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PubMed1983

Social Security Amendments of 1983--Public Health Service. Notice of changes in the review thresholds under Section 1122.

This notice provides information on the Social Security Amendments of 1983 (Pub. L. 98-21) which were effective upon enactment on April 20, 1983. Under Section 1122 of the Social Security Act, the expenditure threshold for reviews of capital expenditures is changed from $100,000 to $600,000 and an exemption from review is provided for HMOs (and similar entities) if certain conditions are met. In addition, the amendments require all hospitals participating in the Medicare program to provide their overall 3-year capital expenditure plans to the designated planning agency or other appropriate health planning agency in the State.

Capital Expenditures↗
PubMed1995

OxDONS syndrome: the inevitable disease of the NHS reforms.

The financial demise of Oxford's department of neurosurgery (OxDONS) was precipitated by the financial rules of the reformed NHS. In particular it was produced by the failure of "resources to follow patients"; the requirement that "prices have to follow costs"; and the use of private income for revenue expenditure, not capital expenditure. This process will eventually affect all hospital departments, but it affected the unit in Oxford sooner as it started as "efficient"--that is, underresourced--and has depended on income from extracontractual referrals and private work. Current NHS accounting rules act as a disincentive to private income being generated in NHS hospitals, and consultants should be aware of this.

England↗
PubMed1984

Evaluating the impact of certificate-of-need regulation using measures of ultimate outcome: some cautions from experience in Massachusetts.

Prior evaluations of certificate of need (CON) have concluded that such regulation did little to reduce the level of hospital capital investment. These studies, however, failed to examine the underlying patterns of hospital investment behavior onto which CON was imposed and further neglected to determine the lag period that separates the introduction of regulation and the appearance of outcomes actually attributable to the presence of CON. This article addresses these two issues by using rate-setting data to examine the details of hospital capital investment across the whole voluntary hospital industry in one state--Massachusetts--both before and after the introduction of certificate of need. Massachusetts voluntary hospitals were found to devote most of their capital expenditures to the construction of major new inpatient facilities built in cycles of 14 years average duration throughout the post-World War II period. The date of completion of such a facility proved to be the major determinant of a hospital's capital expenditure pattern over time, and hospitals of similar teaching status and geographic location showed considerable synchrony in the construction of such facilities. At least in Massachusetts, the introduction of certificate-of-need regulation coincided with but was not responsible for the conclusion of a major construction peak among nonteaching hospitals and the beginning of such a peak among teaching hospitals, greatly complicating the evaluation of actual CON effects. Further, capital expenditures actually approved by CON did not appear until the third year of program operation, and even five years post-CON, the majority of hospital capital expenditures reflected projects approved in the first year of regulation, a period during which the program had neither the expert staff nor extensive review capacity that characterized CON function in later years. These findings hold implications for the evaluation of CON effectiveness and, indeed, for the future existence of certificate of need.

Boston↗
PubMedDate not supplied

Cost analysis of eye camps and camp-based cataract surgery.

BACKGROUND: Although cataract accounts for half the blindness in the world, the resources available are not sufficient to meet the existing need for operations. The most effective low cost cataract surgery is probably performed in community camps. METHODS: We estimated the costs incurred in performing cataract operations in makeshift comprehensive eye care camps. Both the capital and recurrent inputs were costed at current market rates. RESULTS: Rupees 1,508,600 (US$ 47,100) was spent on conducting 17 camps during April 1992 to March 1993. Recurrent inputs were responsible for 83% of the total costs. Sixty per cent of the recurrent inputs were borne by non-governmental organizations. The total capital expenditure was borne by the mobile ophthalmic units. Food and drugs for patients (40%), and staff salaries and allowances (35%) were the major recurrent expenditure, while 60% of the capital expenditure was accounted for by vehicles. The unit cost of cataract surgery was Rs 772 (US$ 23). CONCLUSIONS: We suggest that comprehensive eye camps are cost-effective.

Cataract Extraction↗
PubMed1984

Forecasting expenditure on capital projects.

S-curves are widely used for planning, forecasting and control of cost, time and resources of a project. In this paper, a comparison of two S-curve models developed at the Department of Health and Social Security (DHSS) and Bradford University is carried out both from the viewpoint of predictive accuracy and ease of use. The models are validated using expenditure data for 21 recent U.K. health building projects. Methods of least squares is used to estimate the parameters of the two models. These parameters are categorized according to the total cost of the projects. Both the models are shown to be of comparable accuracy for fitting actual expenditure data. The DHSS model has a major advantage of simplicity of form and use, although the slightly greater mathematical complexity of the Keller-Singh model is off-set by the readily interpretable nature of its form and basic parameters. It is concluded that both or either of the models could be used by clients/contractors for effective planning and control of project costs.

