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PubMed1987

Distribution in the visual field of the costs of voluntarily allocated attention and of the inhibitory after-effects of covert orienting.

By using a simple reaction time (RT) paradigm we have investigated the spatial distribution of the benefits and costs of voluntarily directed attention and of the inhibitory after-effects of covert orienting. In the first experiment subjects deliberately allocated attention to each one of five stimulus positions disposed along the horizontal meridian, while at the same time fixing their eyes on the central position. The separation in visual angle between the central position and the two nearest positions, one on the left and the other on the right, was 10 degrees; that between the central position and the two most eccentric positions was 30 degrees. By comparing RT to brief flashes of light presented at each position during directed attention with RT to identical flashes at the same position during diffuse attention (i.e. in a condition in which subjects paid equal attention to all five positions), it was possible to determine that benefits, that is RT decreases relative to the diffuse-attention condition, were strictly limited to the attended position. Costs, i.e. RT increases relative to the diffuse-attention condition, showed a more diffuse and complex spatial pattern. When attention was directed to one of the noncentral positions, costs were apparent at the two contralateral positions and at the central position, but not at the ipsilateral position. When attention was directed to the central position, costs occurred at all other positions. This suggests a special role for the vertical meridian in delimiting the area of costs when one covertly orients towards the opposite right or left visual half field. Work of others and our preliminary evidence indicate that the area of costs is similarly limited by the horizontal meridian when one orients toward the opposite upper or lower visual field. In the second experiment we studied the inhibitory after-effect of covert orienting. Orienting to a light stimulus without moving the eyes to it may induce a short-lived facilitation of the speed of response to a second stimulus presented at the same position, but this facilitation is followed by a profound and prolonged RT retardation. By using a two-flashes paradigm we observed this RT retardation not only when the two stimuli appeared at the same position, but also when they occurred at different locations in the same altitudinal or lateral visual hemifield. There were no inhibitory after-effects when the two stimuli appeared on opposite sides of the vertical or horizontal meridian.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1997

Affordability, cost-effectiveness and efficiency of primary health care: the Bamako Initiative experience in Benin and Guinea.

Since 1986 two West African countries, Benin and Guinea, have been actively reorganizing their peripheral health systems according to strategies subsequently called the "Bamako Initiative". Two preceding articles described the strategies implemented and the increased effectiveness of primary health care (PHC) witnessed over a period of six years. This article presents an analysis of cost and coverage data from biannual monitoring sessions between 1988 and 1993 in approximately 200 health centres in Benin and 214 in Guinea. In order to assess affordability, the total and per capita recurrent costs for operational health centres are analysed and then compared. The cost analysis reveals a mean total cost per health centre per year of slightly over US+11,000 in Benin and nearly US+9,000 in Guinea. The median cost per capita per year is approximately US+1.0 in Benin and between US+0.60 and US+0.80 in Guinea. Comparisons of these costs between regions, health centres and over time (as coverage levels evolved) show very little variation in either country. Cost-effectiveness is estimated by allocating these costs to immunization, antenatal and curative care and comparing them to the coverage achieved with these interventions. First, the cost-effectiveness of the Bamako Initiative (BI) system as a whole is analysed. The cost per fully vaccinated child is calculated at US+10.9 in Benin and US+8.8 in Guinea. The cost per woman receiving at least three antenatal visits is US+7 in Benin and US+4.7 in Guinea. For curative care, cost per full treatment is US+1.6 in Benin and half this amount in Guinea. Cost-effectiveness is variable between regions, health centres reveals that these differences in cost-effectiveness are mainly caused by the coverage levels achieved, since total costs are relatively stable. Finally the efficiency of drug management and prescriptions as well as of outreach for the expanded programme of immunizations (EPI) is estimated by relating specific drug and outreach activities costs to the number of beneficiaries. The average cost of drugs per treatment is around US+0.5 in Benin and around US+0.3 in Guinea. Cost analysis of outreach activities undertaken for EPI in Guinea revealed a similar average cost per child completely vaccinated for health centres with different intensities of outreach (approximately US+10) and an additional cost per child vaccinated attributable to outreach of US+1-2.

Benin↗
PubMed2000

Cost analysis helps evaluate contract profitability.

