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PubMed2003

Evaluation of primary health care reform in Estonia.

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.

Efficiency, Organizational↗
PubMed1998

Using the balanced scorecard to align strategy and performance in long-term care.

The Sisters of Charity of Ottawa Health Service (SCOHS) is a Canadian health care corporation that has adapted Kaplan and Norton's balanced scorecard to enhance strategic management and measurement in a multisite health care facility comprising long term care, continuing complex care, rehabilitative services, palliative care and ambulatory care. This article discusses how the SCOHS has incorporated the following principles into the balanced scorecard: demonstration of cause and effect; inclusion of outcomes and performance drivers; linkage to fiscal and utilization indicators; and integration of the mission and values of the organization. Examples of corporate level outcomes and performance measures are provided in the form of lead and lag indicators.

Delivery of Health Care, Integrated↗
PubMed1994

Key operating and financial ratios for Alberta hospitals.

Comparative financial and operating ratios in Canadian hospitals are examined to reveal sources of increased efficiency. The study involved 70 Alberta hospitals, which were divided into three groups: teaching hospitals, regional hospitals and smaller rural hospitals. Data were obtained from HS-1 and HS-2 reports. Hospitals across Canada can calculate their own ratios to give them a general idea of how they compare with the hospitals in this report.

Alberta↗
PubMed2002

Assessing the financial health of the endoscopy center.

Just as a trend of a patient's physiologic vital signs is more informative than a single assessment, the most reliable measure of EASC financial health is achieved over a continuum of time. The earliest estimate of prognosis is accomplished with a business plan that is based on an analysis of practice history, strategic planning, and carefully derived assumptions. Periodic assessments of financial performance with benchmarking data provide a current assessment of health and allow trending of performance improvements or decline. Assurance of future financial health is derived from focusing on customer needs, developing EASC core competence, and creating value through innovation. Following these guidelines helps to ensure a strong, productive, and long-lasting EASC.

Ambulatory Surgical Procedures↗
PubMed2002

A comparison of two injury surveillance systems within sports medicine clinics.

This study compares a comprehensive method of collecting injury data from sports medicine clinics, with a more simplified method of injury surveillance. The sports medicine injury surveillance (SMIS) project was implemented in a group of five allied sports medicine clinics in Melbourne. over two consecutive years. The injury surveillance method used in the second year (SMIS2) was a simplified version of that used in the first year (SMIS1). Methodological differences in the injury surveillance systems included form design, staff commitment and training, auditing process, financial incentives offered and employment of a project officer. Data were collected on 6479 new sports injury patients during SMIS1 and on 1682 patients during SMIS2. Comparative data from the two years of injury surveillance included patient profile (gender. age. days from injury to treatment, sport and context of injury) and injury information (site, cause and nature of injury). The SMIS2 methodology was associated with a lower sensitivity (p < 0.001) and a higher proportion of missing information (p < 0.001) than the SMIS1 methodology. There was also a significant difference in the nature and cause of injury variables (p < 0.001) between SMIS1 and SMIS2 and this was associated with coding changes. This study shows that the method of data collection influences both the proportion of missing information and the sensitivity of the system. A comprehensive method of injury surveillance will lead to a more complete data collection process. Methodological differences, however, do not appear to substantially alter conclusions about general patient characteristics, but do have some influence on the accuracy with which broad injury data are identified. Notwithstanding these comments, this study shows that injury surveillance activities can be successfully implemented in sports medicine clinics.

Ambulatory Care Facilities↗
PubMed2005

Marginal cost of operating a positron emission tomography center in a regulatory environment.

