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Since most hospital programs are not discretionary, they cannot be successfully evaluated by the "decision package" methodology of ZBPD. For carefully selected hospital services, however, ZBPD may be an effective tool.
In addition to providing comparable and verifiable evidence regarding outcomes, clinical trials could also serve as sources of accurate and replicable financial information. Trial reports that identify expenses associated with effective diagnostic and therapeutic interventions enable cost controls. Standardized cost calculations could help clinicians and administrators identify more efficient health care technologies. Unfortunately, relatively few published trials include economic analyses and when they do, data are incomplete. Based on analyses of 97 clinical trial reports, this article proposes a standard costing format. Health care financial managers have the costing expertise necessary to implement and interpret standardized cost calculations for clinical trials. With the active involvement of financial managers, a standard costing format for clinical trials can be achieved.
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OBJECTIVE: To identify, quantify, and compare total facility costs for 2 breast biopsy methods: vacuum-assisted biopsy (VAB) and needle-wire-localized open surgical biopsy (OSB). STUDY DESIGN: A time-and-motion study was done to identify unit resources used in both procedures. Costs were imputed from published literature to value resources. A comparison of the total (fixed and variable) costs of the 2 procedures was done. PATIENTS AND METHOD: A convenience sample of 2 high-volume breast biopsy (both VAB and OSB) facilities was identified. A third facility (OSB only) and 8 other sites (VAB only) were used to capture variation. Staff interviews, patient medical records, and billing data were used to check observed data. One hundred and sixty-seven uncomplicated procedures (71 OSBs, 96 VABs) were observed. Available demographic and clinical data were analyzed to assess selection bias, and sensitivity analyses were done on the main assumptions. RESULTS: The total facility costs of the VAB procedure were lower than the costs of the OSB procedure. The overall cost advantage for using VAB ranges from $314 to $843 per procedure depending on the facility type. Variable cost comparison indicated little difference between the 2 procedures. The largest fixed cost difference was $763. CONCLUSIONS: Facilities must consider the cost of new technology, especially when the new technology is as effective as the present technology. The seemingly high cost of equipment might negatively influence a decision to adopt VAB, but when total facility costs were analyzed, the new technology was less costly.
This analysis examines what is currently known about the financial efficacy of mental health services in relation to the cost offset effect in health care. Moreover, it suggests that the provision of mental health services should be intertwined with cost offset strategies in regard to its practice, research, and promotion. In doing so, policy decisions and ethical practices of care concerning mental health care delivery may be shaped within an adequate cost structure.
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In using the business planning process we defined our services, determined the lowest available open market price for each, and multiplied the unit price by the number we performed in the year to calculate our income. All our costs were then allocated to these services, and a cost per service determined. These were compared to the commercially available rates. Our unit is the low cost provider by 10%, even when using worst case assumptions. We concluded that contracting with outside organizations for occupational medical services could not be justified on either a cost or a quality basis.
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Nursing administrators are faced with the challenge of containing costs under Medicare's prospectively set reimbursement limits. The author suggests that nurses "work smarter" by utilizing the unique aspects of prospective pricing in a program that will maintain professionalism while improving "bottom line" outcomes. A pro-active strategy for administrators within nursing departments, on a hospital-wide basis, and in the entire health care delivery system is described. The author shows how determining nursing costs and revenues by diagnosis can be a way to validate both the cost-effectiveness of an RN staff and a high professional standard of practice. She outlines four elements of a trustworthy, effective change process.