A cost-accounting analysis can help group practices assess their costs of doing business and determine the profitability of managed care contracts. Group practices also can use cost accounting to develop budgets and financial benchmarks. To begin a cost analysis, group practices need to determine their revenue and cost centers. Then they can allocate their costs to each center, using an appropriate allocation basis. The next step is to calculate costs per procedure. The results can be used to evaluate operational cost efficiency as well as help negotiate managed care contracts.

Accounting↗
PubMed2003

Activity-based costing: a practical model for cost calculation in radiotherapy.

PURPOSE: The activity-based costing method was used to compute radiotherapy costs. This report describes the model developed, the calculated costs, and possible applications for the Leuven radiotherapy department. METHODS AND MATERIALS: Activity-based costing is an advanced cost calculation technique that allocates resource costs to products based on activity consumption. In the Leuven model, a complex allocation principle with a large diversity of cost drivers was avoided by introducing an extra allocation step between activity groups and activities. A straightforward principle of time consumption, weighed by some factors of treatment complexity, was used. The model was developed in an iterative way, progressively defining the constituting components (costs, activities, products, and cost drivers). RESULTS: Radiotherapy costs are predominantly determined by personnel and equipment cost. Treatment-related activities consume the greatest proportion of the resource costs, with treatment delivery the most important component. This translates into products that have a prolonged total or daily treatment time being the most costly. The model was also used to illustrate the impact of changes in resource costs and in practice patterns. CONCLUSION: The presented activity-based costing model is a practical tool to evaluate the actual cost structure of a radiotherapy department and to evaluate possible resource or practice changes.

Accounting↗
PubMed1994

Financial advantages of operating a skilled nursing unit.

Hospitals may accrue specific financial advantages from the operations of a skilled nursing unit (SNU), such as the ability to allocate some fixed costs to a hospital-based unit that receives cost-based reimbursement from Medicare. The level of reimbursement SNUs receive from Medicare, however, can be optimized by obtaining an exemption or an exception to routine cost limits.

Bed Conversion↗
PubMed1982

Economic costs of attrition in clinical trials.

Conventional analyses of the cost-effectiveness of preventive regimens fail to account for the impact of attrition on reported costs. Using an economic model in which costs are allocated to fixed and variable components, and data from a recently completed clinical field trial, costs per participant are shown to vary with the rate of attrition. That this variation is usually obscured in reported studies results from methods conventionally used to measure the participants in calculating average costs. This paper proposes a method for resolving this dilemma by allocating costs among the number of beneficiaries in terms of resource utilization.

Adolescent↗
PubMed1989

Cost determination: the essential element in medical practice budget development and cost containment programs.

The process of cost-containment in health care begins at the level of delivery of service. This article describes an implementation and delivery system which addresses the process of cost determination. It develops an operating budget establishing cost centers to allocate direct and indirect costs and provides the framework for a cost-containment program within a medical practice.

Ambulatory Care↗
PubMed1988

Principles and methods of managerial cost-accounting systems.

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

Accounting↗
PubMed1993

Unit cost analysis in a university hospital: an example from Srinagarind Hospital, Khon Kaen.

This is the first analytic study to identify the unit cost in the University Hospital using the standard method of analysis in health economics. The unit costs in the report can be used to calculate the cost of each service for any disease. The costs of the hospital administration cost center and the supportive cost center were both allocated to the patient care service center by the simultaneous allocation method. The cost of teaching personnel was excluded from the analysis because it is quite difficult to estimate and differentiate the ratio of teaching costs to service costs. The hotel cost of the inpatient ward varied from 77.81 baht to 604.7 baht per day. The unit cost per service per day is different from the charge which is presently used at Srinagarind Hospital. Some services, such as in-house transportation are not included in the charge. This study was conducted to identify the unit cost of each service. The decision to establish charges can depend partly on this data and partly on the administrator's judgement. Other factors, such as patient poverty can dictate the final decision. In any case, the hospital and health service center should identify their own unit costs to be able to plan for effective budget management.

Cost Allocation↗
PubMed1983

Developing a client-focused allocation statistic of inpatient nursing resource use: an alternative to the patient day.