OBJECTIVES: Cost studies of positron emission tomography (PET) imaging are important for resource and operational planning; the most relevant cost analysis in this regard is the marginal cost. Operating within a regulatory environment can add considerably to the costs of providing PET services. Previously published research has not examined the marginal cost structure of PET nor have they described the implications of regulatory compliance to operational costs. The purpose of this study was to conduct a comprehensive cost estimation of PET imaging with 18F-fluorodeoxyglucose (18F-FDG) to better identify the fixed and variable cost components, the marginal cost structure, and the added costs of satisfying regulatory requirements. METHODS: Financial data on capital and operating expenses were collected for the PET center at the Cross Cancer Institute in Edmonton, Alberta, Canada. RESULTS: The total per-service cost for clinical operations ranged between $7,869 (400 annual scans) and $1,231 (3,200 annual scans). The marginal cost for the center remained steady as volume increased up to the throughput capacity. CONCLUSIONS: Results indicate that economies from increased volumes did not arise. Regulatory requirements added significant costs to operating an 18F-FDG-PET center.

Alberta↗
PubMed2005

Performance monitoring in the Victorian health care system: an exploratory study.

This paper reports on an exploratory study which aims to improve our understanding of how the Chief Executive Officers of Victorian health services monitor strategic and operational performance in their organisations. As a component of a large scale human resource management study, we surveyed 130 Chief Executive Officers (CEOs) of Victorian health sector agencies. Our findings suggest that performance monitoring was more advanced among the larger Victorian health sector organisations, and that there were areas for improvement throughout the system. Overall, the CEOs reported limited use of performance indicators related to service and clinical perspectives, with financial and volume indicators most widely used. There was little evidence that these organisations had processes in place (such as benchmarking and linking required outcomes to staff performance management) to understand the implications of the performance information and translate them into management action. The findings suggest that the sector requires technical expertise and support in data reporting, benchmarking and quality improvement in order to improve performance monitoring and ensure its relevance to strategic control, but further study is required.

Accreditation↗
PubMed1996

Casemix funding in psychiatry: some problems and common pitfalls.

The aims of this study were to evaluate the accuracy of AN-DRG version 2.0 codings. Ninety-two separations, covering three of the most commonly occurring AN-DRG in psychiatry, were reviewed by a psychiatrist. The AN-DRG diagnosis was then compared to that given by morbidity coders. There was agreement for 69 (79 per cent) separations and disagreement for 18 (21 per cent) separations. Recoding of the 18 separations altered average length of stay data and the funding received. The high error rate of coding stimulated changes to the training of morbidity coders and registrars.

Abstracting and Indexing↗
PubMed1995

Cost-effectiveness of nutritional support in the elderly.

There is clear evidence that nutritional support is effective in elderly patients, reducing mortality, morbidity and in some cases hospital stay. Its effectiveness depends upon its being part of an overall management strategy, including screening for patients at risk and appropriate nutritional policies. The extra cost of meals of high energy density, extra snacks and food supplements is minimal compared with the potential benefit. Artificial feeding by the enteral or parenteral route is extremely effective, especially when carried out by an expert team and in appropriately-selected patients in whom the outcome justifies the additional expenditure.

Aged↗
PubMed1999

Managing external resources in Mozambique: building new aid relationships on shifting sands?

The Mozambican health sector is recovering from war and general disruption. This massive endeavour is supported by several donor agencies, which contribute a substantial proportion of national health expenditure. The final years of the war and the transition period have seen an extreme fragmentation of the health sector. To correct it, serious efforts to coordinate the plethora of aid agencies and related external inputs have taken place. This paper reviews the actors present on the Mozambican health scene and their interactions. The existing aid management mechanisms are described and their effectiveness appraised. The factors affecting both the process and its outcomes are analyzed. Given the prevailing complexity, this research presents a number of tentative conclusions. First, the evidence suggests that coordination efforts have paid off. However, progress has required intense and sustained work. Incremental approaches, where donor demands are progressively raised as the system is strengthened, have been crucial. The initiative has come mainly from donors, with the Ministry of Health receptive and reactive. When the recipient administration has been able to take advantage of donor initiatives, success has ensued. Individual people have been crucial in shaping the process. Critical factors contributing to positive developments on both sides of the donor-recipient relationship have been frankness, risk-taking and a long-term perspective.

Budgets↗