Capital Expenditures↗
PubMed1997

Managing the strategic capital cycle.

A healthcare organization's financial strategy should be defined within the context of the capital cycle and provide for the management of three critical components that will ensure the expansion and renewal of capital capacity--the design and implementation of the financial plan, the design and implementation of an appropriate capital structure, and a means to strategically utilize capital and reinvest it in the organization. The capital cycle comprises two parts--strategic planning and implementation, and the development of the support infrastructure that includes financial planning, capital structure, and capital allocation. The financial plan positions an organization within an area of financial equilibrium and defines its organizational capabilities. The financial infrastructure gives integrity and momentum to the capital cycle. Capital structure addresses critical funding and financing questions and is best defined as the combination of debt and equity that funds the strategic plan. In regard to capital allocation, healthcare organizations should follow a corporate "best practices" approach for such areas as financial objectives and policies, project review, and the capital expenditures approval process.

Capital Expenditures↗
PubMed1980

Government moves to tighten capital investment.

In recent years, programs designed to control hospital capital investment have become a highly visible aspect of federal health policy. This article describes federal efforts to limit capital expenditures; describes the effect on hospitals of such capital limitation policies; and suggests how hospitals can deal with them.

Capital Expenditures↗
PubMed1982

Health planning reform: a proposal for the eighties.

Efficacious but expensive new technology has contributed to the rapid escalation of health care costs. The CT Scanner has become a symbol of the technological imperative. The health planning process at its best has experienced only limited success with this problem. This article highlights the findings of the author's study of regional planning for CT Scanner diffusion, and draws the implication that the existing system of planning and certificate-of-need regulation has been only marginally successful because of the absence of a proper incentive system. Under the reform proposal, an annual dollar limit would be placed on the capital expenditures that could be approved for future Medicare-Medicaid reimbursement. This limitation would create a set of incentives leading to close community scrutiny of capital expenditures, and would allow changes in the institutional structure of regional planning to create greater public accountability.

Capital Expenditures↗
PubMed1982

Factors that may explain interstate differences in certificate-of-need decisions.

A major difficulty in conducting studies of the impact of certificate-of-need programs is in accounting for interstate differences in program characteristics. This paper addresses this problem by examining the empirical relationship between various characteristics of certificate-of-need programs and program decisions, measured in terms of the approvals of hospital capital projects. Aggregate data on capital expenditure approvals and net bed change approvals for 28 States are correlated with an index of each State's regulatory characteristics that was developed in an earlier study. In addition, a multivariate model of certificate-of-need approvals is estimated in which certain measures associated with the need for hospital capital in a State are introduced, along with the indices of regulatory characteristics, to explain interstate differences in regulatory characteristics, to explain interstate differences in program decisions. The results of this analysis indicate that although regulatory characteristics are significantly correlated with the relative number of new beds approved, they have little correlation with total capital expenditure approvals. Moreover, variables reflecting the need for new hospital capital in a State, such as past population growth and existing hospital capacity, appear to be more important than regulatory characteristics in explaining the relative amount of capital approvals.

Capital Expenditures↗
PubMed1984

Designing a capital budgeting system that works.

Conventional capital budgeting systems do not fully reflect or adequately respond to the way in which capital expenditure decisions are actually made. Evidence also exists that the nature of this decision process is dependent on the type of the organization. This paper describes an empirically developed understanding of how capital expenditure decisions are being made, identifies ways to support and improve these decisions, and proposes an approach to linking the design of capital budgeting systems with the type of organization in which they are to operate.

Budgets↗
PubMed1996

Household composition and expenditures on human capital formation in Kenya.

"Expenditures on human capital determinants in Kenya are analyzed using microdata. Specific expenditures on food, schooling, and medical care provide evidence of human capital formation activities of households. The analysis is focused on expenditure and distributional effects of household composition dimensions. To determine empirical magnitudes of the effects, a flexible form of a household expenditure function is estimated. The results of the analysis show that gender and age composition are important determinants of the level and distribution of human capital investments in a household. In addition, household budget allocation favors boys over girls for secondary school education. The policies implied by the findings are discussed."

Africa↗