A sample survey (N = 2660) was conducted at eight acute care hospitals in New Jersey during an 11-month period between 1979 and 1981 in order to develop a client-focused, case-mix sensitive measure of resource use for the allocation of inpatient general nursing costs. Using general linear modelling techniques, the direct and indirect effects of age, length of stay, multiple diagnoses, multiple procedures, the ratio of special care unit days to length of stay and the effects of the presence of surgery, admission status, discharge status and membership in Major Diagnostic Categories on indexed total units of nursing service were explored. The results of the analysis suggested that length of stay is the most significant predictor of indexed nursing units of service regardless of age and the complexity of the medical problem when case-mix is controlled through the assignment of cases to 13 nursing services isoresource clusters. The methodology yields an empirically derived patient-specific, case-mix adjusted length of stay statistic which can be used to apportion nursing costs by the case. The approach permits the estimation of nursing units of service which reflect the relative amount of nursing inputs and corresponding costs of direct patient care consumed by any given inpatient in any given hospital.

Cost Allocation↗
PubMed1984

Relative intensity measures: pricing the inpatient nursing services under diagnosis-related group prospective hospital payment.

A sample survey (N = 2660) was conducted at eight acute care hospitals in New Jersey during an 11-month period between 1979 and 1981 in order to develop a client-focused, case-mix sensitive measure of resource use for the allocation of inpatient general nursing costs. Using general linear modeling techniques, the direct and indirect effects of age, length of stay, multiple diagnoses, multiple procedures, the ratio of special care unit days to length of stay, and the effects of the presence of surgery, admission status, discharge status, and membership in Major Diagnostic Categories on indexed total units of nursing service were explored. The results of the analysis suggested that length of stay is the most significant predictor of indexed nursing units of service regardless of age and the complexity of the medical problem when case-mix is controlled through the assignment of cases to 13 nursing services isoresource clusters. The methodology yields an empirically derived patient-specific, case-mix adjusted length of stay statistic which can be used to apportion nursing costs by the case. The approach permits the estimation of nursing units of service which reflect the relative amount of nursing inputs and corresponding costs of direct patient care consumed by any given inpatient in any given hospital.

Cost Allocation↗
PubMed2006

A modified method of activity-based costing for objectively reducing cost drivers in hospitals.

OBJECTIVES: Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of "cost drivers", for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method. METHODS: In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function. RESULTS: We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC. CONCLUSIONS: Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.

Accounting↗
PubMed2002

Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

BACKGROUND: Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs. METHODS: The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases. RESULTS: Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs. CONCLUSIONS: The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants.

Accounting↗
PubMed1993

Cost accounting in radiation oncology: a computer-based model for reimbursement.

PURPOSE: The skyrocketing cost of medical care in the United States has resulted in multiple efforts in cost containment. The present work offers a rational computer-based cost accounting approach to determine the actual use of resources in providing a specific service in a radiation oncology center. METHODS AND MATERIALS: A procedure-level cost accounting system was developed by using recorded information on actual time and effort spent by individual staff members performing various radiation oncology procedures, and analyzing direct and indirect costs related to staffing (labor), facilities and equipment, supplies, etc. Expenditures were classified as direct or indirect and fixed or variable. A relative value unit was generated to allocate specific cost factors to each procedure. RESULTS: Different costs per procedure were identified according to complexity. Whereas there was no significant difference in the treatment time between low-energy (4 and 6 MV) or high-energy (18 MV) accelerators, there were significantly higher costs identified in the operation of a high-energy linear accelerator, a reflection of initial equipment investment, quality assurance and calibration procedures, maintenance costs, service contract, and replacement parts. Utilization of resources was related to the complexity of the procedures performed and whether the treatments were delivered to inpatients or outpatients. In analyzing time motion for physicians and other staff, it was apparent that a greater effort must be made to train the staff to accurately record all times involved in a given procedure, and it is strongly recommended that each institution perform its own time motion studies to more accurately determine operating costs. Sixty-six percent of our facility's global costs were for labor, 20% for other operating expenses, 10% for space, and 4% for equipment. Significant differences were noted in the cost allocation for professional or technical functions, as labor, space, and equipment costs are higher in the latter. External beam treatment-related procedures accounted for more than 50% of all technical and professional revenues, simulation for 8% to 10%, and other physics/dosimetry procedures for 11% to 14% of revenues. Some discrepancies were identified between the actual cost and level of reimbursement of various procedures. Details are described in the manuscript. CONCLUSION: It is imperative to develop an equitable reimbursement system for radiation oncology services, based on cost accounting and other measures that may enhance productivity and reduce the cost per procedure unit, while at the same time preserving the highest quality of service provided to patients.

Accounting↗