecasts, data on the group's experience must be combined with research data on the impact of plan changes. Application of employers' experience and research from mental health economics can contribute to better public and private decisions, including those that are part of current health reform.
OBJECTIVE: Despite falling admissions and declining lengths of stay, Medicare expenditures for inpatient physician services have continued to climb; this article seeks to understand this trend by examining the expenditures on a per admission basis. DATA SOURCES AND STUDY SETTING: One hundred percent Medicare claims data were available from nine states for the 1985-1988 time period. STUDY DESIGN: Because Medicare's prospective payment system encourages hospitals to shift some services outside the inpatient setting, we examined trends in episodes of care, encompassing some time both before and after the inpatient stay itself. Trends were also examined at the individual DRG level in order to partially control for case-mix shifts and increased surgical use. Allowed charges were purged of both Medicare fee updates and geographic price variation in order to derive estimates of real spending growth. DATA COLLECTION/EXTRACTION METHODS: Hospital and physician claims were merged to form inpatient episodes that included seven days prior to admission as well as 30 days following discharge. PRINCIPAL FINDINGS: Physician spending per episode increased 27 percent just over this four-year time period, but with considerable variation by DRG ranging from only 2 percent for transurethral prostatectomies (TURPs) to 56 percent for uncomplicated acute myocardial infarctions (AMIs). Changes in case severity and hospital and physician characteristics were all found to be important contributors to the increase in physician inpatient spending. Most important seemed to be the growth in the number of physicians associated with the inpatient stay (and the subsequent increase in diagnostic tests and other procedures). CONCLUSIONS: The findings suggest that control of technology and control of the number of physicians involved in the care of a patient are both critical to constraining the rate of increase in physician inpatient expenditures.
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Health care expenditures in the United States have continued to grow despite efforts to control them. This Article discusses the need for health care reform, outlines the model that reform should follow, and considers why the United States has not progressed toward a workable solution. It introduces a single-payer approach to cost containment and explains how such an approach could be "sold" in the United States. Finally, the Article examines various ways to mobilize support for such health care reform.