The need for health care reform is an economic reality. The urgency with which it must be pursued is apparent. The direction it will take is clear. The implications it has for transplantation are ambiguous. Managed competition will take time to implement, but managed care is here now and will surely become more prevalent. Thus, it is timely to examine the future of transplantation from the perspective of managed care. Foremost among our concerns is just how transplantation will factor into the debate as to what constitutes a basic health care benefits package. The National Cooperative Transplantation Study (NCTS) was undertaken to address a variety of clinical, economic, social, ethical, and quality-of-care issues. Based on a random sample of all transplants performed in the United States in 1988, individual assessments were made of charges for kidney, heart, liver, heart-lung, and pancreas transplantation. Insurance coverage and reimbursement policies and practices were also analyzed. In 1988 dollars Medicare procedure charges from date of transplant through date of initial discharge were as follows: kidney, $39,625; heart, $91,570; liver, $145,795; heart-lung, $134,881; and pancreas, $66,917. Both patient charges and outcomes were adversely affected by the patient's status prior to surgery, and by the need for retransplantation. The associations among transplant program activity, procedure charges, and patient outcomes varied. While insurance coverage for transplantation has steadily improved, hospital reimbursement is often well below billed charges, as a result, access for some patients may be limited. Organ transplantation is often criticized as too costly, given other health care needs. A recent report indicates that the total first-year charges for transplantation continue to increase. Estimated charges in 1993 dollars are as follows: kidney, $87,700; heart, $209,100; liver, $302,900; heart-lung, $246,000; pancreas, $65,000; and lung, $243,600. Although expensive, transplantation can be equally if not more cost-effective than other accepted therapeutic approaches for the treatment of catastrophic disease. Nonetheless, under managed care and capitated payment it will be essential that the high cost of transplantation be addressed. To reduce charges, enhance patient outcomes, and improve access patient selection policies must be reconsidered. Currently, those patients who are least likely to benefit, yet whose treatment cost the most, are given priority for transplantation. While this approach may be clinically indicated, it is socially unacceptable. Managed care and managed competition will force physicians and surgeons to adopt a more conservative and cost-efficient practice style. The patients who stand to benefit most are those whose needs are consistent with the principles of cost effectiveness.(ABSTRACT TRUNCATED AT 400 WORDS)
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A comparative analysis of anesthesia use, perioperative morbidity and mortality, capital, and treatment cost of high dose rate versus low dose rate intracavitary brachytherapy for gynecologic malignancy is presented. To assess current anesthesia utilization, application location, and high dose rate afterloader availability for gynecologic brachytherapy in private and academic practices, a nine-question survey was sent to 150 radiotherapy centers in the United States, of which 95 (63%) responded. Of these 95 respondents, 95% used low dose rate brachytherapy, and 18% possessed high dose rate capability. General anesthesia was used in 95% of programs for tandem + ovoid and in 31% for ovoids-only placement. Differences among private and academic practice respondents were minimal. In our institution, a cost comparison for low dose rate therapy (two applications with 3 hospital days per application, operating and recovery room use, spinal anesthesia, radiotherapy) versus high dose rate treatment (five outpatient departmental applications, intravenous anesthesia without an anesthesiologist, radiotherapy) revealed a 244% higher overall charge for low dose rate treatment, primarily due to hospital and operating room expenses. In addition to its ability to save thousands of dollars per intracavitary patient, high dose rate therapy generated a "cost-shift," increasing radiotherapy departmental billings by 438%. More importantly, perioperative morbidity and mortality in our experience of 500+ high dose rate applications compared favorably with recently reported data using low dose rate intracavitary treatment. Capital investment, maintenance requirements, and depreciation costs for high dose rate capability are reviewed. Application of the defined "revenue-cost ratio" formula demonstrates the importance of high application numbers and consistent reimbursement for parity in high dose rate operation. Logically, inadequate third-party reimbursement (e.g., Medicare) reduces high dose rate parity and threatens the future availability of high dose rate technology.
This paper provides some basic insights in economic evaluation and costing methodology by means of illustrations in the field of laparoscopic surgery. Some general methodological aspects are discussed, as well as their impact on the calculation of both societal and hospital costs of medical interventions. First, Health Care Technology Assessment is described, and several techniques of economic evaluation in health care are situated in this area. Two fundamental concepts in costing analysis are discussed : opportunity costs and marginal (or incremental) analysis. Furthermore, it is argued that in designing an economic analysis, sufficient attention should be given to delineating the alternative treatment options and to determining the perspective from which the study is performed (patient, hospital, insurer, society,...). Subsequently, it is argued that all price and wage data for activities performed within a certain period should apply to the same time period. Finally, in order to facilitate overview, re-calculation and interpretation of cost data, it is advised to distinguish fixed from variable costs. Different categories of societal costs are described, as well as a number of methodologies for their evaluation. In calculating hospital costs, the costs of all different resources used (e.g. buildings, equipment, staff, materials) must be identified precisely. The issues of annuitising initial investment expenses, calculating operating and maintenance costs, and allocating labour and overhead costs are discussed. Finally, it is argued that, in all studies, it should be investigated whether the results of the economic analysis are robust to the models' assumptions, by means of sensitivity analysis. This paper provides a practical toolkit for medical doctors, to allow a correct understanding and critical analysis of economic literature in the field of laparoscopic surgery.
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